CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek, CA
020102 - Ms. Jeanne Bradley; Coordinator =925 906 2204
020103 - Jeanne.Bradley@ncal.kaiperm.org
020104 - Administration Department
0202 - Kaiser Permanente - Shadelands       925 906 2200
020201 - Walnut Creek, CA
020202 - Dr. Elia Racah, M.D.; Primary Care Physician =925 906 2040
020203 - stkejr@ncal.kaiperm.org
020204 - Primary Care =925 206 2040

SUBJECTS
Colonoscopy Test
Mistakes in Medical Practice Reduced by Com Metrics
Medical Management Needs SDS
Exam 000208 Colonoscopy

0706 -    ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 67 0000, ref SDS 65 0000.
070802 -
070803 - Received in the mail today a letter from....
070804 -
070805 -                    Kaiser permanente
070806 -                    Gastroentorology Department Staff
070807 -                    Walunt Creek Medical Center
070808 -                    1425 S. Main Street
070809 -                    Walnut Creek, CA  94596
070810 -
070811 - Submitted ref DIT 1 0001 to Jeanne with copy to Elia requesting
070812 - comments on issues raised by this notice.
070813 -
070814 -    Cited progress on 000324 where SRI reported all KM projects in the
070815 -    world are failing. ref SDS 68 4877  More recently, on 001130 IBM's
070816 -    $4B effort to develop KM from Lotus Notes failed. ref SDS 69 F26K
070817 -
070818 -    Got notice that Doctor Racah's email address
070819 -
070820 -              stkejr@ncal.kaiperm.org
070821 -
070822 -    ...is no longer valid, indicating he has changed the address, or
070823 -    has left Kaiser.
070824 -
070825 - The letter today from Kaiser came in an envelope post marked 010108.
070826 - It is undated and there is no name or signature indicating who
070827 - initiated the document. It appears to be a standard form 04860-3
070828 - (5-00) REVERSE 1501-00003-01
070829 -
070830 -    It is extremely valuable to have the date and a name of someone who
070831 -    made the decision to issue a document.  This supports traceability
070832 -    to original sources cited on 950721 by ISO criteria as the core of
070833 -    good management. ref SDS 5 1740
070834 -
070835 - Kaiser's letter says in part....
070836 -
070837 -    Your primary care physician has requested thatyou have a flexible
070838 -    video sigmoidoscopy (commonly known as "flex sig").  This is a test
070839 -    that allows a physician or specialty nurse to examine the lining of
070840 -    the rectum and lower bowel (part of the colon) with a small camera
070841 -    attached to a flexible probe.
070842 -
070843 -    To schedule this examination, call the Department of
070844 -    Gastroentrerology at 925 295 6277....
070845 - ..
070846 - This appears to be the same scope schedule by Jeanne Bradley in
070847 - her letter dated 000120 (see para 5), ref DRP 8 6392, which was
070848 - received on on 000121, ref SDS 66 1681, and later performed on 000208
070849 - by Doctor Dyke Edward. ref SDS 67 0001
070850 -
070851 - Since the doctor advised on 000208 that this procedure is only needed
070852 - every 10 years, unless a symptom is reported, and since the prior
070853 - examination on 000208 was reported satisfactory, the notice today
070854 - raises several questions....
070855 -
070856 -     1.  What does the medical chart show with respect to the
070857 -         examination on 000208? ref SDS 67 0001
070858 -
070859 -         a.  Is there a record of the examination?
070860 -
070861 -         b.  Does the record report satisfactory results?
070862 -
070863 -     2.  Who issued this notice and why?
070864 -
070865 -         a.  Was it issued by the current Primary Care Physician,
070866 -             Doctor Elia Racah?
070867 -
070868 -         b.  Is this is notice to schedule an examination a
070869 -             continuation of Doctor Syed Naqvi's planning on 990628,
070870 -             ref SDS 13 2099, which was later expedited by Jeanne
070871 -             Bradley on 000121? ref SDS 66 1681
070872 -
070873 -     5.  Have the results of the examination on 000208 been misplaced?
070874 -
070875 -     6.  Do the results of the examination on 000208 show cause for
070876 -         follow up examination within the 10 year period cited by
070877 -         Doctor Edward on 000208?
070878 -
070879 -
070880 -
070881 -
070882 -
070883 -
070884 -
070885 -
070886 -