One thing that I like to do from time to time is to highlight a story or incident relevant to the mission of this blog that has happened in southeast Michigan, where I live. This time around, it’s the tragic story of a five-year-old boy named Thomas Cooper, who met a tragic end six weeks ago undergoing hyperbaric oxygen treatment (HBOT) for ADHD at The Oxford Center, a quack clinic that operates two locations, one in the suburbs of Detroit and one in Brighton, near Ann Arbor. Unfortunately, it’s such a horrific story that it is no longer strictly a local story; it’s hit the national and even international news. As regular readers know, I’ve long been critical of the Food and Drug Administration (FDA), but not for the reasons that our new Secretary of Health and Human Services (HHS) Robert F. Kennedy, Jr. has been in his deceptive, antivax- and quack-friendly “Make America Healthy Again” (MAHA) manifesto or in his declaration of war on the FDA after he had suspended his independent Presidential campaign and bent the knee to Donald Trump.
Contrary to RFK Jr.’s apparent view of the FDA as jack-booted thugs who are “persecuting” brave maverick doctors curing chronic disease (and vaccine injury) with “natural therapies” (and even sunlight!), my view has been that the FDA has failed to protect the public by letting these sorts of quack treatments flourish mostly unpunished. Indeed, I’ve discussed numerous examples of this, although perhaps the one example most discussed a decade or more ago was that of Houston cancer quack Dr. Stanislaw Burzynski, who has somehow managed to ply his antineoplastons-based quackery for nearly 50 years, with only occasional attempts by the FDA (or his state medical board) to shut him down, all of them failing. Of course, it’s not entirely the FDA’s fault, as it’s been chronically underfunded and understaffed compared to the magnitude of its tasks making sure that food is safe and that medical devices and pharmaceuticals are effective and safe, but that’s not RFK Jr.’s beef with the FDA. Instead, he portrays the FDA as insufficiently rigorous when it comes to vaccines and pharmaceuticals and way too harsh enforcing regulations when it comes to “alternative medicine” practices, you know, like HBOT. Just as a reminder, I’ll repost something RFK Jr. posted to X, the hellsite formerly known as Twitter, a few months ago:
What is HBOT, though? In brief, it is the use of 100% oxygen under pressures higher than atmospheric. By way of comparison, the amount of oxygen in the air we breathe normally is around 21%, the rest being mostly nitrogen, and, to a smaller degree, CO2 and other trace gases. Usually, HBOT uses 100% oxygen at pressures between 1.5- and 3-times atmospheric pressure. According to Johns Hopkins Medicine and the FDA these are the conditions for which HBOT is evidence-based:
- Air and gas bubbles in blood vessels
- Anemia (severe anemia when blood transfusions cannot be used)
- Burns (severe and large burns treated at a specialized burn center)
- Carbon monoxide poisoning
- Crush injury
- Decompression sickness (diving risk)
- Gas gangrene
- Hearing loss (complete hearing loss that occurs suddenly and without any known cause)
- Infection of the skin and bone (severe)
- Radiation injury
- Skin graft flap at risk of tissue death
- Vision loss (when sudden and painless in one eye due to blockage of blood flow)
- Wounds (non-healing, diabetic foot ulcers)
The FDA further notes:
HBOT is being studied for other conditions, including COVID-19. However, at this time, the FDA has not cleared or authorized the use of any HBOT device to treat COVID-19 or any conditions beyond those listed above. The website, clinicaltrials.gov, has more information on HBOT clinical trials for COVID-19 and other conditions.
Anything else is not evidence-based or FDA-cleared.
Let’s just show what happens when HBOT is not “suppressed.” First, however, here’s one last thing. Some of the links go to stories that describe how Thomas Cooper died and his mother was burned trying to rescue him. The descriptions are hard to take. You might want to be careful reading and be ready to skip passages that might cause too much distress. I’m not going to sugarcoat anything, though, because I am indeed outraged that centers like The Oxford Center not only continue to exist and thrive, but could well, under RFK Jr.’s HHS leadership, become even more common and immune from the law. Worse, if anything, what we have learned in the six months since Thomas’ death makes this case even more egregious than it had first appeared upon initial reporting.
The death of Thomas Cooper
I debated about how to describe what happened on January 31, 2025 at The Oxford Center in Troy and ultimately decided on starting with how the event was reported and then proceeding to what has recently been reported, the latter of which makes the story so much more horrific and despicable than even the initial reporting did. So let’s start with the first story that I encountered that weekend, Boy dies in explosion of hyperbaric chamber at Troy medical facility:
A 5-year-old boy from Royal Oak died Friday during an explosion of a hyperbaric chamber at a Troy medical center, police said.
The explosion happened shortly before 8 a.m. at The Oxford Center at 165 Kirts Blvd. Police said the boy was found dead inside the chamber. His mother, who was injured, was with him at the facility at the time of the explosion, officials said.
The Oxford Center’s website says that it provides therapy for children with such health conditions as autism, cancer, ADHD, autoimmune diseases, and multiple others.
Troy Fire Lt. Keith Young said investigators do not yet know what caused the explosion, but concentrated oxygen and the pressure used inside hyperbaric chambers are fuel for fire.
In a statement from The Oxford Center, spokesman Andrew Kistner said the cause of the explosion is unknown and that Friday was an “exceptionally difficult day for all of us.
Naturally, The Oxford Center soon tried to spin what happened:
“As law enforcement officials have shared, at our location in Troy, Michigan, this morning, a fire started inside of a hyperbaric oxygen chamber,” Kistner wrote in the emailed statement. “The child being treated in that chamber did not survive and the child’s mother was injured.
“The safety and wellbeing of the children we serve is our highest priority. Nothing like this has happened in our more than 15 years of providing this type of therapy. We do not know why or how this happened and will participate in all of the investigations that now need to take place.”
Imagine my relief at the time.
Here’s a press conference given by the police and fire departments in Troy:
From the press conference above, according to Lt. Keith Young of the Troy Fire Department:
Shortly before 8:00 AM this morning Troy Fire and Police Department responded to a medical facility at 165 Kirts Boulevard for report of a hyperbaric chamber ber explosion with the child still inside the chamber. Upon arrival it was determined the child inside was deceased, and the victim has been identified as a 5-year-old boy from Royal Oak. A hyperic chamber contains 100% oxygen, which is up to five times the amount of oxygen in a normal room. The presence of such a high amount of oxygen in a pressurized environment can make it extremely combustible. Our initial research shows that this is not a common incident and the scene remains under active investigation. Social workers from the Oakland Community Health Network have made themselves available to work with emergency Personnel who responded to the scene and medical staff at the facility…
I can’t even imagine the horrific scene that the child’s mother saw and that the first responders encountered when they arrived. In fairness, tragic accidents like this involving HBOT chambers are rare, regardless of whether the chamber is being used at a hospital for science- and evidence-based indications (e.g., to counter the effects of decompression sickness in scuba divers, to treat carbon monoxide poisoning, to improve the “take” rate of skin grafts, or to speed up healing of diabetic foot ulcers) or at the many, many, “integrative” medical clinics that use HBOT for everything ranging from autism to cancer to stroke to dementia. Guess which one of these facilities The Oxford Center is? More on that shortly, but first let’s continue with the tragic story.
First, before I discuss revelations that came to light early this month, let me note that this is not the first time such an accident has killed a child. In 2009, a boy named Francesco Martinizi suffered massive burns that ultimately claimed his life in an HBOT chamber being used by quacks at a Florida clinic, the Ocean Hyperbaric Neurologic Center, to treat his cerebral palsy, a tragedy that also claimed the life of his grandmother. Again, as is the case for ADHD and autism, there is no good scientific or clinical evidence to justify using HBOT to treat cerebral palsy. This latest victim might be considered fortunate compared to Francesco, as Francesco lingered with his injuries for a month and a half before dying. I did rotations in burn units during my general surgery residency. I know from observing patients firsthand how painful being treated for large burns is and how disfiguring they can be. Moreover, news reports then described how the family had brought Francesco from Italy to the US for treatments supposedly not available there and had spent hundreds of thousands of dollars doing so.
It didn’t take long for the family to call in the lawyers, and in this case I can’t blame them.
Citing concerns about the oversight and regulations of hyperbaric chambers, Fieger Law announced Saturday that it has been retained by the family of the 5-year-old boy who died in a hyperbaric chamber explosion in Troy on Friday.
“This is an unimaginable tragedy, and our hearts are with the family as they navigate this immeasurable loss,” said James Harrington, managing partner of Fieger Law in a statement.
The high-powered law firm is also representing the boy’s mother, who was also injured in the explosion.
The law firm’s founder Geoffrey Feiger retired in 2024 after a major stroke. You might also remember him as having run for Governor of Michigan, although he is most (in)famous for having defended “Dr. Death,” a.k.a. Dr. Jack Kevorkian in the 1990s. I will admit that I’ve never been a fan of his and tend to view his law firm as among the worst of the worst when it comes to ambulance chasing attorneys, but in this case the firm that he founded might actually do some good. If there’s one thing I’ve often wondered, it’s why more victims and families of victims of clinics like The Oxford Center don’t sue quacks and quack clinics for malpractice after being harmed or having a loved one killed. Moreover, if you’re going to sue a clinic like this victimizing children and are in the Detroit area, Feiger Law or The Sam Bernstein Law Firm would be the ambulance chasers I’d recommend. Sometimes big sharks have their uses.
The family soon started a GoFundMe page for family support, and, I swear, reading it made my eyes tear up:
Thomas Cooper was 5 when he passed away in the hyperbaric chamber in Troy.
He was the smartest and cutest kid that liked to zoom, zoom, zoom. He asked to see pictures of germs, liked to know how things worked, he liked to make field journals and he had finally started adding facial features to his people drawings….
…He loved audio books and had just fallen in love with James and Giant Peach, BFG and Charlie and Chocolate Factory. He had just watched the first classic movie, then the Johnny Depp version and he was so excited there was a third newest one.
He loved life. He loved running and swimming. He was planning to try mountain bmx racing and karate in the summer.
Before his passing, he asked for a Chinese red pocket money for the new year. He placed it underneath his pillow and declared “he’d have the best luck ever!” The day of his passing was the day he was planning to spend his red pocket with his little brother.
His favorite thing to do is “super sonic mode.” Run as fast as humanly possibly. He had nature school last year and ran, jumped and rolled down hills. He loved mud. Loved to stomp on ice. Loved his mama and daddy so much.
Minecraft was his life. He loved all the characters and the YouTube channel with mikey and JJ. He loved Mario. He loved to dress as Mario and his brother dressed as Luigi. They were the best of friends.
He loved his Nintendo DS. His dad got him a Yoshi game the night before (for trying new foods) and he was excited to come home after the hyperbaric treatment to play.
He loved to sing “I love mama, I love mama, I love mama so very much.”
He also loved to say “my momma is the best in the whole world.”
He wanted to grow up to be a chef. His mom asked him why and he said,”so I can be with mommy forever.”
His family loved him very much. He was a smart, intelligent boy and his parents loved him how he was. He was perfect in every way. He was the best, best boy there ever was.
It was soon reported that at the time of his death, Thomas had been undergoing HBOT for indications that are most definitely not evidence- or science-based, specifically ADHD and sleep apnea. In other words, he was the victim of quackery and an unscrupulous quack. Just how unscrupulous, you will soon see when I revisit Thomas’ story. In the meantime, let’s take a look at The Oxford Center.
HBOT at The Oxford Center: The main quackery among other quackery
I like to think that I’m aware of most of the quack clinics in my neck of the woods. However, the metro Detroit area (indeed, all of southeast Michigan) is quite a large and populous area, and of course I don’t know all the local quacks (although there is a chiropractic “wellness” center disturbingly close to where I live that I’ve been meaning to write about). So I had never heard of The Oxford Center before I encountered this story. That’s why I feel the need to discuss this quack clinic a bit. As is usual, the original press stories, while being mostly accurate describing how HBOT is not evidence-based for the conditions for which it is used at The Oxford Center, tended to be too…moderate…in its description, for example, in the original Detroit Free Press article:
You can get a bit of an idea why HBOT quackery is the main—but by no means the only—quack modality sold at The Oxford Center just by looking at its origin story:
The Oxford Center is among the alternative medical centers or medical spas that, in recent years, have offered hyperbaric oxygen therapy for conditions that are not approved by the U.S. Food and Drug Administration, such as autism spectrum disorder, cerebral palsy, sports injuries, COVID-19, depression, alopecia, HIV/AIDS, strokes, migraine headaches, and as an anti-aging treatment.
No kidding. I could tell just by perusing the clinic’s website some more. Just take a look at the splash page, which features photos of multiple HBOT chambers:
Then there’s a Google image on the website, where I count at least eight HBOT chambers:
Then, of course, there’s a spiffy little cute video touting HBOT for, well, almost everything!
Besides the pictures of banks of HBOT chambers, it doesn’t take long to learn that the founder of the clinic is a true believer:
Oxygen is a “nutrient”? No…just no. It’s not. It is true that oxygen is necessary for human life. It’s necessary to generate sufficient energy from the food that we consume. (There is such a thing as anaerobic metabolism, but it generates far less energy than aerobic metabolism, and is insufficient for anything other than short-term bursts of energy, which must be “paid back” using oxygen.) It is not, however, a “nutrient,” as the medical definition of “nutrient” is limited to substances that we ingest; i.e., to food. It does not apply to chemicals that we breathe, like oxygen. Scientific illiteracy is not a good sign on a quack website.
Let’s compare and contrast the evidence-based uses for HBOT to the uses touted by The Oxford Center. I’ve already listed the conditions for which HBOT might be indicated and evidence-based in the introduction to this post. Now let’s look at the conditions for which The Oxford Center touts HBOT as an effective treatment:
It claims that the benefits of HBOT include:
Basically, The Oxford Center sells HBOT as a magic therapy for almost anything and everything. My first reaction upon reading this was utter horror at how the child died. My second reaction (aside from horror) after reading the initial accounts above was to ask: What condition was being treated with HBOT? Was it a condition for which use of HBOT is in any way science- or evidence-based? I noted that, if you play the law of averages for these quack clinics (particularly given that I know knew that that it was a five-year-old boy who was being treated), it was not unreasonable to guess that the boy was probably receiving HBOT for autism or ADHD, the two most common indications (in my experience) for which quack clinics employ HBOT.
It turns out that I was partially correct:
The Cooper family’s attorney told the Free Press the boy was being treated at the center for ADHD and sleep apnea, which also are not conditions approved for treatment with hyperbaric oxygen therapy.
Oddly enough, I don’t see sleep apnea in the large list of conditions above. It is, however, another condition not considered to be an evidence-based indication for HBOT.
It is not surprising that The Oxford Center is all-in on HBOT. All you have to do is to read the origin story of the center:
Our Founder and CEO, Tami Peterson, discovered hyperbarics after her daughter, JeAnnah, was diagnosed with viral encephalitis. JeAnnah went from a happy, functioning 9-year-old girl to functioning at the level of an 11-month-old infant in one day.
Tami did not give up hope for JeAnnah, and through countless hours of research and talking to parents of children around the world with similar conditions, Tami discovered Hyperbaric Oxygen Therapy.
She was able to convince a local hospital to treat JeAnnah, and within a few months, JeAnnah danced The Nutcracker ballet and was completely healed. Her recovery was a miracle. Tami knew that she was called to use her experience with JeAnnah to provide the healing and hope of Hyperbaric Oxygen Therapy for others.
Tami founded The Oxford Center in 2008 in South Lyon, Michigan. Since then, she has worked to add multiple other therapies to our list of services, opened a second location in Troy, Michigan, moved our South Lyon location to Brighton, Michigan, and then expanded that location to the over 70,000 square foot facility that it is today.
This is the main form of evidence for HBOT success stories and “miracle cures,” namely anecdotes. The most likely explanation is that JeAnnah would have likely gotten better without the HBOT and that Peterson is confusing correlation with causation. However, without better evidence, it’s impossible to say. I did a PubMed search for hyperbaric oxygen and viral encephalitis, and all I could find were three articles, only one of which addressed the question of whether HBOT can treat viral encephalitis, and the paper was a mouse study.
As for The Oxford Center, although hyperbaric oxygen seems to be its raison d’être and the primary therapy that it uses for basically everything, it also offers a veritable cornucopia of the usual “integrative medicine” nonsense, in particular functional medicine, under the supervision of Anna Dobracki, MD, PhD. (It really disappoints me that an MD/PhD would embrace functional medicine, which I like to refer to as “reams of useless tests in one hand, a large invoice in the other.”
It’s rather interesting to look at some conditions The Oxford Center treats. For instance, if you go to the page on ADHD, the Center’s first choice of therapy is…HBOT! Its next choice, often done with HBOT, is a “quantitative EEG and neurofeedback therapy”:
A Quantitative EEG shows us electrical activity of the brain. We will be able to see if inflammation is present, if there are any areas of hyper- or hypoactivity, and any areas of disconnect. Using this information, we can focus on the area(s) of the brain most affected and bring those areas back into balance using Neurofeedback Therapy. Research has shown a reduction in hyperactivity, more focus and attention with Neurofeedback Therapy and ADHD.
NFT is very much a dubious therapy, with little evidence to support it and evidence that it does no better than placebo, with an article in Psychology Today noting that the “procedure is safe and non-invasive, but given that it can also be expensive, time-consuming, and less effective than proven treatments, patients should carefully consider their options” and a 2016 review article concluding that “current research does not support conclusive results about its efficacy.”
What about autism? The Oxford Center’s page on autism does recommend applied behavioral analysis (ABA); so I guess there’s that. However, The Oxford Center also recommends—you guessed it!—HBOT, justifying it thusly:
Research has shown decreased cerebral perfusion, increased neuroinflammation, inflammation throughout the GI system, and increased oxidative stress in individuals with autism. Decreased blood flow to the temporal region and areas that are specifically related to language comprehension and auditory processing. Decreased blood flow to these areas may contribute to many of the characteristics that are common with autism listed above. HBOT delivers 100% pure oxygen to the body through increased atmospheric pressure, saturating the plasma and oxygenating the entire body. Research has shown that HBOT reduces inflammation systemically, lowers oxidative stress, and increases circulating stem cells, up to 800% after twenty sessions, which leads to the possibility of regrowth of certain brain cells.
None of this has been shown in anything resembling rigorous to affect positivel the clinical course in autism and autism spectrum disorders. Not that that stopped the quacks at The Oxford Center from publishing a retrospective analysis of 65 of the clinic’s patients who were treated for autism in a dodgy journal (Cureus) comparing those who received ABA to those who received ABA+HBOT, which claimed to show better verbal behaviors in children with autism who received the combined treatment with hyperbaric oxygen. From my perusal of the study, my immediate question was whether confounders were adequately considered. (Surprise! I don’t think they were!) Perhaps I’ll look at the study in more detail at another time, but I’ll just mention that a Cochran Review concluded that “there is no evidence that hyperbaric oxygen therapy improves core symptoms and associated symptoms of ASD” and cautioned that “is important to note that adverse effects (minor-grade ear barotrauma events) can occur.”
Oh, and the only treatment that The Oxford Center offers for cancer is…HBOT. Because of course. Basically, the mainstay of treatment for every condition treated by The Oxford Center is HBOT, regardless of what else is also offered. It seems to me that it’s more appropriate to call The Oxford Center an HBOT clinic rather than any sort of “integrative medicine” clinic. It’s a one-trick pony.
And, as is typical for clinics like this:
The Oxford Center, which has locations in Brighton and Troy, has generated controversy. In August, the facility’s former director Kimberly Coden pleaded guilty to nine charges after officials with Michigan Attorney General Dana Nessel’s Office said she used false credentials to treat children with autism.
She falsely presented herself as a board-certified behavioral analyst without being licensed and without the proper education and used an actual analyst’s certification to get jobs within the health sector, officials said. And she’d also used professional business cards, verbal statements, written documents and presented university degrees she allegedly didn’t earn.
Coden also tried to intimidate a witness through text messages to keep them from testifying against her, officials said.
When Coden pleaded guilty, her lawyer said her client was “really, truly remorseful.”
Lovely. Let’s just say that her behavior after Thomas Cooper died was…consistent…with her past behavior.
It’s so much worse than it first appeared
The story of Thomas Cooper is back in the news again, because investigations have yielded results. For instance, in mid-February, we learned more about what happened based on the testimony of the mother Annie Cooper. I will warn you that this testimony is difficult to read:
The boy, described by his family as curious, energetic and thoughtful, was in the midst of his 36th hyperbaric oxygen therapy treatment at the center when the pressurized chamber burst into flames. Thomas was trapped inside.
His mother, Annie Cooper, raced from a nearby waiting area to his side, but couldn’t get Thomas out of the sealed, tube-like chamber, said James Harrington, managing partner at Fieger Law, which is representing the family.
She was left to watch in horror as her son burned to death inside the chamber, which was full of highly combustible pure oxygen. Annie Cooper suffered third-degree burns to her arms, but the psychological trauma was far worse, Harrington said.
“It’s literally the worst thing that any parent could (experience),” he said. “And poor Thomas … his last moments of life were being engulfed in flames and perishing in front of his mother. He was certainly aware of what was going on.”
Then, last week it was reported that there had been several arrests, with the CEO, safety director, and others charged with second-degree murder:
Calling the death of a 5-year-old boy “an easily preventable tragedy,” Michigan Attorney General Dana Nessel said Tuesday that the Oxford Center in Troy operated the hyperbaric oxygen chamber that engulfed the child in flames on the morning of Jan. 31 “in defiance of international safety standards in accordance with whatever would provide them the most income or profit.”
“The investigation into this tragedy has revealed how the Oxford Center in Troy and several of its key decision makers held safety among their lowest considerations in their hyperbaric treatment practice,” she said.
Nessel charged three people with second-degree murder, which carries a penalty of up to life in prison:
Calling the death of a 5-year-old boy “an easily preventable tragedy,” Michigan Attorney General Dana Nessel said Tuesday that the Oxford Center in Troy operated the hyperbaric oxygen chamber that engulfed the child in flames on the morning of Jan. 31 “in defiance of international safety standards in accordance with whatever would provide them the most income or profit.”
“The investigation into this tragedy has revealed how the Oxford Center in Troy and several of its key decision makers held safety among their lowest considerations in their hyperbaric treatment practice,” she said.
Nessel charged three people with second-degree murder, which carries a penalty of up to life in prison:
- The Oxford Center’s CEO and founder Tamela Peterson, 58, of Brighton.
- Gary Marken, 65, of Spring Arbor, who serves on the center’s advisory board and is its director of operations.
- Jeffrey Alan Mosteller, 64, of Clinton Township, who is the center’s safety director and director of training.
Each of them also was given an additional alternative charge of manslaughter, which carries a maximum penalty of 15-years in prison, Nessel said, “meaning that a jury will be able to decide which charge properly befits their conduct.”
A fourth person, Aleta Harward Moffitt, 60, of Rochester Hills, was the operator of the hyperbaric chamber on the morning of Thomas’ death, Nessel said. She is charged with involuntary manslaughter and one count of intentionally placing false information on a medical record, a four-year felony, Nessel said.
Although I generally like Attorney General Nessel and have tended to support her, I can’t help but add here that the State of Michigan bears at least a modicum of responsibility for Thomas Cooper’s death in that it allows quack clinics like The Oxford Center to flourish. Every time there is a harm, our law enforcement will (appropriately) treat it as the violation of the law, but then our regulatory agencies will do little or nothing to correct the underlying flaw in the system that allows such tragedies to happen.
Indeed, later in the story:
The Oxford Center staff failed to meet the following safety standards, Nessel said, on the day of Thomas’ death:The Oxford Center, which has locations in Brighton and in Troy, issued a statement to the Free Press late Monday, calling the timing of the charges “surprising as the typical protocol after a fire-related accident has not yet been completed.”
- Conduct a daily maintenance check and pre-dive safety check.
- Have a medical doctor or safety supervisor at the Troy facility at the time of Thomas’ treatment.
- Provide a licensed technician to perform the treatment.
- Complete yearly inspections of the hyperbaric chamber as recommended by the manufacturer.
- Require Thomas to wear a grounding strap during his treatment. It controls the risk of static electricity inside the chamber to reduce risk of fire.
It gets even worse, though. Later in the week, news stories started reporting that there were attempts to destroy evidence, as well as text messages found with some breathtakingly callous comments from CEO Tamela Peterson:
Tamela Peterson, the CEO of the Oxford Center in Troy, ran away from detectives when they asked for her cellphone and had her son scrub her laptop days after 5-year-old Thomas Cooper was burned alive inside one of the center’s hyperbaric oxygen chambers on Jan. 31, Troy Police say.
According to another news story:
Investigators noted that when they tried to get the CCTV footage from all of Cooper’s other treatments, Peterson claimed she did not remember her password to access the system.
IT personnel then said she should have it because they had just given it to her “very recently.” The IT personnel were the ones who provided the login information needed to access the video.
Investigators said Peterson was constantly monitoring video in real-time at the Troy facility, based on message and email correspondence.
“I don’t remember the password”? That reminds me of “The dog ate my homework.” But, unbelievably, it gets even worse (and, again, this is very, very bad—take care):
Still, police found electronic messages on Peterson’s devices, said Detective Danielle Trigger, including an exchange in which Peterson sent photos of the boy’s burning body and wrote “something to the effect of: ‘If my leg was on fire, I would at least try to hit it and put it out. He just laid there and did nothing.’ ”
First, it’s horrifying that pictures of the boy burning to death in the HBOT chamber exist on Peterson’s phone, but it’s even worse that she was so callous. “He just laid there and did nothing”? Was he already dead? Was he in shock? One can only imagine.
And, as I always like to say about these clinics, it was all about the Benjamins:
Peterson’s messages also show that when she was asked whether the company was promoting hyperbaric chambers to treat erectile dysfunction, she responded: “Whatever gets bodies in those chambers, lol,” according to a transcript of Trigger’s March 7 testimony before 52-4 District Court Magistrate Elizabeth Chiappelli, which was obtained by the Detroit Free Press.
We also learned that the HBOT treatment that killed Thomas Cooper was the 36th of 40 planned treatments, and that The Oxford Center wasn’t exactly careful about safety protocols. Compare what is recommended as best practice for such chambers to what happened the morning of Thomas Cooper’s death:
Hyperbaric chambers contain 100% oxygen that is pressurized. Those conditions make the environment inside them highly combustible. And while adults at the Oxford Center were required to wear medical scrubs when using the center’s chambers, children were allowed to wear their own pajamas inside, so long as they were made of 100% cotton, police said.
The type of material matters, according to a 1997 study that determined synthetic materials and wool fibers can “build up static charges (and) should not be permitted inside the chamber” because of the risk that they could ignite a fire.
A video obtained by Troy police showed that the tags on Thomas’ pajamas were never checked to ensure they were made of cotton before he went inside the chamber, Trigger said. And she said the facility hadn’t used grounding straps for years on patients, including on Thomas the day he was killed. The straps typically are worn around the wrist during hyperbaric oxygen therapy to discharge static electricity that could spark a fire. They were found by detectives in the center’s “junk drawer,” according to Trigger.
And, almost unbelievably, but really not, I guess:
Peterson, Marken and Mosteller allegedly advised employees that grounding strips, a safety measure, were not necessary, despite industry experts, safety manuals, and the Oxford Center’s own training materials suggesting otherwise. Police say Mosteller conducted his own experiments in an attempt to prove grounding straps are not necessary, even though he could not recall to police one facility that does not use them in his 41 years of experience with hyperbaric chambers.
Unsurprisingly, this story has gone national and international, and this NBC News report sums up the practices at The Oxford Center rather nicely as Hyperbaric chamber facility where boy died put profits before client care, Michigan attorney general says:
Michigan Attorney General Dana Nessel described the business as “unscrupulous,” saying that, for years, Peterson, Marken and Mosteller disregarded safety measures. They used the highly pressurized oxygen chambers on children’s bodies “over and over again to provide unaccredited and debunked so-called treatments, chiefly because it brought cash into the door.”
Indeed. I would, however, repeat that the State of Michigan bears some culpability for letting these quacks operate for so long. Somehow, I doubt that Nessel will acknowledge that, other than by way of excuses:
In a news conference Tuesday, Nessel accused Oxford Center staff of holding “safety among their lowest considerations” but said officials had no way of knowing about the danger until it was too late, and cannot proactively investigate other facilities.
“Michigan law doesn’t require any oversight over the use of hyperbaric chambers, so without having some sort of probable cause to believe that there are crimes being committed involving hyperbaric chambers in other places in the state, we wouldn’t have the authority to go in and perform an inspection,” Nessel said.
It really sounds as though legislators in Michigan and other states should do something about that, doesn’t it?
What will happen now that RFK Jr. runs all nonmilitary federal health programs?
It took the tragic death of a five-year-old boy to stop the use of HBOT at The Oxford Center, but it’s only completely closed one location, the one in Troy; apparently the Brighton location is still in operation; it just shut down its HBOT program.
There is some hope in Michigan, as there are legislators who are working on legislation to do something about all the unregulated HBOT facilities across the state. This NBC News report notes that The Oxford Center where Thomas died was subject to occasional fire safety inspections by the Troy Fire Department, whose spokesman noted that “our inspections are fire- and life-safety focused” and that there’s “nothing that covers the operation or the maintenance of the chambers themselves.” Hospitals using hyperbaric chambers for evidence-based indications “abide by codes developed by the National Fire Protection Association, a standards development organization.” However, Michigan is not unique in lacking a regulatory framework for hyperbaric oxygen therapy outside of traditional health care facilities. Moreover, accreditation by Undersea & Hyperbaric Medical Society involves inspections and costs around $10,000 for each accreditation cycle of three or four years.
According to a spokesman for the Undersea & Hyperbaric Medical Society:
He estimated that thousands of spas, wellness companies and other storefronts are operating hyperbaric chambers in the U.S. without having undergone accreditation, and he said he fears many may not be upholding stringent standards.
No kidding.
I will say that the Michigan legislators seem to “get it” in that they aren’t just focused on safety but on cracking down on the quackery surrounding HBOT:
Two Democratic legislators in Michigan, state Sen. Stephanie Chang and state Rep. Sharon MacDonell, are working together to explore regulatory options after Thomas’ death.
Chang said she was alarmed by what appeared to be a myriad of problems that led to the fire, based on what the Michigan attorney general outlined, including allegedly not having a properly trained technician operating the hyperbaric chamber.
“Let’s fix all of those loopholes,” Chang said. She said she and MacDonell are aiming to introduce legislation in the spring.
MacDonell said it was important not just to make hyperbaric chambers safer but also to stop businesses from making unproven claims about what the therapy can do.
“People are taking advantage of parents with children with hard-to-treat conditions, and just kind of monetizing the desperation of the parents,” she said. “It’s just incomprehensible.”
Actually, if you had been paying attention, you would find it quite comprehensible. Quacks are either true believers in HBOT or they like money, often both. Moreover, these sorts of “holistic spas” have been a problem for literally decades. Indeed, the Michigan Department of Licensing and Regulatory Affairs does not have oversight of hyperbaric chambers. In Michigan, they are not even required to be licensed.
This brings me back to RFK Jr., who now oversees the FDA. Of course, the Senate Committee on Health, Education, Labor and Pensions (HELP) just advanced Dr. Marty Makary’s nomination to be FDA Commissioner, and he’s likely to be confirmed by the full Senate this week. If there were an area that cries out for more FDA regulation, it would be something like hyperbaric oxygen chambers, given that:
While there are guidelines for how to safely construct and operate hyperbaric chambers, there is no consistent federal, state or local oversight of the practice outside of hospitals. The FDA said in an email last month that it regulates certain hyperbaric chambers that meet the agency’s definition of Class II medical devices, which are “intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease.” But it does not regulate the practice of medicine and referred NBC News to the Centers for Medicare & Medicaid Services, The Joint Commission and state medical licensing agencies for more information.
The Centers for Medicare & Medicaid Services requires Medicare and Medicaid providers to comply with parts of the National Fire Protection Association code, but that does not apply to other facilities, which must still adhere to local building and fire codes, said Brian O’Connor, a senior engineer at the National Fire Protection Association.
Oh, wait. America’s Quack, Dr. Mehmet Oz, will soon be running CMS.
My point in starting this story out by quoting RFK Jr. is that he’s not just an antivaxxer. He’s in favor of a lot of unproven medical treatment and outright quackery, which he hopes to “mainstream” through his MAHA agenda. Dr. Makary has made a name for himself claiming (falsely) that medical error is the third leading cause of death in the US and, with more justification, that the FDA’s approval process is too lax, although he definitely undermined that message by focusing primarily on COVID-19 vaccines to the point where his contrarianism suggests ideology more than a genuine desire to reform the FDA for the better.
What needs to happen are two things. First, the FDA needs to classify these HBOT chambers formally as medical devices, subject to FDA regulation. That includes all the thousands of HBOT chambers in all the spas and alternative health clinics throughout the US. Second, states need to consider HBOT therapy a medical treatment subject to regulation by their departments of health and state medical boards. The first, I just don’t see happening with RFK Jr. in charge, given that I highly doubt that Dr. Makary has the intestinal fortitude to challenge his boss on this issue. The second, I don’t see happening much, except maybe in a few states. Indeed, I’m not even sure that it will happen in Michigan even after this tragedy. After all, although the 2009 case that I mentioned above did lead the doctor to lose his license, no one went to prison. (One technician was sentence to house arrest.) Worse, no laws were passed or changed to prevent such a tragedy again.
Certainly, I hope that all those responsible for Thomas Cooper’s death receive the justice that they are do, particularly Peterson, whose behavior after the investigation started sure does suggest that she knew what she was doing. Failing to shut them down (which would have been a lot better), the best that the state can do is to do its best to convict them and send them to prison for a long time, while the parents can sue for civil damages. Unfortunately, more broadly, with RFK Jr. in charge of HHS, I expect harms and deaths from quackery to increase, not decrease. Why? Because I expect him to do his damnedest to make sure that no stronger regulations and laws are passed; more than that, I expect him to weaken the already lax laws and regulations governing quackery like The Oxford Center’s use of HBOT.
After all, if someone like Stanislaw Burzynski could operate for nearly five decades without being shut down by either the FDA or the State of Texas and that, he is still in business, what hope is there with RFK Jr. in charge and a lot of RFK Jr.-inspired politicians who are at least antivax-adjacent as well as pro-“health freedom” at the state level overseeing the practice of medicine? Sadly, there is not much, but that doesn’t mean we should stop trying to protect patients.