796,340 Veterans have died from Lower Limb Amputations (LLA) resulting from Diabetic Foot Ulcers (DFU) in the past 22-years. This is more than all US Service members Killed in Action in all the U.S. Wars (623,982) since the start of World War I.

Hundreds of Thousands of Veterans are Dying Prematurely from Diabetic Foot Ulcer Amputations When a Life-Saving Treatment is Available but Widely Unused by the VHA

Veteran Eric Koleda with the TreatNOW Coalition has updated and (re)released, The Veteran Diabetic Foot Ulcer (DFU) Epidemic: A U.S. Department of Veterans Health Administration (VHA) Hyperbaric Oxygen Therapy (HBOT) Services Review. 

His analysis of recent data acquired from a Congressional office provided by the Deputy Under Secretary of Health for the VHA, Dr. Steven Lieberman, indicates 796,340 Veterans have died from Lower Limb Amputations (LLA) resulting from Diabetic Foot Ulcers (DFU) in the past 22-years. This is more than all the Veterans Killed in Action in all the U.S. Wars (623,982) since the start of World War I. The current VHA DFU Lower Limb Amputations (LLA) Veteran mortality rate is 64-71 percent within 3-years post-LLA surgery. 

Glenn Butler, Founder and CEO of Life Support Technologies Group in New York, who operates a network of twelve New York Tri-State Hospital-based Wound Care and Hyperbaric Oxygen Therapy Services participating in the VA Community Care Provider Network. 

Glenn shared, “We have been available to accept referrals for HBOT from the New York Manhattan, Bronx and Northport VA Medical Centers for many years and have only seen a few family or self-referred Diabetic Veteran’s requesting advanced care in one of our hospital-based Diabetic Limb Salvage Programs. These services provide aggressive evaluation, vascular surgical intervention, wound care and Hyperbaric Oxygen Therapy per CMS Medicare, FDA, Tricare, and VA guidelines.” 

The VA does not operate any HBOT chambers throughout their entire 1,298 Facility national Hospital network because they are not staffed or equipped and instead rely on civilian hospital HBOT experts that specialize in providing HBOT to patients that qualify, including Veterans. 

Glenn said, “To date, we have been unable to meet with the local VA and to offer clinical support. The VA total Lifetime cost of Diabetic Veteran care, LLA amputations, prosthesis, morbidity and mortality rates are appalling as compared to the civilian diabetic community. The civilian sector clinical track record can offer the VA diabetic Veteran at risk of lower limb amputation superior clinical outcomes, the duration and quality of life, plus a significant reduction in lifetime care costs to the American Taxpayer.” 

Eric Koleda has interviewed several DFU Veterans including Hershel Bowling from Indiana. We asked Hershel and his wife Cindy, “Did the VHA ever mention HBOT treatment for his DFU?”, they both responded, “What is that?” When we spoke with DFU Veteran Jim Divone from NY, he saidhe received HBOT for his DFU after seeing a Podiatrist outside the VA and having the treatment paid for by his health insurance outside the VHA network. “The Northport VA never mentioned to me HBOT was an approved treatment modality, it was not offered to me as a treatment option, nor was I made aware it was readily available through the Community Care Provider network.” 

Hyperbaric Oxygen Therapy (HBOT) has been approved by the Center for Medicaid and Medicare Services (CMS) since 2002 for all Veterans over the age of 65. According to the recent VHA data, the average age for DFU Veterans having Lower Limb Amputations due to DFUs is 66.2 years old. The majority were eligible to receive CMS covered HBOT treatments as an insured, covered and approved treatment. The VHA data indicates the last 20-years on average 93.7 percent of DFU Veterans are not receiving HBOT treatments. Conversely, the Medicare Civilian Wound / HBOT Center average is 74 percent HBOT heal rate for DFU cases when treated with aggressive vascular intervention, wound care plus HBOT. The addition of HBOT to the Plan of Care for “At Risk” for amputation patients provides a unique wound healing environment. HBOT uniquely grows new capillary blood vessels that were destroyed by Diabetes and thereby improves blood flow to provide additional oxygen, boost the immune system to fight infection and speeds overall healing as compared to wound care without HBOT. 

The 50-page report raises several questions: If Hyperbaric Oxygen Therapy has been approved since 2002 and Veterans are eligible to receive these insured and approved treatments, why is the VHA delaying timely referrals or denying Veterans access to treatment that will save their lives in 74% of cases? If there is even a 15-day delay in referring “at LLA Risk” DFU Wagner Grade III Veterans for HBOT treatments outside the VHA, it is potentially a death sentence for the Veterans. 

The report indicates an estimated annual $2.7 billion spend for Veteran DFU and Lower Limb Amputation in surgical, hospitalization, aftercare, prosthesis and wheelchair, and disability costs. All 2021 DFU 9,542 Veterans could have been treated with CMS, FDA, and Tricare approved HBOT for approximately $115 million, just 4% of the estimated total VA annual cost. 

The doctrine of “Informed Consent” seeks to ensure that doctors: tell patients of their diagnosis; and that those patients understand the nature and purpose of recommended interventions; and, most importantly, that patients are made aware of the burdens, risks and expected benefits of all options under the Code of Medical Ethics Opinion 2.1.1. Are the VHA medical doctors informing DFU Veterans they are entitled to receive HBOT treatments outside the VHA? Are DFU Veterans being referred to outside HBOT services on a timely basis? Are Veterans told the mortality rates for LLAs as opposed to the success rate when HBOT is used?

The VHA currently does not operate any HBOT chambers in their 1,298 healthcare facilities nationwide. There are an estimated 1,156 hospitals across the U.S. with HBOT chambers staffed with medically qualified, trained, and certified personnel. Hundreds of private clinics already treat DFUs safely and effectively. The HBOT infrastructure exists to treat all DFU patients. 

The full 50-page report including recommendations may be viewed on the TreatNOW website, www.treatnow.org. TreatNOW is requesting that diabetic Veterans under VHA healthcare with a DFU or LLA get in touch so that we can pass information and speak with them or a family member about their DFU and medical experience. 

By Eric Koleda, TreatNOW.org, ewk7405@aol.com

###

The information provided by TreatNOW.org does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.