question on tunning an SQL

The following is being run by a user and is spiking the Database. I ran a tunning advisor for it and it came back with the following recomendation:

Predicate "TRX"."Procedure"<>:B1 used at line ID 7 of the execution plan is an inequality condition on indexed column "Procedure". This inequality condition prevents the optimizer from selecting indices on table "AXIUM"."TRX".

Here is the statement:
SELECT "PATIENT"."Chart", "CONTRACT"."Consent", "CONTRACT"."Deleted", "TRX"."Type", "TRX"."Procedure", "PROCEDUR"."Discipline", "TRX"."Status", "TRX"."Deleted", "TRX"."TreatmentDate", "NOTES2"."Code", "TRX"."Producer", "PATIENT"."Last", "PATIENT"."First", "CONTRACT"."Patient" FROM "AXIUM"."PATIENT" "PATIENT", "AXIUM"."TRX" "TRX", "AXIUM"."CONTRACT" "CONTRACT", "AXIUM"."PROCEDUR" "PROCEDUR", "AXIUM"."NOTES2" "NOTES2" WHERE ("PATIENT"."Patient"="TRX"."Patient" (+)) AND (("TRX"."Patient"="CONTRACT"."Patient" (+)) AND ("TRX"."TreatmentDate"="CONTRACT"."Date" (+))) AND ("TRX"."Procedure"="PROCEDUR"."Procedure" (+)) AND ("TRX"."ChartTrx"="NOTES2"."TxId" (+)) AND "PATIENT"."Chart"=:"SYS_B_0" AND "TRX"."Type"=:"SYS_B_1" AND ("TRX"."Status"=:"SYS_B_2" OR "TRX"."Status"=:"SYS_B_3") AND "TRX"."Deleted"=:"SYS_B_4" AND NOT ("TRX"."Procedure"=:"SYS_B_5" OR "TRX"."Procedure"=:"SYS_B_6") AND "TRX"."TreatmentDate">=TO_DATE (:"SYS_B_7", :"SYS_B_8") AND "TRX"."Producer"=:"SYS_B_9"


I don't really understand there recomendation. I don't see in the code where
"TRX"."Procedure"<>:B1 is.
would any one be able to explain there recomendation to me, please. thank you.

Are you sure you have the entire statement? Why not look at the original query instead of the formatted one?