[Congressional Record Volume 143, Number 108 (Monday, July 28, 1997)]
[House]
[Pages H5895-H5896]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    CALLING ON HCFA TO STOP RESTRICTING USE OF MULTIDEX BY DENYING 
                     REIMBURSEMENT WHEN IT IS USED

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Tennessee [Mr. Duncan] is recognized for 5 minutes.
  Mr. DUNCAN. Mr. Speaker, every year 54,000 Americans lose a foot or a 
leg to diabetes. As terrible as this is, one thing that makes this 
statistic especially heartbreaking is that many thousands of these 
amputations could have been prevented were it not for Federal redtape. 
Two-thirds of all amputations in diabetic patients are precipitated by 
traumatic foot ulceration, which could have been prevented with proper 
care and modern medical products that are already available.
  However, Federal bureaucrats at the Health Care Financing 
Administration, HCFA, are restricting FDA-approved dressings which have 
been proven to heal these types of wounds. If this is not a scandal, I 
do not know what is, people who are having amputations thanks to our 
own Federal bureaucracy.
  Just think how wonderful it will be if we could prevent up to two-
thirds of these 54,000 diabetic amputations each year. Sadly, it seems 
that the Medicare system sometimes gives little or no incentives to 
doctors, nursing homes, or hospitals to help their patients get better 
quickly because as long as they are

[[Page H5896]]

treating patients they are getting payments from the Government. There 
are better ways to treat patients, Mr. Speaker, especially diabetic 
patients.
  To get more specific, Mr. Speaker, there is a product approved by the 
FDA which has been shown through repeat success to have healed 
repeatedly diabetic ulcerations and to have eliminated the need for 
amputations. This product is called Multidex. HCFA, however, is 
restricting the use of Multidex through bureaucratic redtape and 
needless Government road blocks. The way they are restricting the use 
of Multidex is by routinely denying reimbursement to providers who use 
it on patients.
  If ever there was an effective way to stop the use of a medicine or a 
medical product, this is it. This is because most of the patients who 
have these amputations are senior citizens who are on Medicare. Between 
the ages of 65 and 74, nearly 17 percent of the U.S. white population, 
25 percent of African-Americans, and more than 33 percent of Hispanic-
Americans have diabetes. Each year we are spending $1.5 billion on 
diabetic amputations. Within 3 years of a major amputation 30 to 50 
percent of diabetic patients will die, yet many thousands of these 
amputations could be prevented with proper care, and this product 
Multidex, which is being restricted by HCFA, is the most effective 
treatment available today for these diabetic ulcerations.
  I would like to show four pictures, Mr. Speaker, which demonstrate 
the effectiveness of Multidex, and I apologize for the graphic nature 
of these pictures, and while these pictures all show the same foot at 
different stages, and these are the same case, huge numbers of pictures 
and tests and data have been presented to HCFA from many, many other 
cases showing similar results.
  This first photograph shows the foot of a 75-year-old diabetic 
patient with a massive ulcer of the right foot. It is a stage four 
wound with heavy infection, gangrene, and amputation of the left toe. 
The second photograph shows the same foot 19 days after treatment with 
Multidex has begun. The infection has cleared, and the healing has 
begun. The third photograph shows the same foot 25 days after the 
treatment with Multidex has begun. It is obvious that the treatments 
are working. The final photograph shows the same foot at the time of 
discharge. Without Multidex or some similar product this foot would 
probably never have healed. The foot might have had to have been 
amputated if Multidex had not been used.
  This is obviously a situation where the system has broken and needs 
fixing. Clearly helping the body to heal itself is a much better choice 
than amputation from both a quality-of-life point of view and a cost-
of-Medicare point of view.
  If any part of the Federal Government needs reinventing, Mr. Speaker, 
it is Medicare. Here is a vital Government service where artificial 
barriers need to be broken down and effective products like Multidex 
need to get to these desperately ill patients. I call on HCFA to stop 
restricting the use of Multidex by denying reimbursement when it is 
used. It is a scandal of major proportions to think that thousands of 
senior citizens might have to have amputations in the next few months 
because of this bureaucratic redtape.

                          ____________________