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Fire, Fatal Injury, and Claims of Certification in an Independent HBOT Clinic

4 May

By now, most readers of LB/RB have learned about the critical injury of an Italian 4 year-old (Francesco Martinizi), and the death of his grandmother, which occurred as the result of an apparent flash fire/explosion at a hyperbaric oxygen therapy center in Florida.

Media Story

Apparently, the boy was likely being treated for Cerebral Palsy.

Media Story

Cerebral Palsy is not an Undersea and Hyperbaric Medical Society (UHMS)-approved indication for the use of hyperbaric oxygen therapy, and this was recently commented on by Dr. Charles S. Graffeo in an article in the New York Times online by Jane E. Brody.

He cautioned patients to steer clear of independent hyperbaric centers owned by a single doctor or small medical group that is not affiliated with a major hospital or medical school. Commenting on claims commonly made by such clinics, he said: “No legitimate organization would condone treating cerebral palsy with hyperbaric oxygen therapy. I haven’t seen anything that is even potentially promising to support such a use. If I had a C.P. child, I wouldn’t even consider it.”

Given these recent comments in the New York Times article, I wanted to learn a little more about this Florida hyperbaric oxygen therapy clinic – Ocean Hyperbaric Neurologic Center (OHNC). It’s a clinic that apparently may also use HBOT to treat autism. The clinic appears to be exactly what Dr. Graffeo cautioned about. It seems to be an independent, privately-owned hyperbaric center, and according to the clinic’s website, appears to have a single MD on the board and staff.

The medical director listed at the OHNC’s website is George F. Daviglus.

Dr. Daviglus is a licensed medical doctor in the state of Florida, and apparently, as allowed for by Florida law, may not carry medical malpractice insurance.

Additional information from the OHNC’s website tells us the following about Dr. Daviglius:

Dr Daviglus performed duties as co-director of Ocean Hyperbaric Neurologic Center since 1998 and is now proud director of the clinic. He is certified in Hyperbaric Medicine by the Undersea and Hyperbaric Medical Society and is Diplomate of the American Board of Surgery, Thoracic & Cardiovascular. Additionally, Dr Daviglus holds teaching and attending medical positions at numerous medical institutions including Thoracic & Cardiovascular Surgery at VA Hospital, Jackson Memorial Hospital and University of Miami School of Medicine.

While seemingly innocuous (and likely reassuring to potential patients), it’s probably somewhat misleading because it’s stated that Dr. Daviglus is “certified” in Hyperbaric Medicine “by the Undersea and Hyperbaric Medical Society”. The UHMS is apparently not an organization that “certifies” the medical expertise of physicians in hyperbaric oxygen therapy like a medical specialty board at all. From the UHMS website page that elaborates on physician certification:

Physician Certification

Physicians can obtain board certification in Undersea and Hyperbaric Medicine through the American Board of Emergency Medicine (ABEM) and the American Board of Preventive Medicine (ABPM), with a current certification from one of the 24 primary member boards of the American Board of Medical Specialties (ABMS). Physicians must submit an application to the board through which they are certified. Physicians certified by an ABMS member board other than ABEM and ABPM and who fulfill the eligibility criteria must apply to ABPM. Upon successful completion of the examination, certification is awarded by the board through which the physician submitted the application.

So it appears that “certification” in Undersea and Hyperbaric Medicine is actually the responsibility of ABEM and ABPM, not the UHMS. Both the ABEM and the ABPM are member boards of the American Board of Medical Specialties. If a physician is certified by either the ABEM or the ABPM (or any other ABMS member boards), a search at the ABMS website should reveal this. A search for physicians with the last name “Daviglus” turns up the following:

George F. Daviglus

American Board of Surgery
Surgery – General (General indicates Primary Certificate)

American Board of Thoracic Surgery
Thoracic Surgery – General (General indicates Primary Certificate)

There was nothing returned for ABEM or ABPM, nothing about Undersea and Hyperbaric Medicine, and Dr. Daviglus does not appear on UHMS-maintained lists of physicians certified by ABEM and ABPM.

The UHMS does provide accredidation for hyperbaric facilities themselves – The Ocean Hyperbaric Neurologic Center is not listed by the UHMS as a UHMS-accredited facility.

Additionally, the UHMS appears to have some potential affiliation with the National Board of Diving and Hyperbaric Medical Technology (NBDHMT), the board that certifies hyperbaric technicians, diving medical technicians, and hyperbaric registered nurses.

While the two technicians listed on the Ocean Hyperbaric Neurologic Center’s staff page do appear certified as stated, a search for “Daviglus” turns up zero results at the NBDHMT website for CHT, DMT, or CHRN.

It should also be noted that the UHMS does certify “Diving Medical Examiners”. Physicians receiving this education and certification provide medical assessments of “fitness for diving”. Dr. Daviglus does not appear on the list of UHMS-certified Diving Medical Examiners.

It seems possible at this point, that the Ocean Hyperbaric Neurological Center webpage about the staff may not reflect what some would expect with such a claim of certification.

Although unconfirmed, it may be that the director of the clinic possesses a certificate (or certificates) of completion from UHMS-approved Hyperbaric Medicine CME coursework for physcians. Such courses do have the objective of providing education on the subject and often include the word “certification” in the course title. While not exactly “certification in Hyperbaric Medicine by the Undersea and Hyperbaric Medical Society”, according to one of the providers of this type of education, an introduction to hyperbaric medicine course “provides the credentials recommended for Physician Hyperbaric Supervision”.

If this is the extent of the “certification” held by Dr. Daviglus in hyperbaric medicine, the clinic’s website might better serve those seeking to clearly understand the staff’s relevant training and “certifications” by adding some clarification. Then again, if something along the lines of completion of one or two weeks worth of CME coursework in hyperbaric medicine represents the extent of the “certification” in hyperbaric medicine held by the director of this clinic, this may contribute to an explanation of why this facility appears to treat conditions like cerebral palsy and autism in the first place – conditions for which there appears to be very little legitimate scientific support behind the use of hyperbaric oxygen therapy (some have even called the use of hyperbaric oxygen therapy for such conditions, “quackery”).

Yes, this accident (fire/explosion) is tragic, very tragic. If Francesco indeed survives the injuries he’s apparently sustained, the next couple of months are likely to be very very rough. The situation certainly isn’t helped by the fact that there probably isn’t much in the way of good scientific evidence to support the notion that little 4 year-old Francesco should have ever been in such a facility in the first place.

Author Note: “Do’C” is a nickname, short for Dad Of Cameron. Do’C is not a physician or licensed healthcare provider of any kind. Along with occassional guests, Do’C writes the Autism Street blog.

HBOT quackery maims 4 year old

2 May

So it turns out that four year old Francesco Pio Martinisi had Cerebral Palsy.

HBOT is not a valid treatment for CP and there is no quality science to support the idea that it may be one day.

There is growing interest in the use of hyperbaric oxygen therapy (HBO2) for children with cerebral palsy. Although there is no rigorous evidence to support this management, private hyperbaric centers have been established throughout the United States and Canada….

They are Italian and in an echo of Tariq Nadama, came to the US for a treatment not offered in their home country. CBS4 states they have spent ‘hundreds of thousands’ of dollars on HBOT ‘treatment’.

Nobody knows why the fire started but one thing is sure. There was no medically indicated reason for Francesco to be in that chamber. This was another totally unnecessary accident.