[Congressional Record Volume 140, Number 15 (Tuesday, February 22, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 22, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
              THE NEED FOR PRESCRIPTION DRUG ACCOUNTABILTY

                                 ______


                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, February 22, 1994

  Mr. STARK. Mr. Speaker, as part of national health care reform, we 
need to stop the abusive overprescribing of dangerous and addictive 
drugs. In the 102d Congress, I introduced H.R. 5051, the Prescription 
Accountability Act. This bill required the use of electronic data to 
detect patients, doctors, and pharmacists who were abusing and 
overutilizing controlled substances.
  I hope the basics features of this legislation will be included in 
this year's reform legislation.
  Last November, the Chicago Tribune released a nine-part series on 
Medicaid in Illinois titled, ``Medicaid: System in Chaos.'' Parts of 
those articles focused on the abuse of prescriptions and make an 
outstanding case for the passage of H.R. 5051-type safeguards.
  Here are some of the examples pulled from the series:

       In 1991 almost $53 million was spent on prescription 
     drugs--prescriptions that cannot be linked to a doctor 
     without months of searching. The prescribing doctor's name 
     and Drug Enforcement Agency registration number is not 
     required. In fact, $5.3 million was spent on prescriptions 
     that listed the doctor's number as BB1111111, a number 
     invented just to keep the bill from being rejected by the 
     computer.
       About $2 million went to just three medical clinics, where 
     the doctors shared a number of the same patients--some of 
     whom visited all three doctors in one day to pick up 
     prescriptions.
       Doctors who prescribe drugs without examining patients or 
     questioning requests for drugs. A 24-year-old alcoholic 
     complaining of seizures asks for refills of Phenobarbital and 
     Dilantin. She walks out with that and more, without ever 
     being examined.
       ``I have no record of it,'' says Dr. Pirruccello, looking 
     over the file. But that's nothing unusual. He admits he 
     doesn't like to write in the charts. Rarely does he venture 
     beyond scratching the names of the drugs he prescribes. 
     Sometimes he writes nothing at all. Eventually, he decides to 
     take her word for it. ``Anything else you need?'' he asks.
       Eventually she walks out with prescriptions for: 
     Phenobarital, Dilantin, two Ventolin inhalers, Zantac, 
     Ampicillan, birth control pills, a bottle of rubbing alcohol, 
     diuretics, and two bottles of Maalox.\1\ The bill? $145.63.
---------------------------------------------------------------------------
     \1\In order for Medicaid to pay for over-the-counter 
     medications, a prescription is required.
---------------------------------------------------------------------------
       ``Shopping'' for drugs is a common occurrence. Patients 
     line up in the waiting rooms discussing what to get and how 
     to get it.
       ``Every now and then, the multisyllabled names of 
     prescription medications travel back and forth in hushed 
     conversations. As do locations of friendly pharmacies. Names 
     of other doctors. Dosages to ask for, symptoms to describe. 
     Patients work out lists on tiny pieces of paper of all the 
     medications they will ask the doctor to prescribe.''

  Here are some examples of what patients have been able to accumulate.

       A diabetic patient collected, in visits to 46 doctors in 1 
     year, 7,800 hypodermic syringes--enough to use two a day for 
     more than 10 years.
       One women saw 52 doctors in 9 months, collecting 2,000 
     Prozac antidepressant capsules.
       A 34-year-old patient collected 3,540 condoms, 234 asthma 
     inhalers, and enough antibiotics, sedatives, and painkillers 
     to swallow 46 pills a day. His total bill for 1 year: 
     $20,664.
       A patient obtained 11,000 codeine-based pills, while being 
     treated for pancreatitus.

                          ____________________