Oklahoma's Leadership Role in the Treatment of Brain Injured Veterans
In 2014, the Oklahoma Legislature voted unanimously for passage of The Oklahoma Veteran Traumatic Brain Injury Treatment and Recovery Act to establish a system of treating the 60,000 veterans in Oklahoma that are not receiving effective care. This event marks Oklahoma’s decision to use the constitutional powers granted to each state governor as Commander-in-chief (by executive order) and each state legislature to use its police powers to protect the health and welfare of all its citizens.
Oklahoma state officials have determined that there is a health crisis caused by untreated brain injuries which include Post Traumatic Brain Injury (PTSD) and Traumatic Brain Insult (TBI) that can be effectively treated using hyperbaric oxygen therapy. (HBOT). It is noted that, nationally, 22 veterans a day commit suicide and according to the Oklahoma State Department of Health, Oklahoma sees twice the national average of suicides each year.
State leaders have been convinced that by using existing equipment and by creating hyperbaric clinics across the state, it will be possible to prevent suicides as well as restore the health of not only veterans but active duty military personnel, first responders and ordinary citizens who are currently suffering brain injuries. They note that every person who is not a taxpayer, is a loss of $16,800 in taxes to the Federal Government and $4,000 in taxes to the State. It is also noted that if individuals are not able to work due to brain injuries, they are a burden on society. Many are incarcerated for criminal behavior, are inmates at mental institutions, live on the streets, are self-medicating (substance abuse), are recipients of various State welfare help, are receiving Federal disability entitlements or are kept at home by families who may also be on some form of welfare due to having the principle breadwinner unable to work.
Despite passage of the legislation, veterans were still not being treated, so the creation of a network of Patriot clinics is a novel approach to delivering health care. It was designed by Dr. William “Bill” Duncan, who, for over a decade, was a legislative aide to former Fifth District Congressman, Ernest Istook. Istook served on the U.S. House Appropriations Committee and charged Dr. Duncan, who has a Doctorate in Political Science, Economics and Public law, with the responsibility to figure out how to create a more efficient and less expensive way to deliver effective care.
During the years Duncan served Rep. Istook, he came upon Hyperbaric Oxygen Therapy (HBOT), an old technology that is widely used in China and Russia for over 50 uses. Here in the States, the FDA approves 13 uses including several for brain injuries. Seeing how effective and cost effective HBOT was, Duncan envisioned a solution to the high cost of health care by just fixing people’s brains. Thanks to our current Governor, Mary Fallin, when she replaced Rep. Istook as Congressman, was able to have The TBI Treatment Act unanimously passed in the US House to establish HBOT as the primary means of restoring brains. The bill was blocked in the Senate twice despite the efforts of Sen. Jim Inhoff.
Consequently, the idea was brought to Oklahoma where it was well received due to the State’s longtime interest in with brain injury, as well as concerns about the lack of effective care for veterans.
In 1980, Presbyterian Hospital in Oklahoma City brought Cognitive Rehabilitation from Israel, where it was developed to treat Yom Kippur War casualties. This was the first cognitive rehabilitation in the Nation. Further, Oklahoma University had already developed a mental assessment screening test called the Automated Neuropsychological Assessment Metrics (ANAM), to test the functionality of Vietnam veterans who had been exposed to Agent Orange. The FAA Civil Aerospace Medical Institute in Oklahoma City provides ongoing information regarding Aviation Decompression Sickness, which is routinely treated by HBOT.
The overall plan is to establish a network of clinics across the state. The Patriot Clinic in Oklahoma City is considered the headquarters where many effective care services are being developed. By definition, “’Effective care’ refers to services that are of proven value and have no significant tradeoffs – that is, the benefits of the services so far outweigh the risk that all patients with specific medical needs should receive them.”
A Lawton clinic is scheduled to open in 2016, (named after Martin Hoffmann, Secretary of the Army for President Gerald Ford) to serve both active and retired military personnel along with the civilian population. There are 6,000 young veterans who need treatment in this community. Plans for a Tulsa clinic are underway and in coming years mobile clinics will serve smaller communities.
One feature of the law is the establishment of a revolving account under the authority of the Oklahoma Department of Public Affairs managed by the Office of Management and Enterprise Services to pay for the treatment of veterans. $25,000 are needed from the public as seed money to trigger the ability of Patriot Clinics to bill for services from the account. Funds for this revolving account are then replenished by Federal funds as required by the Veterans Bureau Act of 1921, which directs the Federal Government to repay the State for all medical services spent on treating veterans. This $25,000 actually is actually “rotated” several times a year and actually multiplies to $100,000, enough to completely treat four veterans.
Key to this revolving account and how it provides a new and more thrifty health care payment system, is that the Patriot Clinics are non-profit charities where no patient will ever be charged for HBOT services. In addition, volunteers are used extensively to run the clinic and many of the day-to-day supplies are donated as needed from the public.
The Oklahoma City Patriots Clinic, in its 21 months of existence, has already provided 10,000 HBOT treatments representing nearly 300 patients. It has just moved to a new 17,000 square foot medical facility and has begun a fundraising campaign to pay for $100,000 additional equipment and $150,000 to purchase the building. A new urgent care center will be added to the clinic to help fund the HBOT services for civilians and it is expected that many urgent care patients will have need for free HBOT services as well.
Once the revolving account is established, with the $250,000 equipment already in place and the urgent care center established, it is expected that the Oklahoma City headquarters clinic will be self-sustaining.
When HBOT is fully implemented for both acute and chronically injured patients, they will not only become taxpayers again, the high cost of entitlements and mandatory spending which is linked to brain insults will be reduced by 50% in the next 10 years.