Should Podiatric Physicians Monitor HBOT?

Patrick DeHeer DPM FACFAS

“First do no harm.” Many often refer incorrectly to this phrase as part of the Hippocratic Oath. (In fact, the quote is “to do good or to do no harm.”) This phrase actually comes from the Hippocratic writing Epidemics. The meaning of this statement is of the utmost importance no matter the origin.

I am proud to be part of the progress of the podiatric profession in its quest of the American Podiatric Medical Association (APMA) Vision 2015. In my opinion, however, some of these professional advancements violate the aforementioned quote.

One of the cases that I have been directly involved with as President of the Indiana Podiatric Medical Association and a Healogics Wound Healing Center physician is that of podiatric physicians supervising hyperbaric oxygen (HBOT) treatment.

The factors in the potential of podiatric physicians monitoring HBOT patients are the Medicare LCD (L25204) and state law for podiatric privileging. The Medicare LCD states the following:

“Podiatric physicians may supervise hyperbaric oxygen therapy if such a service is within their State scope of practice. However, such supervision is only covered for Medicare reimbursement when the body area or condition being treated by the hyperbaric oxygen is also within the scope of practice (e.g., a diabetic wound of the foot).”

The Indiana state law regarding podiatry (IC 25-29-1-12) states the following:

“Sec. 12. (a) ‘Podiatric medicine’ means the diagnosis or medical, surgical (as described in IC 25-22.5-1-1.1(a)(1)(C)), and mechanical treatment of the human foot and related structures. (b) Podiatric medicine includes the administration of local anesthetics. As added by P.L.33-1993, SEC.55.”

The staff at our wound healing center contemplated the question. By a legal evaluation, it appeared as if podiatric physicians would be able to monitor HBOT.

The more important question that arose was whether podiatric physicians should be allowed monitor HBOT. I know there are podiatrists around the country who monitor HBOT and this would add credence to the question in the affirmative.

I was willing to get my Advanced Cardiac Life Support (ACLS) certification. The primary care physicians at our center were willing to teach me the specifics of monitoring HBOT, such as the use and interpretation of an otoscope. We questioned the qualification of a podiatric physician to insert a chest tube in a patient with a pneumothorax.

After much consideration and taking “to do good or to do no harm” to heart, the wound center and I came to the conclusion it was not in our patients’ best interests to have podiatric physicians monitoring HBOT.

Just because we can do something does not mean we should and I think this is a perfect case of that. The advances I have seen in our profession throughout the 20-plus years that I have been in practice are phenomenal. Despite being a proud member of the podiatric profession, I feel that until we have a combined MD-DPM degree, it is in our patients’ best interest to have our allopathic and osteopathic colleagues monitor HBOT patients.

Best wishes and stay diligent.

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