Legislators, public haggling over hyperbaric treatment

Proposed study promises relief from brain injuries and expensive treatments

On a chilly January evening in Fargo, Hannah Anderson went out to dinner. She was able to concentrate on the menu, order her own meal and keep up with the table’s conversation throughout the night.

This may not sound like much of an achievement for a seemingly average young woman. But Hannah hadn’t had a night out like this in 11 years.

“I felt like my brain injury almost didn’t exist,” said Anderson, the survivor of a nearly fatal car accident in 2007. She said she had to relearn to walk, talk and breathe on her own, and she has since suffered from poor short-term memory, frequent headaches and fatigue.

Anderson and other survivors of traumatic brain injuries told their stories to the North Dakota House Human Services Committee Jan. 16 to support the use of hyperbaric oxygenation treatment for such injuries. A bill before the committee would create a Medicaid-funded pilot project treating brain injury patients with hyperbaric oxygenation, a process that places patients in a pressurized chamber, increasing the amount of oxygen in the blood and better dispersing that oxygen to damaged cells. The estimated cost of the project is $335,000.

Dr. Daphne Denham, the general surgeon who runs the Healing with Hyperbarics clinic in Fargo, said the process can even re-energize cells that were injured years ago. If the bill were to pass, Denham would oversee the study from her nonprofit clinic, which was funded through a loan from North Dakota hotel magnate Gary Tharaldson.

The Medical Services Division of the Department of Human Services in North Dakota opposes the bill. Tammy Zachmeier, utilization review administrator for the division, said one of their largest concerns is that they “do not as of yet have specific approval from the centers of Medicare and Medicaid” and federal funds possibly could not be used for the project.

Zachmeier also said that the true fiscal impact of the bill should be estimated at $4.9 million to potentially cover all brain injuries in the state.

“If we are legislated to cover this injury, it’s always been Medicaid’s history that we would cover all individuals whether they were in this study or not because we’re not going to say only the first 30 of you who come forward are going to be allowed to have this treatment paid for,” Zachmeier said.

According to the Undersea and Hyperbaric Medical Society, the FDA approves hyperbaric treatment for 14 conditions, such as carbon monoxide poisoning or diabetic abscesses, but not traumatic brain injuries. Denham said she is confident the study would prove that the treatment works with TBI. She also is confident it would be a financial benefit to Medicaid and the state to treat brain injuries in this manner.

“We are looking at patients who are far enough out from their injury that data would suggest that they have optimized their recovery, and this is as good as it’s going to get,” Denham said.

In many cases, this treatment does not have to be repeated after its initial run, Denham said. Patients who have not been able to work and were receiving Medicaid assistance to manage their symptoms could once again become contributors to the economy, she said.

Lisa Anderson, Hannah’s mother, also testified on the benefits of hyperbaric treatment. Anderson said her insurance company estimated that it paid over $500,000 for Hannah’s treatments over 11 years.

“We could have saved hundreds of thousands of dollars if we could have known about this or had it available sooner,” Anderson said.

Roughly 1,200 people live with severe brain injuries in North Dakota, Denham testified, costing Medicaid over $9 million in 2017 and 2018. She said the study could have wide-reaching impact, providing data to Medicaid, Medicare and insurance companies for reexamining their coverage decisions on the treatment. That could be “invaluable for the entirety of the United States,” she said.

Some of those testifying for the study said it could lead to improved treatments for other conditions not yet approved by the FDA, such as post-traumatic stress disorder.

James Nelson, first vice commander of North Dakota AMVETS, said this bill has become the organization’s “major push” this legislative session because of the potential to treat older head injuries and PTSD. Nelson said he has seen a lot of early interest on the topic, but he couldn’t predict how much legislative support the bill will get in its current form.

“A lot of legislators are veterans or know veterans, so I’m going to see an extreme amount of interest in it,” Nelson said. “But I’ve come to experience that interest does not always equate to dollars. There’s a lot of hands in the pot and they all want something.”