October 18, 2005

08 02 04 61 05101801

Department of Surgery
Kaiser Permanente
Permanente Medical Group, Inc.
1425 South Main Street
Walnut Creek, CA 94596
Subject:   Time Out Mastectomy Surgery Due Diligence

Dear Doctor:

I was notified today of favorable results from biopsies you took on October 12. Very good news! Inflammatory breast cancer (IBC) was diagnosed from a biopsy you took on April 19, 2004; now 18 months later, your follow up biopsies show no evidence of cancer. Favorable mammogram results, and the PET scan test on October 5th showing no evidence of distant, nor locoregional metastatic disease presents a "clean bill of health" that relieves a big weight off my mind. Right now, thanks to Doctor Johnson and the Kaiser team, I feel so healthy and grateful I could cry!
At this time the Surgery Department has scheduled mastectomy to remove my left breast on Friday, October 21. Thanks very much for expediting Doctor Johnson's request, which he asked me to file with the Surgery Department after I met with him on October 7th.
During our meeting on September 23rd, you seemed to indicate plans for ordering a retest of the biopsy on April 19, 2004, which, as noted above, diagnosed inflammatory breast cancer. Retesting was recommended by Doctor Shim, in Kaiser's Oakland office, for the purpose of status change that might increase treatment options in the event of relapse. Second opinions by Doctor's Grissom and Bailey concurred. The report I received on your notes of our meeting makes no mention of this retest having been ordered. Similarly, status change retesting was discussed with Doctor Johnson on October 7th; however, the doctor's notes, also, do not mention this issue. Please investigate, and let me know when retesting the biopsy was ordered for status change.
I deeply appreciate the time you have given my case. Doctor Smith and Doctor Johnson cite your strong commitment to patient care. I have a few questions about the purpose, risks and benefits of mastectomy surgery, which can be addressed with Kaiser's team care practice for a
Time Out to implement treatment guidelines followed by Kaiser and presented in the Healthwise Handbook listed on your website.
I am informed by you, and others, that my case is unusual and high risk. Therefore, workup for this surgery requires special attention. Before signing a consent for surgery, I want to know what is being done and how this will benefit in relation to risks for complications, which you and Doctor Smith mention in your notes. Please coordinate with Doctor Johnson and submit written explanation of the proposed surgery following Kaiser's outline in the
Healthwise Handbook, that says in part...
Shared Decisions About Surgery

Every surgery has risks. Only you can decide if the benefits are worth the risks.
Learn the facts: ..
Consider the risks and benefits:
I would like to get a draft of your report on the above issues by Thursday, so there is time for review and finalization. You can submit draft language via email to expedite the process After we agree on the language, I will then attach your signed report to the consent form I sign for the mastectomy operation on Friday, October 21. A copy of this letter to Doctor Johnson facilitates collaboration on Time Out review.
Thanks again for your excellent work in my case, and please extend to Doctor Smith my deep appreciation for her clear and informative presentation on September 28th.