THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: April 16, 2004 10:45 AM Friday;
Rod Welch
Meeting at Kaiser with the doctor preparing to start treatments.
1...Summary/Objective
2...Recovery Progress CA 15-3 Cancer Marker Rises from 60 to 70
3...CA 15-3 Cancer Marker Continues Strong Rise Consistent with Pathology
4...Rise in CA 15-3 Cancer Marker Attributed to Trauma of Biopsy
5...Treatment Scheduled to Recover from Cancer in Neck Lymph Nodes
6...Cancer Cells Reported in Biopsy of Lumps in Neck Treatment Scheduled
7...Chemotherapy Prescribed Surgery Not Effective for Lymph Node Cancer
8...Surgery Not Prescribed for Lymph Node Cancer Chemotherapy Scheduled
9...Rosalie's Assistant Stephanie Introduced
10...Tumor Board Report Not Submitted to Patient Verbal Explanation
11...2nd Opinion Verify Scope of Problem and Treatment Planning
12...Cancer Neck Only Evidence of CT Scan Shows Distant Metastasis
13...CT Scan Shows Evidence of Distant Metastasis Carcinoma Only in Neck
14...Medical Tests Analysis Erroneous Incomplete Cursory Limited Time
15...Separate Signal from Noise in Documents Case Study Not Enough Time
16...Case Study Not Enough Time to Study Test Reports Discover Variances
17...CT Test Reporting Variance Language Terminology Scope Cause Errors
18...Medical Mistakes Case Study Patient History for Millie
19...Case Study Limited Time Weakens Health Care Diagnosis Treatment
20...Medical Tests Require Careful Review for Effective Diagnosis Study
21...Distant Metastasis Cancer Neck Only Evidence of CT Scan Shows
22...Chemotherapy Cleared to Start Avastin Trials
23...Treatment Proceeds Diagnosis Cellulitus Changed to Radiation Reaction
24...Redness Breast Diagnosis Changed from Cellulitus to Radiation Reaction
25...Radiation Reaction Redness Breast Diagnosis Changed from Cellulitus
26...Blood Tests Causing Painful Condition on Right Arm
27...Port to Support New Treatments Administered Intravenously
..............
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CONTACTS
SUBJECTS
Meeting Doctor Examination Clear Patient for 1st Treatment Taxol Bev
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 67 0000. ref SDS 65 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Discussion
0409 -
040901 - Recovery Progress CA 15-3 Cancer Marker Rises from 60 to 70
040902 - CA 15-3 Cancer Marker Continues Strong Rise Consistent with Pathology
040903 -
040904 - Follow up ref SDS 67 SM6M, ref SDS 65 SM6M.
040905 -
040906 - There were no new blood tests reported today on CA 15-3.
040908 - ..
040909 - 040318......... 70 H............. 040211, ref SDS 65 SM6M
040910 - 040205......... 60 H............. 040211, ref SDS 61 SM6M
040911 - 031205......... 62 H............. 031205, ref SDS 60 SM6M
040912 - 030915......... 66 H............. 030913, ref SDS 58 SM6M
040913 - 030708......... 68 H............. 030710, ref SDS 57 SM6M
040914 - 030503......... 54 H............. 030508, ref SDS 53 SM6M
040915 - 030403......... 45 H............. 030403, ref SDS 53 SM6M
040916 - 030220......... 46 H............. 030220, ref SDS 52 5E6L
040917 - 030106......... 37 H............. 030109, ref SDS 50 SM6M
040918 - 021202......... 41 H?............ 021204, ref SDS 46 SP5G
040919 - 021102......... 36 H?............ 021113, ref SDS 45 Y65I
040920 - 021023......... 33 H?............ 021023, ref SDS 44 SQ5I
040921 - 020930......... 33 H?..29........ 021002, ref SDS 43 SQ5I
040922 - 020917......... 36 H?............ 020924, ref SDS 42 SQ5I
040923 - 020717......... 59 H?............ 020726, ref SDS 41 YN5K
040924 - 020629......... 75 H ............ 020705, ref SDS 39 UX6I
040925 - 020608........ 67 H ............ 020614, ref SDS 35 0001
040926 - 020603........ 108 H ............ 020607, ref SDS 33 X67F
040927 - 020511........ 117 H ............ 020603, ref SDS 32 PJ4J
040928 - 020419......... 81 H ............ 020430, ref SDS 28 7N5H
040929 - 020321......... 85 H ............ 020405, ref SDS 17 6T8K
040930 -
040931 -
040933 - ..
0410 -
0411 -
0412 - Analysis
0413 -
041301 - Rise in CA 15-3 Cancer Marker Attributed to Trauma of Biopsy
041302 -
041303 - Follow up ref SDS 67 GJ5M, ref SDS 65 GJ5M.
041304 -
041305 - There was no further discussion today on CA 15-3.
041306 -
041307 -
041308 -
041309 -
041310 -
0414 -
SUBJECTS
Cancer Cells Detected in Biopsy of Lumps in Neck Taken on 040303 by
Trial on New Cancer Treatment Double Blind Test Alternative Approach
Treatment Relapse Patient Approved Begin Taxol Bevacizumab (Avastin)
Treatment Relapse Testing Indicates Swelled Lymph Nodes in Neck is O
Treatment Cancer and Trial on New Cancer Treatment Double Blind Test
Approves Clears Millie for Receiving Cancer Treatments Enrolled in A
Treatment Patient Approved Begin Taxol Bevacizumab (Avastin) Chemoth
Avastin Patient Randomized Approved 1st Taxol Bevacizumab Treatment
1910 -
191101 - ..
191102 - Treatment Scheduled to Recover from Cancer in Neck Lymph Nodes
191103 - Cancer Cells Reported in Biopsy of Lumps in Neck Treatment Scheduled
191104 - Chemotherapy Prescribed Surgery Not Effective for Lymph Node Cancer
191105 - Surgery Not Prescribed for Lymph Node Cancer Chemotherapy Scheduled
191106 -
191107 - Follow up ref SDS 67 8R6M, ref SDS 65 8R6M.
191109 - ..
191110 - Treatments begin on 040420, advised by Rosalie in a call on 040407.
191111 - ref SDS 68 3S6L
191112 -
191113 - Stephanie Aguilar came into the exam room prior to the doctor
191114 - arriving and reported that Millie has been randomized by the folks
191115 - managing the trial, and she has been selected to receive the
191116 - bevacizumab, ref OF 10 QR4J, also, called VEGF and Avastin, per
191117 - planning on 040318. ref SDS 65 BK8M
191119 - ..
191120 - Stephanie seemed very pleased with this announcement. He hugged
191121 - Millie, and noted that others on the staff are pleased that Millie
191122 - will receive the new treatment. She indicated that the past few
191123 - patients placed in the trial at the Kaiser Walnut Creek facility
191124 - were not selected to get the new drug.
191125 -
191126 - [On 040420 Stephanie visited Millie briefly in the Chemotherapy
191127 - treatment center. ref SDS 74 014F
191129 - ..
191130 - A colleague, also, stepped into the examination room and was
191131 - equally effusive about Millie having been placed in the group to
191132 - receive bevacizumab.
191134 - ..
191135 - When the doctor finally arrived for the meeting, he, too, was very
191136 - pleased that Millie will be treated with the new drug.
191138 - ..
191139 - The doctor reviewed results of CT test shown below, and commented that
191140 - the swelled lymph nodes in the neck are the only indications of
191141 - cancer. ref SDS 0 WE7N
191143 - ..
191144 - The doctor examined lumps in the neck and commented that they feel
191145 - bigger, than when he made a similar examination on 040318. ref SDS 65
191146 - 565L which aligns with the CT test results. ref SDS 0 7U6O The doctor
191147 - used an ordinary ink pen and drew a circle around each of the two
191148 - lumps in Millie's neck. He then used an instrument, that seemed
191149 - similar to a rolled cloth measuring tape, commonly found in a sewing
191150 - kit, to measure the diameter of each swelled node.
191152 - ..
191153 - The doctor indicated the report shows that cancer is limited to the
191154 - neck area. ref SDS 0 IG9K While this is not expressly stated in the
191155 - report, the findings appear to show there has been some expansion of
191156 - lymph nodes in the neck, since the prior report received on 040318,
191157 - per above. ref SDS 0 7U6O
191159 - ..
191160 - What are implications from rate of growth for lymph nodes in the neck
191161 - -- normal, below or above average?
191162 -
191163 -
191164 -
191165 -
191166 -
1912 -
SUBJECTS
Treatment Patient Approved Begin Taxol Bevacizumab (Avastin) Chemoth
2203 -
220401 - ..
220402 - Rosalie's Assistant Stephanie Introduced
220403 -
220404 - Follow up ref SDS 67 WW7I.
220405 -
220406 - Prior to meeting with the doctor, Stephanie Aguilar came into the
220407 - examination room and introduced herself. Earlier, in a letter on
220408 - 040410 Rosalie explained that Stephanie is Rosalie's assistant.
220410 - ..
220411 - In her letter, Rosalie provided a backup up email address for
220412 - contacting the protocol team.
220413 -
220415 -
220416 -
220417 -
220418 -
2205 -
SUBJECTS
Tumor Board Hearing Today Report Not Submitted to Patient Verbal Exp
2503 -
250401 - ..
250402 - Tumor Board Report Not Submitted to Patient Verbal Explanation
250403 - 2nd Opinion Verify Scope of Problem and Treatment Planning
250404 -
250405 - Follow up ref SDS 67 AW6M, ref SDS 65 AW6M.
250407 - ..
250408 - The doctor reported that he presented Millie's case to the Tumor Board
250409 - this morning, in accordance with Millie's letter on 040409,
250410 - ref SDS 69 HS3O, and Debra's call later that day, ref SDS 69 7K4G, and
250411 - further in accordance with notice to Millie on 040414 about the
250412 - hearing today. ref SDS 70 HS3O
250414 - ..
250415 - Millie requested a copy of Tumor Board procedures, and the report
250416 - showing what was reviewed, findings and recommendations.
250417 -
250418 - Published procedures were not submitted.
250420 - ..
250421 - The doctor did not submit any written reports he may have
250422 - submitted to the board showing what records were reviewed to guide
250423 - recommendations.
250425 - ..
250426 - Results of Tumor Board Hearing have not yet been published...
250427 -
250428 - The doctor said that the Tumor Board suggested radiation may be
250429 - helpful in Millie's case, since it apears from testing that at
250430 - this time cancer recurrence is localized to the neck.
250431 -
250432 - [On 040517 doctor submits pathology report on biopsy for
250433 - left breast taken on 040419, ref SDS 73 789F, and it
250434 - diagnoses metastatic disease consistent with inflammatory
250435 - carcinoma. ref SDS 77 7D6F
250437 - ..
250438 - [On 040614 doctor reports Millie has been diagnosed with
250439 - IBC, ref SDS 78 6T5G, and changed to the most severe cancer
250440 - treatment level of stage IV. ref SDS 78 6M9H
250442 - ..
250443 - Millie asked for the actual published report.
250445 - ..
250446 - The doctor said the Tumor Board will submit a written report; the
250447 - doctor will submit a copy to the patient along with published policy
250448 - and procedures that guide Tumor Board hearings and disposition, per
250449 - Millie's request. ref SDS 0 F46M
250450 -
250451 - [On 040517 doctor submits written report on findings and
250452 - conclusions of Tumor Board hearing to support Team Care practice
250453 - in Millie's case. ref SDS 77 MB7G
250454 -
250455 -
250456 -
250457 -
250458 -
250459 -
2505 -
SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Metastasis New Nonspecific May be Post Treatment Trauma Inflammatory
CT Scan Performed for Comparison with PET Scan to Evaluate New Metas
CT Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Axilla and 18 MM Referenced CT Report 040410 Received 040416 Says 18
CT Scan Findings Show 2 New 1 CM Masses in Area of Prior Surgery for
Distant Metastasis Not Reported in CT Test on 030508
CT Scan Findings Show 1 CM Masses Increased to 1.5 CM 50% Growth
CT Scan Test Ordered Instead of PET Scan Test and Compare with Origi
CT Scan Test Shows No Evidence Progression Distant Metastasis Stable
CT Test 040410 Shows Cancer Lymph Nodes No Increase Size Growing No
3713 -
371401 - ..
371402 - Cancer Neck Only Evidence of CT Scan Shows Distant Metastasis
371403 - CT Scan Shows Evidence of Distant Metastasis Carcinoma Only in Neck
371404 -
371405 - Follow up ref SDS 67 LK5L, ref SDS 65 LK5L.
371406 -
371407 - The doctor used a computer in the examination room, which was
371408 - running the Windows 2000 operating system. This is new capability
371409 - from prior visits, reflecting improvements on information management
371410 - planned for release in 2001, reported by Jeanne Bradly on 000121.
371411 - ref SDS 4 CG61
371413 - ..
371414 - The doctor found on Kaiser's computer the report for the CT test on
371415 - 040410, which was ordered on 040402 by Rosalie, as a condition of the
371416 - Avastin trial protocol. ref SDS 67 LK5L Today, the doctor printed the
371417 - report and submitted it to Millie during the meeting. The report
371418 - shows...
371419 -
371420 - [On 040811 received CT test after 3rd treatment cycle.
371421 - ref SDS 79 WV7H
371423 - ..
371424 - Patient
371427 - ..
371428 - Personal Physician:
371431 - ..
371432 - 68/F Radiology Report Exam 1 of 1
371433 - Page 1
371435 - ..
371436 - CT of the head, neck, chest and abdomen and pelvis (digital)
371438 - ..
371441 -
371442 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
371444 - ..
371445 - History
371447 - ..
371448 - Breast CA
371450 - ..
371451 - Findings
371453 - ..
371454 - The ventricles and sulci are symmetrical and normal. There is no
371455 - abnormal contrast enhancement. There are no abnormal high or low
371456 - attenuating lesions seen. There are no parenchymal or
371457 - extra-axial hemorrages seen.
371459 - ..
371460 - The skull base and nasopharynx are normal. There is no
371461 -
371462 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
371463 -
371464 - hypopharyngeal mass. The sinuses are clear. There is no cervical
371465 - adenopathy aside from the 1.3 mm left posterolateral retro
371466 - sternocleidomatoid node and a 14 mm left scaline node.
371468 - ..
371469 - Compare 040307:
371471 - ..
371472 - There are 18 mm nodes in both axili, unchanged from prior study,
371473 - post op changes are seen on the left. There is stable left
371474 - apical interstitial septal change. The lungs are otherwise
371475 - clear, free of infiltrates or masses. There are no pleural
371476 - effusions. There are no hilar or mediastinal masses seen.
371477 -
371478 - [On 040811 CT test after 3rd treatment cycle seems to indicate
371479 - 18 mm nodes in axili are now about 9 mm. ref SDS 79 RU45
371480 -
371481 -
371482 -
3715 -
SUBJECTS
Case Study Medical Mistakes Diagnosis CT PET Tests IBC Pulmonary Emb
7703 -
770401 - ..
770402 - Medical Tests Analysis Erroneous Incomplete Cursory Limited Time
770403 - Separate Signal from Noise in Documents Case Study Not Enough Time
770404 - Case Study Not Enough Time to Study Test Reports Discover Variances
770405 - CT Test Reporting Variance Language Terminology Scope Cause Errors
770406 -
770407 - Neither the term "axili" nor the number "18" seem to appear in the
770408 - prior report received during the meeting on 040318. ref SDS 65 LK5L
770409 - Therefore, in order for "18 mm nodes" to be "unchanged," as reported
770410 - today, ref SDS 0 EH47, descriptions in the prior report must be
770411 - different, but intended to mean the same thing.
770413 - ..
770414 - Variance in terminology, quality, and scope of medical test reports,
770415 - ranging from thorough and comprehensive to cursory and neglegent,
770416 - including lack of notice about symptoms and diagnoses buried within
770417 - long paragraphs cause doctors with hectic schedules to rely solely on
770418 - first impressions from reading a summary with the gist of findings,
770419 - rather than actual findings. Busy doctors with limited span of
770420 - attention, and in some cases inattention, and sloth, cited 010908
770421 - discussing the "fools gold" of "expediting," ref SDS 6 YF5O, overlook
770422 - critical details that influence care. Practitioners with limited time
770423 - for study and analysis due to a hectic schedule caring for many
770424 - patients, and managing a department, reported on 020321, ref SDS 12
770425 - MK4J, get frustrated when small, complex details that seem
770426 - inconsequential later explode into major problems, reported on 921127.
770427 - ref SDS 2 0674
770429 - ..
770430 - [On 040517 lessons learned doctors do not have enough time to read
770431 - complex medical test reports and correlate clinically with complex
770432 - patient history. ref SDS 77 VG6U
770434 - ..
770435 - [On 050517 case study cognitive overhead shows culture resists due
770436 - diligence to collaborate, communicate, investigate, study,
770437 - analyse, and verify accuracy that levearages experience for taking
770438 - effective action, because people do not have time to think.
770439 - ref SDS 91 PY4U
770441 - ..
770442 - [On 060628 testimony before US Congress reports national security
770443 - intelligence analysis cursory, incomplete, inaccurate; warns
770444 - leadership to spot check bibliography. ref SDS A9 SY3O
770446 - ..
770447 - A color coded scheme might be considered to provide alerts in test
770448 - reports for overcoming limited span of attention to expand situational
770449 - awareness (see NWO, ref OF 29 08XX) of clinical correlations during
770450 - the "fog of war," as described in NWO. ref OF 28 159O
770451 -
770452 -
770454 - ..
770455 - Medical Mistakes Case Study Patient History for Millie
770456 - Case Study Limited Time Weakens Health Care Diagnosis Treatment
770457 - Medical Tests Require Careful Review for Effective Diagnosis Study
770458 -
770459 - Examples of limited time influencing analysis in medical management,
770460 - causing meaning drift, compounding mistakes, bumbling, conflict,
770461 - crisis, and calamity...
770463 - ..
770464 - 1. Meeting productivity poor, example
770465 - in other fields; communication
770466 - collaboration cognitive overhead
770467 - avoids investing time to review
770468 - documents for accurate understanding
770469 - people rely on official view of
770470 - reality that emerges from repeating
770471 - guess and gossip over time in
770472 - meetings and correspondence........... 920123, ref SDS 1 9054
770474 - ..
770475 - 2. Doctors scheduled to see
770476 - patients every 15 minutes
770477 - do not have time for analysis
770478 - to review the record.................. 000207, ref SDS 5 0788
770480 - ..
770481 - 3. Emergency pulls doctor from
770482 - examination; diverts attention
770483 - and compresses time to understand
770484 - critical details causing errors
770485 - due to stress......................... 020726, ref SDS 41 YT6L
770487 - ..
770488 - 4. Doctors do not have time to
770489 - perform Kaiser requirements for
770490 - "ping pong" method to review
770491 - feedback from patient that
770492 - verifies accurate and complete
770493 - communication......................... 020402, ref SDS 15 KG4H
770495 - ..
770496 - 5. Doctors invest a lot of time
770497 - sending email to other doctors
770498 - so there is not enough time to
770499 - communicate with
770500 - patients.............................. 020708, ref SDS 40 EY9N
770502 - ..
770503 - 6. PET test on 021218 reports findings
770504 - of new mild diffuse increased uptakes
770505 - at region of left supraclavicular,
770506 - left upper chest, and, also, left axilla;
770507 - not enough time to align and correlate
770508 - clinically with increased discomfort
770509 - under left arm, clincial finding of
770510 - inflammation on left breast, and
770511 - patient reports stiff neck fits
770512 - diagnosis for IBC..................... 030109, ref SDS 50 L66M
770514 - ..
770515 - 7. Emergency meeting with doctor requested
770516 - to evaluate recurrence inflammation left
770517 - breast rising discomfort left
770518 - axillary.............................. 030606, ref SDS 54 7C6W
770519 - rising cancer marker.................. 030606, ref SDS 54 NE7L
770520 - doctor defers biopsy testing to
770521 - diagnose symptoms
770522 - of IBC................................ 030606, ref SDS 54 P97J
770524 - ..
770525 - 8. CT scan test on 030626 finds
770526 - persistant dermal (skin)
770527 - thickening left breast; notes
770528 - invasion of dermal lymphatics
770529 - from known breast cancer can
770530 - present similarly; left axillary
770531 - adenopathy nodes measuring 1.5 cm
770532 - increase 50% from prior study,
770533 - but not expressly stated;
770534 - findings attributed to radiation
770535 - treatment a year earlier; test
770536 - report recommends correlate
770537 - clinically; not enough time to
770538 - separate signal from noise by
770539 - correlating symptoms reported
770540 - on 030109 and PET test findings
770541 - that cite all three elements of
770542 - IBC diagnosis delayed until
770543 - 040614................................ 030710, ref SDS 57 VM7I
770545 - ..
770546 - 9. Not enough time to review
770547 - test reports to prepare for
770548 - meeting............................... 030710, ref SDS 57 7C6W
770550 - ..
770551 - 10. Biopsy and PET scan tests deferred
770552 - again to evaluate recurrence of
770553 - breast cancer so that treatment
770554 - can start in time to be
770555 - effective............................. 030710, ref SDS 57 WS3M
770557 - ..
770558 - 11. Patient requests PET scan and other tests
770559 - to evaluate treatment of rising symptoms
770560 - which later were discovered to be IBC;
770561 - Kaiser defers testing
770562 - again................................. 030915, ref SDS 58 7C6W
770564 - ..
770565 - 12. CT test on 031031 described by
770566 - doctor as "great" prognosis for
770567 - patient during progress review
770568 - meeting at Kaiser..................... 031205, ref SDS 60 LK5L
770570 - ..
770571 - 13. 2 lymph nodes increased 50% in prior
770572 - CT test on 030710, not reconciled in
770573 - follow up test on 031031 without
770574 - any treatment......................... 031205, ref SDS 60 GJ69
770576 - ..
770577 - 14. CT scan recent tests on 030710 and
770578 - 031031 doctor cannot find reports
770579 - in medical chart to check for errors
770580 - and omissions from prior work on
770581 - 031205 to diagnose and treat cancer
770582 - relapse; Kaiser's computer system
770583 - out of service temporarily for
770584 - repairs; doctor will investigate
770585 - later................................. 040227, ref SDS 62 YE4F
770587 - ..
770588 - 15. CT test errors and omissions not
770589 - enough time to research doctor cannot
770590 - find test reports in patient's
770591 - medical chart nor on Kaiser's
770592 - computer system....................... 040318, ref SDS 65 ZE5O
770594 - ..
770595 - 16. Accuracy and precision paramount
770596 - for medical practice shown by
770597 - requirements for audits of
770598 - Kaiser's medical
770599 - records............................... 040402, ref SDS 66 6E4K
770601 - ..
770602 - 17. Doctor failed perform follow up examinations
770603 - for surgery; limited time and computer
770604 - glitch prevent doctors from
770605 - implementing team care
770606 - requirements.......................... 040419, ref SDS 73 XU75
770608 - ..
770609 - 18. Primary care physician cites Kaiser policy
770610 - on proactive management to order biopsy
770611 - for accurately diagnosing red rash in this
770612 - case on the left) breast, first noticed
770613 - on 030109; but invariably results are
770614 - negative, so this time the policy was
770615 - ignored to save time and money; it
770616 - turned out the patient has IBC
770617 - which some authorities
770618 - say has 18 months
770619 - survival.............................. 040504, ref SDS 76 WI8F
770621 - ..
770622 - 19. Medical test reporting erroneous,
770623 - cursory, and misleading; language
770624 - variance and burying notice of symptoms
770625 - in long narrative findings; busy
770626 - doctors only have time to read analysts'
770627 - impressions that summarize the gist
770628 - of findings, overlook diagnosis that
770629 - requires investigation and timely
770630 - treatment............................. 040416, ref SDS 0 PTSX
770632 - ..
770633 - 20. Tumor Board re-hearing new evidence
770634 - biopsy diagnosis IBC very rare, very
770635 - aggressive cancer major change patient
770636 - profile doctor fails to update findings
770637 - and recommendations on treatment
770638 - plan.................................. 040517, ref SDS 77 4R59
770640 - ..
770641 - 21. Family history of blood clot problems
770642 - reported to doctor.................... 040812, ref SDS 80 MG5K
770644 - ..
770645 - 22. Doctor advises patient can continue
770646 - on Avastin trial with documented
770647 - side effects of pulmonary
770648 - emboli................................ 040812, ref SDS 80 W35K
770650 - ..
770651 - 23. Manufacturer discloses recent deaths
770652 - from pulmonary emboli (blood clots)
770653 - that cause heavy chest, difficult
770654 - breathing, and coughing on the
770655 - Avastin drug trial.................... 040812, ref SDS 80 MG4G
770657 - ..
770658 - 24. Patient suffers increased side
770659 - effects of difficult breathing,
770660 - coughing, nose bleeds on Avastin
770661 - (bevacizumab) trial................... 040812, ref SDS 80 RZ4I
770663 - ..
770664 - 25. Accuracy medical practice requires less
770665 - precision than engineering for diagnosis
770666 - and treatment ignores conflicts, errors,
770667 - omissions in pathology reports on
770668 - medical tests......................... 040812, ref SDS 80 T761
770670 - ..
770671 - 26. Pulmonary embolism symptoms rise bleeding
770672 - nose, chronic cough, shortness of breath,
770673 - heavy chest; Kaiser continues treatment
770674 - bevacizumab and Taxol with documented
770675 - side effects pulmonary embolism, because
770676 - numerous CT tests show no findings of
770677 - pulmonary embolism; patient seeks 2nd
770678 - opinion on 041018 at UCSF; on 041103
770679 - Kaiser orders emergency CT test; next day
770680 - on 041104 diagnoses pulmonary embolism ends
770681 - treatment with bevacizumab and Taxol; patient
770682 - treated for life with warfarin (Coumadin);
770683 - on 061020 Kaiser discloses treatment
770684 - delayed 6 months because PE requires
770685 - special method of CT test using
770686 - thin-slice technology................. 041005, ref SDS 81 RZ4I
770688 - ..
770689 - 27. Medical chart patient history
770690 - review to prepare for 2nd opinions
770691 - reveals errors and omissions case
770692 - study................................. 041014, ref SDS 82 T49J
770694 - ..
770695 - 28. Doctor Benz at UCSF Cancer Center
770696 - noted importance of accurate patient
770697 - history for 2nd opinion on diagnosis
770698 - and treatment; ignored written record,
770699 - and relied on hurried, cursory note
770700 - taking to construct chronology of
770701 - patient history by asking an elderly
770702 - traumatized patient about details
770703 - of events covering 3 years of
770704 - treatment for cancer.................. 041018, ref SDS 83 EN63
770706 - ..
770707 - 29. Doctor Benz at UCSF Cancer Center
770708 - requests documentation of CA 15-3
770709 - cancer marker, which UCSF ignores
770710 - for patient diagnostics; demonstrates
770711 - strong commitment to accuracy in
770712 - medical practice...................... 041018, ref SDS 83 L16Q
770714 - ..
770715 - 30. Doctor Benz at UCSF Cancer Center
770716 - read from patient's letter to verify
770717 - accuracy on scope of work for 2nd
770718 - opinion............................... 041018, ref SDS 83 LX3U
770720 - ..
770721 - 31. Stanford Cancer Center relied on
770722 - written record to construct accurate
770723 - chronology of patient history for
770724 - preparing 2nd opinion................. 041019, ref SDS 84 WR9F
770726 - ..
770727 - 32. Doctor Guardino at Stanford Cancer
770728 - Center performed due diligence by
770729 - directing an aide to authenticate
770730 - conversation on the date of a biopsy
770731 - that diagnosed IBC by leaving the
770732 - room during a meeting and going to
770733 - another locatoin to check
770734 - documentation......................... 041019, ref SDS 84 BV92
770736 - ..
770737 - 33. Chemotherapy treatment confusion and
770738 - errors by Infusion Clinic illustrate
770739 - requirement for high degree of
770740 - precision following
770741 - protocols............................. 041021, ref SDS 85 NG7B
770743 - ..
770744 - 34. Analyst for CT test called and
770745 - alerted the doctor about pulmonary
770746 - emboli to ensure serious condition
770747 - not overlooked; why didn't the
770748 - analyst for PET scan test on 030109,
770749 - and later CT test on 030710 also
770750 - call the doctor to alert about
770751 - finding 3 symptoms of IBC,
770752 - similar to collaboration and
770753 - support to alert of pulmonary
770754 - emboli?............................... 041104, ref SDS 86 RZ4I
770756 - ..
770757 - 35. Patient rushed to emergency treatment
770758 - elevated temperature required for
770759 - cancer patients; IBC symptoms rising
770760 - rapidly; examination showed IBC not
770761 - rising, symptoms are expected side
770762 - effects of antibiotics to treat
770763 - cellulitus, but not disclosed to
770764 - the patient by doctor................. 041202, ref SDS 87 0001
770766 - ..
770767 - 36. Patient history doctor cannot find
770768 - reasons for ending treatment with AC
770769 - assumes no problems giving additional
770770 - AC treatments because nothing
770771 - written in medical chart.............. 041230, ref SDS 88 XQ84
770773 - ..
770774 - 37. Doctor cannot find patient history in
770775 - medical chart and on Kaiser's computer
770776 - required to diagnose and prescribe
770777 - treatment in Emergency
770778 - Room.................................. 050212, ref SDS 89 VC8H
770780 - ..
770781 - 38. Mistake avoided treatment prescription
770782 - doctor patient partnership with Zan
770783 - in Pharmacy using feedback from
770784 - patient to authenticate conversation
770785 - with doctor........................... 050415, ref SDS 90 KX49
770787 - ..
770788 - 39. Medical chart entered in computer improves
770789 - legibility and timely access to reduce
770790 - medical mistakes at
770791 - Kaiser................................ 050520, ref SDS 92 HX6J
770793 - ..
770794 - 40. Meeting productivity rises, SDS
770795 - work product provides precision
770796 - access for timely, accurate patient
770797 - history enables understandings of
770798 - complex record; attitudes change
770799 - when doctors can work quickly and
770800 - accurately to save lives, time,
770801 - and money............................. 050826, ref SDS 94 V15F
770803 - ..
770804 - 41. Pathology reports on biopsies missing
770805 - from medical records for Millie's
770806 - 2nd opinion process................... 050907, ref SDS 96 FB6X
770808 - ..
770809 - 42. Medical records for another patient
770810 - distributed incorrectly for
770811 - Millie's 2nd opinion
770812 - process............................... 050907, ref SDS 96 028E
770814 - ..
770815 - 43. Nuclear medicine department cannot
770816 - find Millie's PET scan files for
770817 - 2nd opinion process................... 050907, ref SDS 96 FA57
770819 - ..
770820 - 44. Computer notification failed pathology
770821 - slides not prepared for 2nd opinion
770822 - process............................... 050907, ref SDS 96 4R89
770824 - ..
770825 - 45. 2nd opinion reports patient history
770826 - shows no metastatic cancer, when
770827 - CT test and biopsy reports and team
770828 - care physicians have reported for
770829 - 4 years that patient has metastatic
770830 - cancer with regional disease, and no
770831 - evidence of distant
770832 - metastasis............................ 050907, ref SDS 95 555G
770834 - ..
770835 - 46. Doctor preparing 2nd opinion does
770836 - not have time to review summary
770837 - of critical details on patient
770838 - history because the case is too
770839 - complex............................... 050907, ref SDS 95 D05G
770841 - ..
770842 - 47. Medical staff afraid of reprisals to
770843 - notify doctor of hospital requirements
770844 - for Coumadin treatment of patients
770845 - with pulmonary emboli; requests
770846 - patient present hospital policy
770847 - to the doctor......................... 051006, ref SDS 97 5F62
770849 - ..
770850 - 48. Pulmonary emboli treatment with
770851 - Coumadin ended rather than paused
770852 - for surgery; conflicts with
770853 - policy to treat cancer patients
770854 - for life after diagnosis of
770855 - pulmonary emboli...................... 051007, ref SDS 98 OG5J
770857 - ..
770858 - 49. PET scan test on 051005 omits
770859 - comparison CT test on 050530 that
770860 - reported swelling right axillary
770861 - requires monitoring................... 051007, ref SDS 98 OG5J
770863 - ..
770864 - 50. Mastectomy surgery reduces palliation
770865 - prospects and benefits, and also reduces
770866 - ability to treat patient for IBC relapse;
770867 - surgery removes blood vessels and
770868 - capillaries in breast tissue, which
770869 - may slow delivery of chemotherapy
770870 - drugs and immune system nutrients
770871 - to infected area, 2nd opinion
770872 - consultation.......................... 051011, ref SDS 99 G65S
770874 - ..
770875 - 51. Palliation does not justify
770876 - mastectomy surgery for patient
770877 - NED 2nd opinion consultation
770878 - Doctor Bailey......................... 051011, ref SDS 99 G66W
770880 - ..
770881 - 52. Due diligence analysis requirements
770882 - for "Time Out" to evaluate need
770883 - for surgery, scope, schedule,
770884 - tasks, and risks were not performed
770885 - by medical team....................... 051019, ref SDS A0 O95W
770887 - ..
770888 - 53. Surgeon's analysis on necessity for
770889 - operation showing alignment with
770890 - patient history missing from medical
770891 - records required for due diligence
770892 - to avoid mistakes; not corrected
770893 - prior to surgery because not
770894 - enough time........................... 051021, ref SDS A1 QV4H
770896 - ..
770897 - 54. Pulmonary emboli treatment with
770898 - Coumadin initiated by Kaiser's
770899 - Coagulation Treatment Clinic to
770900 - comply with policy that cancer
770901 - patients are treated for life after
770902 - diagnosis of pulmonary
770903 - emboli................................ 051026, ref SDS A2 PO7J
770905 - ..
770906 - 55. Pulmonary emboli treatment with
770907 - Coumadin ended permenantly by
770908 - primary care physician, because
770909 - diagnosis originally occurred
770910 - during treatment with Avastin
770911 - (Bevacizumab) on 041104, and
770912 - pulmonary emboli is a side
770913 - effect of treatment
770914 - with Avastin.......................... 051121, ref SDS A3 RZ4I
770916 - ..
770917 - 56. PET scan test 060120 omits
770918 - comparison prior test because
770919 - Kaiser cannot find report for
770920 - test on 051005........................ 060126, ref SDS A4 XF3K
770922 - ..
770923 - 57. Test reports never requested by
770924 - patients nor distribued by doctors
770925 - for patients to review in order
770926 - to be prepared for productive
770927 - meetings.............................. 060428, ref SDS A5 NL4N
770929 - ..
770930 - 58. PET scan test on 060414 fails to
770931 - compare with prior test on 060120
770932 - that reported findings of likely
770933 - esophagitis; did prior findings
770934 - disappear, worsen, was it a mistake,
770935 - what happened?........................ 060428, ref SDS A5 OX62
770937 - ..
770938 - 59. Esophagitis - doctor did not have
770939 - time to read findings in PET scan test,
770940 - and so did not know the test report
770941 - shows "likely esophagitis," because
770942 - this is not mentioned in the analysts'
770943 - summary impression; doctor did not
770944 - have time to read patient's letter
770945 - asking about diagnosis and
770946 - treatment............................. 060428, ref SDS A5 PR9J
770948 - ..
770949 - 60. Read medical test findings - case
770950 - study doctors do not have enough
770951 - time to read findings and correlate
770952 - clinically with compelx patient
770953 - history that discovers symptomatic
770954 - trends in time for proactive
770955 - management; there is only enough
770956 - time to read summaries and rely
770957 - on 1st impression from the
770958 - gist of findings...................... 060428, ref SDS A6 VG5L
770960 - ..
770961 - 61. CT test finds new nodes in right
770962 - paratrcheal region that may support
770963 - prior findings of esophagitis on PET
770964 - scan test on 060120, but terminology
770965 - differences prevent practitioners
770966 - from making mental connections;
770967 - notice buried in findings; doctor
770968 - did not have time to read; summary
770969 - impression does not mention findings
770970 - of new nodes.......................... 060523, ref SDS A7 4O8P
770972 - ..
770973 - 62. CT test compared with prior CT study
770974 - 1 year earlier on 050530, rather than
770975 - with PET scan test a few weeks earlier
770976 - on 060414 which requested contrast CT
770977 - study of new findings possible
770978 - cancer lymphadenopathy................ 060523, ref SDS A7 006P
770980 - ..
770981 - 63. Doctor unable to access computer files
770982 - to evaluate report of esophagitis in
770983 - PET scan test on 060120, and later
770984 - report of nodes in right paratracheal
770985 - in CT test on 060505.................. 060623, ref SDS A8 463H
770987 - ..
770988 - 64. MRI test on brain omitted comparison
770989 - with prior test on 020617 because
770990 - analyst could not find the prior
770991 - report................................ 060711, ref SDS B0 QPRT
770993 - ..
770994 - 65. Doctor discovers cancer status change
770995 - for expanding treatments from biopsy
770996 - on 040419 was available during past
770997 - 2 years by computer access using
770998 - functions which require training
770999 - and experience to
771000 - use................................... 060711, ref SDS B0 SW7O
771002 - ..
771003 - 66. Millie patiet history show high risk
771004 - for recurrence of pulmonary
771005 - emboli................................ 060722, ref SDS B1 6G6O
771007 - ..
771008 - 67. Research indicates 10% of patients
771009 - suffer recurrence for pulmonary
771010 - emboli, and 45% of patients who
771011 - have recurrence die................... 060722, ref SDS B1 BI5J
771013 - ..
771014 - 68. Family genetic disposition to pulmonary
771015 - emboli discovered when Millie's son
771016 - was hospitalized suffering
771017 - recurrence............................ 060722, ref SDS B1 3D9T
771019 - ..
771020 - 69. Genetic disposition for pulmonary
771021 - emboli reported to Kaiser for
771022 - review of decison removing Millie
771023 - from treatment with Coumadin for
771024 - pulmonary emboli...................... 060724, ref SDS B2 NL5Q
771026 - ..
771027 - 70. Communication mistakes case study
771028 - supports Kaiser's good reputation
771029 - for strong doctor patient
771030 - parternship........................... 060809, ref SDS B3 QN6G
771032 - ..
771033 - 71. Doctor Benz at UCSF 2nd opinion
771034 - consultation misled by Kaiser's false,
771035 - medical chart saying patient treated
771036 - with warfarin for pulmonary embolism;
771037 - reliance induced by improved legibility
771038 - beginning on 050520, ref SDS 0
771039 - G57M, using computer
771040 - technology............................ 060821, ref SDS B4 PM4N
771042 - ..
771043 - 72. Primary care and 2nd opinion doctors
771044 - do not have enough time to think and
771045 - plan treatment strategy, establish
771046 - criteria for selecting chemotherapy
771047 - treatment agents, nor to list pool
771048 - of drugs available to
771049 - patient............................... 060825, ref SDS B5 K36G
771051 - ..
771052 - 73. Doctor does not comment on report of
771053 - genetic disposition for pulmonary
771054 - emboli in relation to Millie's
771055 - risk factors of pulmonary
771056 - emoboli............................... 060825, ref SDS B5 9W4L
771058 - ..
771059 - 74. Patient reports chronic fatigue,
771060 - difficult breathing common
771061 - side effects of chemotherapy, and
771062 - symptoms of pulmonary
771063 - emboli................................ 060929, ref SDS B6 B56N
771065 - ..
771066 - 75. Patient requests CT scan to evaluate
771067 - pulmonary emboli and distant
771068 - metastatic disease.................... 060929, ref SDS B6 DY5M
771070 - ..
771071 - 76. Doctor orders CT test for pulmonary
771072 - emboli; specifies date of test that
771073 - made original diagnosis on 041103
771074 - to compare same location.............. 060929, ref SDS B6 DY7G
771076 - ..
771077 - 77. Doctor asks patient to obtain from her
771078 - son's doctor the report on coagulapathy
771079 - showing genetic disposition for blood
771080 - clots which was reported to Kaiser
771081 - on 060724............................. 060929, ref SDS B6 NU4N
771083 - ..
771084 - 78. Pulmonary emboli diagnosed by CT
771085 - test patient begins treatment
771086 - again, previously ended on 051007
771087 - despite policy to treat cancer
771088 - patients with PE for life due to
771089 - elevated risk for recurrence and
771090 - that 45% of patients who suffer
771091 - recurrence die........................ 061002, ref SDS B7 MI5I
771093 - ..
771094 - 79. CT Test 060929 for pulmonary emboli
771095 - doctor orders comparison with prior
771096 - test on 041103 that reported same
771097 - problem; analyst fails to perform
771098 - comparison, compares only to recent
771099 - tests which were not ordered and
771100 - do not demonstrate patient history
771101 - on pulmonary emboli................... 061012, ref SDS B8 2935
771103 - ..
771104 - 80. Mistakes avoided communication
771105 - collaboration coordination Oncology
771106 - and Coagulation Treatment Clinic
771107 - reliance on computer fails to notify
771108 - staff to balance Coumadin (Warfarin)
771109 - treatment for pulmonary emboli with
771110 - capecitabine (Xeloda) treatment for
771111 - cancer; team care feedback doctor
771112 - patient partnership avoided small
771113 - problem cascading out of
771114 - control............................... 061020, ref SDS B9 TZ4I
771116 - ..
771117 - 81. Doctor relied on computer system for
771118 - automatic notification to pharmacy and
771119 - Coagulation Treatment Clinic, and did
771120 - not specify nor follow up to verify
771121 - that prescription on 061002 for Coumadin
771122 - (warfarin) to treat pulmonary embolism
771123 - should be balanced with capecitabine
771124 - (Xeloda) treatments for cancer
771125 - ordered on 060711..................... 061020, ref SDS C0 YQ7L
771127 - ..
771128 - 82. Kaiser discloses CT test pulmonary
771129 - embolism different from testing for
771130 - cancer explains delay discovering
771131 - pulmonary embolism with CT test on
771132 - 041103 for symptoms beginning on
771133 - 040517................................ 061020, ref SDS C0 S56G
771135 - ..
771136 - 83. Communication documentation records
771137 - management doctor cannot find patient's
771138 - letter 061013 asking about severity
771139 - pulmonary embolism, enlarged right
771140 - ventricle patient status for exercise
771141 - return to gym restore
771142 - fitness............................... 061020, ref SDS C0 VJ49
771144 - ..
771145 - 84. CT test 060930 doctor not aware of
771146 - findings enlarged right ventricle
771147 - heart disorder diagnosed in findings;
771148 - hectic schedule not enough time
771149 - to read test findings cannot
771150 - remember reading patient's letter
771151 - asking about severity; Kaiser
771152 - cannot determine severity of
771153 - pulmonary embolism comparing with
771154 - original findings on 041103; cannot
771155 - compare right and left ventricle
771156 - for impact on pulmonary
771157 - embolism.............................. 061020, ref SDS C0 VJ4J
771159 - ..
771160 - 85. Cellulitus complications lymphedema
771161 - diagnosed 060217 compounded by trauma from
771162 - broken finger on 060914 patient treated
771163 - in Emergency Room; hospitalized 5 days
771164 - temperature rising during cancer treatments,
771165 - left arm engulfed with inflammation, red
771166 - rash and excessive swelling diagnosed as
771167 - side effect from loss of lymphatics removed
771168 - on 051021 for mastectomy surgery which
771169 - was not disclosed to patient for approving
771170 - surgery balanced against risks of
771171 - what can go wrong due to
771172 - side effects.......................... 061027, ref SDS C1 714I
771174 - ..
771175 - 86. Medical chart mistakes patient history
771176 - problems diagnosed, communications,
771177 - medications, examinations doctor
771178 - progress notes errors and
771179 - omissions............................. 061110, ref SDS C2 FE4I
771181 - ..
771182 - 87. Mistakes compound in electronic medical
771183 - chart stored on Kaiser's computer, started
771184 - 050520, ref SDS 0 G57M, cannot be corrected
771185 - because Kaiser "locks down" the record
771186 - after doctor meets with patient; compound
771187 - mistakes, e.g., on 060821, ref SDS 0 S16H,
771188 - because lock down prevents feedback
771189 - loops called out in Kaiser's Healthwise
771190 - Handbook from correcting
771191 - medical chart......................... 061208, ref SDS C3 N54K
771193 - ..
771194 - 88. Medical chart shows metastatic breast
771195 - cancer (IBC) lung and lymph node;
771196 - chest wall recurrence conflicts with
771197 - patient history no diagnostic support
771198 - representation........................ 061208, ref SDS C3 G25K
771200 - ..
771201 - 89. Biopsy avoid diagnose IBC spread to
771202 - right breast repeat mistake failing
771203 - diagnose IBC left breast for 18 months,
771204 - prescribe treatment for antibiotic
771205 - testing for ring
771206 - infection............................. 061208, ref SDS C3 KT7J
771208 - ..
771209 - 90. Payment authorization to start treatment
771210 - doctor not enough time to sign document
771211 - for 3 weeks; treatment delayed while
771212 - medical management reacts to
771213 - crisis................................ 070118, ref SDS C4 YF8U
771215 - ..
771216 - 91. Treatment delayed because not enough
771217 - time to resolve policy conflict between
771218 - Kaiser Medicare because work delayed
771219 - 3 weeks until crisis forced problem
771220 - into span of attention in order to
771221 - avoid proactive
771222 - management............................ 070119, ref SDS C5 YF8U
771224 - ..
771225 - 92. Laboratory blood test scope incomplete
771226 - for baseline start new chemotherapy
771227 - treatment on clinical study
771228 - UCSF.................................. 070122, ref SDS C6 LY30
771230 - ..
771231 - 93. Treatment delayed because complex
771232 - referral authorization requirements
771233 - not enough time for doctors and
771234 - staff to resolve...................... 070124, ref SDS C7 YF8U
771236 - ..
771237 - 94. CT test history of breast cancer omits
771238 - context of pulmonary embolism and Cor
771239 - Pulmonale heart disorder enlarged
771240 - right verntircle
771241 - verntircle............................ 070202, ref SDS C8 0Z6O
771243 - ..
771244 - 95. CT test comparison test 060505 omits
771245 - context other related tests, and
771246 - missing comparison nodules in
771247 - right paratrachael.................... 070202, ref SDS C8 0136
771249 - ..
771250 - 96. Blood test diagnostic differences between
771251 - UCSF Kaiser collaborration clinical study
771252 - drug trial increases risk medical
771253 - mistakes requires coordination
771254 - plan to calculate common
771255 - results .............................. 070301, ref SDS C9 Q659
771257 - ..
771258 - 97. Medical Chart shows 4 times daily
771259 - instead of 3 times daily for
771260 - prescribed medication; typing error
771261 - not corrected because there
771262 - is no feedback loop in
771263 - the communication
771264 - process............................... 070302, ref SDS D0 FN5M
771266 - ..
771267 - 98. Blood tests verify ANC high enough for
771268 - safe treatment with strengthened immune
771269 - system that resists infection and
771270 - progression of cancer, not enough time
771271 - for communication and collaboration to
771272 - coordinate scheduling blood
771273 - tests ordered by the
771274 - doctor................................ 070308, ref SDS D1 1M6H
771276 - ..
771277 - 99. Quality control errors failure to
771278 - perform protocol requirements treatment
771279 - cetuximab clinical study
771280 - drug trial............................ 070308, ref SDS D1 FF41
771282 - ..
771283 - 100. Cancer treatment not scheduled for
771284 - cetuximab weekly infusions on clincial
771285 - study................................. 070315, ref SDS D2 1M6H
771287 - ..
771288 - 101. CT test history of breast cancer omits
771289 - context of pulmonary embolism and Cor
771290 - Pulmonale heart disorder enlarged
771291 - right verntircle
771292 - verntircle............................ 070329, ref SDS D3 GH5L
771294 - ..
771295 - 102. CT test comparison test 060505 omits
771296 - context other related tests, and
771297 - missing comparison nodules in
771298 - right paratrachael.................... 070329, ref SDS D3 0136
771300 - ..
771301 - 103. Doctor ordered CT test for pulmonary
771302 - embolism and enlarged right ventricle
771303 - life threatening issues ignored by
771304 - Medical Imaging test department
771305 - without notice nor consideration of
771306 - patient history....................... 070330, ref SDS D4 B74K
771308 - ..
771309 - 104. Treatment Keflex antibiotics prescribed
771310 - by Kaiser for Cellulitis should defer to
771311 - UCSF maintain control clinical
771312 - study................................. 070330, ref SDS D4 V66M
771314 - ..
771315 - 105. Blood tests to evaluate immune system
771316 - strong enough for safe treatments schedule
771317 - changed from protocol requirements for
771318 - testing prior to treatment, to test
771319 - during treatment, results received after
771320 - treatment show sudden reversal; blood
771321 - counts ANC NEUTS too low for safe
771322 - treatment............................. 070426, ref SDS D5 P560
771324 - ..
771325 - 106. Doctor reports CA 15-3 56 "stable"
771326 - referral coordination fails; doctor
771327 - patient partnership collaboration fails;
771328 - mistake occurred because patient history
771329 - weeks earlier reporting CA 15-3 36 and
771330 - then only a few days earlier reporting
771331 - decline to 29, both well below 56, and
771332 - submitted to the doctor through Kaiser's
771333 - email system, were not entered into
771334 - the Kaiser's computer program Medical
771335 - Chart for patient case
771336 - management............................ 070516, ref SDS D6 RH9H
771338 - ..
771339 - 107. Emergency care failure Cellulitis patient
771340 - suffers rising pain, chills, temperature
771341 - risk to Stage IV cancer patient, rapidly
771342 - spreading inflammation and lymphedema
771343 - treatment delayed for staff
771344 - meeting............................... 070607, ref SDS D7 8I89
771346 - ..
771347 - 108. Blood test unnecessary duplication error
771348 - reading Medical Chart misunderstand clinical
771349 - trial protocol; nurse assigned not experienced
771350 - with patient history; not enough time
771351 - to verify accuracy; cost containment
771352 - less important than drawing blood
771353 - which seems fast and easy for
771354 - nurse................................. 070809, ref SDS D8 CN76
771356 - ..
771357 - 109. Doctor submits report on blood test for
771358 - 071017 omits section on Neutrophils,
771359 - Lymphocytes, Bands, etc., used to
771360 - calculate ANC for evaluating safety
771361 - of patient receiving chemotherapy
771362 - treatments; doctor fails to submit
771363 - ANC composite number, requested
771364 - by patient............................ 071023, ref SDS D9 JM41
771366 - ..
771367 - 110. Speciality doctor fails to comment on
771368 - advisability of patient returning to
771369 - work during treatment in clinical
771370 - trial despite request by primary
771371 - care physician for
771372 - review................................ 071023, ref SDS D9 V63L
771374 - ..
771375 - 111. Blood test mistake Magnesium omitted from
771376 - order for labs to start new cycle of treatment;
771377 - conflicts with clinical trial
771378 - specification......................... 080117, ref SDS E0 4F9G
771380 - ..
771381 - 112. CT scan report for on test 080212 omits
771382 - patient history recurrent pulmonary embolism,
771383 - enlarged right ventrical (cor pulmonale),
771384 - enlarged heart, esophigitis; fails to
771385 - perform comparison with prior test
771386 - findings.............................. 080215, ref SDS E1 IX4F
771388 - ..
771389 - 113. CT scan test 080212 findings conflict with
771390 - prior test on 071210 erroneous unit of
771391 - measure substituting "cm" for "mm" 10
771392 - fold mistake; likely typographical
771393 - error; failure reconcile prior
771394 - report................................ 080215, ref SDS E1 EO8F
771396 - ..
771397 - 114. Communication conflicts UCSF proposes using
771398 - conversation to order same day examination
771399 - of Cellulitis for cancer
771400 - patient............................... 080304, ref SDS E2 6T41
771402 - ..
771403 - 115. Patient notifies Kaiser that UCSF recommends
771404 - same day examination for Cellulitis
771405 - recurrence............................ 080304, ref SDS E2 UZ47
771407 - ..
771408 - 116. UCSF submits confirmation letter to
771409 - patient and to Kaiser that does not
771410 - specify same day examination
771411 - conveyed in earlier
771412 - telephone call........................ 080304, ref SDS E2 B18J
771414 - ..
771415 - 117. Kaiser schedules examination for
771416 - following day despite notice that
771417 - UCSF recommends urgency
771418 - requires same day
771419 - examination........................... 080304, ref SDS E2 UZ89
771421 - ..
771422 - 118. Infusion Clinic medical chart shows
771423 - incorrectly blood tests on 6-week cycle
771424 - which is actually 4-week cycle; causing
771425 - confusion and delay despite excellent
771426 - support by Infusion Clinic
771427 - staff................................. 080306, ref SDS E4 NK5L
771429 - ..
771430 - 119. Blood test order delivered to the wrong
771431 - Lab due to communication mistake
771432 - causing delay giving
771433 - treatment............................. 080306, ref SDS E3 JT4F
771435 - ..
771436 - 120. Blood test mistake Magnesium omitted from
771437 - order for labs to start new cycle of treatment;
771438 - conflicts with clinical trial
771439 - specification......................... 080404, ref SDS E5 O059
771441 - ..
771442 - 121. Collaboration failure referral coordination
771443 - blood test at UCSF on 080306 sent to Kaiser
771444 - on 080307 was not evaluated for emergency
771445 - care at Kaiser on 080409; Kaiser compared
771446 - blood test on 080409 with data on 071017
771447 - because nobody entered 6 months of test
771448 - data in Kaiser computer; if data is
771449 - not in the computer it does not
771450 - exist................................. 080409, ref SDS E6 439L
771452 - ..
771453 - 122. Chemotherapy Orders received 2 weeks later
771454 - on 080515 reduced dose Carboplatin withheld
771455 - notice change conflicts with planning to
771456 - maintain full dose to optimize
771457 - recovery.............................. 080501, ref SDS E7 PVUQ
771459 - ..
771460 - 123. Blood draw delayed by reliance on verbal
771461 - coordination causing mistakes submitting
771462 - orders and blood vials for laboratory
771463 - work to the Infusion
771464 - clinic................................ 080529, ref SDS E8 4E5J
771466 - ..
771467 - 124. Replacement medical team did not receive
771468 - agenda for meeting; relied on verbal
771469 - coordination of written instructions
771470 - causing numerous errors
771471 - and delays............................ 080529, ref SDS E8 4E69
771473 - ..
771474 - 125. Medical Chart missing reports on prior
771475 - laboratory blood tests corrected
771476 - during meeting with
771477 - patient............................... 080529, ref SDS E8 L255
771479 - ..
771480 - 126. Chemotherapy Orders received 1 week later
771481 - on 080605 again shows reduced dose
771482 - Carboplatin with handwritten
771483 - notation of error .................... 080529, ref SDS E9 PVUQ
771485 - ..
771486 - 127. Chemotherapy Orders received 1 week
771487 - later on 080605 prescribes 2 Neupogen
771488 - treatments per week when Carboplatin;
771489 - received conflicts with verbal instruction
771490 - for patient to get 1 Neupogen treatment
771491 - which was implemented; did not cause
771492 - patient to miss chemotherapy
771493 - treatment due to low blood
771494 - counts................................ 080529, ref SDS E9 PWSY
771496 - ..
771497 - 128. UCSF requested referral coordination to
771498 - submit "certificate" from Kaiser surgeon
771499 - on suitability of Power Port for Millie's
771500 - blood draws, and cancer treatments;
771501 - patient notified primary care physician,
771502 - who notified the surgeon of UCSF requirement
771503 - for "certificate" of suitability for use;
771504 - Kaiser surgeon annoyed by request for
771505 - "certificate" that conflicts with medical
771506 - documentation practices; UCSF received
771507 - "certificate" provided at great time,
771508 - expense, and annoyance, and advised the
771509 - "certificate" request was a mistake; UCSF
771510 - requirement was for xray report produced
771511 - routinely for port surgery at no extra
771512 - time nor expense; UCSF coordinated
771513 - directly to obtain xray report
771514 - in about 10 minutes................... 080710, ref SDS F1 EE4O
771516 - ..
771517 - 129. Coordinating documentation Chemotherapy
771518 - Orders chemothearpy treatments and
771519 - Neupogen treatments delayed due to
771520 - hectic schedule....................... 080605, ref SDS F0 JO9Q
771522 - ..
771523 - 130. Communication failure CT Department did
771524 - not receive and/or did not have time to
771525 - be prepared for performing CT test with
771526 - new Power Port technology by reviewing
771527 - manufacturer's Instructions for Use and
771528 - to arrange for qualified medical
771529 - professionals to perform the
771530 - work.................................. 080711, ref SDS F2 7K8I
771532 - ..
771533 - 131. Infusion Clinic in Oncology Department
771534 - cannot spare experienced medical
771535 - professional for 30 minutes to support
771536 - CT Department on 080718 perform test
771537 - using new Power Port technology for
771538 - the first time ordered by Oncology
771539 - Department............................ 080715, ref SDS F3 PQ6P
771541 - ..
771542 - 132. CT test using power injection procedure
771543 - for contrast medium medical professionals
771544 - did not have time to be prepared by
771545 - reviewing manufacturer's instructions
771546 - for use............................... 080718, ref SDS F4 2U8V
771548 - ..
771549 - 133. CT test failed using Power Port for
771550 - high pressure injection of contrast
771551 - medium; patient suffers extravasation
771552 - with contrast medium overflowing
771553 - the port into chest, shoulder and
771554 - upper arm; bleeding from surgical
771555 - wound where Power Port was
771556 - implanted a week
771557 - earlier............................... 080718, ref SDS F4 LK3R
771559 - ..
771560 - 134. Medical Chart at UCSF missing CT test due
771561 - to delays reading scans at Kaiser and
771562 - changes to personnel causing problems
771563 - for referral coordination
771564 - requesting report..................... 080724, ref SDS F5 TG96
771566 - ..
771567 - 135. INR test omitted from labs because
771568 - patient failed to submit an agenda to
771569 - remind hospital Infusion Clinic staff
771570 - about scope of work, and because test
771571 - was performed at 0745 earlier than the
771572 - usual time of 0800 causing another nurse
771573 - to perform the work who was not familiar
771574 - with requirements for Millie's
771575 - blood tests starting a new
771576 - treatment cycle every
771577 - 4 weeks............................... 080724, ref SDS F6 IU8H
771579 - ..
771580 - 136. CT test reports with omissions interpreted
771581 - as showing disease is not worsening or
771582 - is too negligible to
771583 - report................................ 080912, ref SDS F7 HI8N
771584 - appears conflicting for CT test on
771585 - 081107 indicating omissions are actually
771586 - mistakes; severe medical problems occurred
771587 - in locations that were ignored by the
771588 - analyst reviewing CT scans for
771589 - prior tests........................... 081113, ref SDS G8 HW8M
771591 - ..
771592 - 137. Communication glitch finding swelled
771593 - lymph node left supraclavicular at UCSF
771594 - on 080821, and at Kaiser on 080829, delayed
771595 - tessting 2 months that required
771596 - changing treatment.................... 081016, ref SDS F8 J34X
771598 - ..
771599 - 138. FNA Biopsy to test for cancer scheduled
771600 - 081023 1050 at Kaiser conflicted with
771601 - Millie getting cancer treatment at
771602 - UCSF on 081023 until
771603 - 1330.................................. 081021, ref SDS F9 4Q4C
771605 - ..
771606 - 139. FNA biopsy to test for cancer requires
771607 - 2 meetings; conflicts with patient
771608 - history doing prior work with
771609 - only 1 visit.......................... 081021, ref SDS F9 YR6O
771611 - ..
771612 - 140. FNA Biopsy to test for cancer scheduled
771613 - in Surgery Department conflicts with
771614 - patient history performing FNA biopsy
771615 - in Kaiser Head and Neck
771616 - Department............................ 081021, ref SDS F9 03GE
771618 - ..
771619 - 141. Referral for FNA biopsy of lump does not
771620 - specify location of lump, conflicts with
771621 - letter to Kaiser submitting prescription
771622 - from UCSF specifying FNA biopsy in
771623 - left suprclavicular................... 081021, ref SDS F9 PQ7T
771625 - ..
771626 - 142. Referral for FNA biopsy of lump does not
771627 - specify check for status change; conflicts
771628 - with letter to Kaiser submitting UCSF
771629 - prescription.......................... 081021, ref SDS F9 WO31
771631 - ..
771632 - 143. CT test request on 080827 cover neck
771633 - evaluate possible spread of new cancer
771634 - reported on 080821; CT test on 080911
771635 - does not report cancer in neck (left
771636 - supraclavicular); review of CT scans
771637 - for test on 080911 shows test did not
771638 - include the neck, so findings yielded
771639 - false negative, reported during
771640 - meeting at Kaiser..................... 081022 ref SDS G0 516F
771642 - ..
771643 - 144. FNA biopsy at Kaiser cannot check for
771644 - status change triple negative ER PR
771645 - HER2 neu; requires core
771646 - biopsy................................ 081022, ref SDS G1 4Q61
771647 - 5 letters from UCSF indicate conflict
771648 - requesting FNA biopsy rather than core
771649 - biopsy to test for status
771650 - change................................ 081022, ref SDS G2 NI7S
771652 - ..
771653 - 145. Muga test ordered by Kaiser on 081106 1030
771654 - conflicts with work plan patient on vacation
771655 - until 081107, and already scheduled
771656 - for tests until
771657 - 081111................................ 081105, ref SDS G3 WO72
771658 - No evident alignment of Muga test and
771659 - screening requirements for sunitinib
771660 - clinical study; not enough time to
771661 - collaborate with referral
771662 - health care provider
771663 - UCSF.................................. 081105, ref SDS G3 6138
771664 - Possible mixup from difficulty reviewing
771665 - patient history associating sunitinib
771666 - clinicial trial treatment using Cytoxan
771667 - with heart damage exposure from prior
771668 - treatments with Adriamycin Cytoxan
771669 - (AC) where heart damage seems to occur
771670 - from Adriamycin which is not part
771671 - of sunitinib treatment plan, and
771672 - Cytoxan is not associated with
771673 - heart damage.......................... 081105, ref SDS G3 WI5L
771675 - ..
771676 - 146. Blood test ordered at Kaiser for CT test
771677 - on 081107; turned out this was reviewed
771678 - earlier on 081024 and decided to use
771679 - blood test at UCSF on 081023 but nobody
771680 - could find the record in Kaiser's
771681 - computer of the work on
771682 - 081024 so rework was
771683 - performed............................. 081106, ref SDS G5 ED6H
771685 - ..
771686 - 147. Muga test ordered on 081103 scheduled
771687 - for 081111 duplicates echocardiogram
771688 - test scheduled the day before on
771689 - 081108 and ordered weeks
771690 - earlier on 081024 was
771691 - cancelled............................. 081106, ref SDS G6 WH9N
771693 - ..
771694 - 148. Core biopsy evaluate status change scheduled
771695 - previously changed on 081027 from 081107 to
771696 - 081117 with Doctor Wong was changed by
771697 - Doctor Daamen back to 081107 at 1600 (4pm)
771698 - with Doctor Kahn; schedule assistant later
771699 - notifies patient schedule changed again
771700 - for Doctor Wong on 081107 1000 because
771701 - Doctor Kahn is not available and sees
771702 - nothing scheduled at 1600; calls back
771703 - and advises mistake occurred using
771704 - computer - core biopsy scheduled
771705 - for 081107 1600 with Doctor
771706 - Khan.................................. 081106, ref SDS G4 IP7L
771708 - ..
771709 - 149. CT test on 081107 was compared with
771710 - test on 080718, rather than the most
771711 - recent test on
771712 - 080911................................ 081112, ref SDS G7 RV49
771714 - ..
771715 - 150. CT test on 081107 resulted in 2 separate
771716 - reports issued days apart, which caused
771717 - confusion in patient care and conveyed
771718 - false impression of error because
771719 - report on neck findings were
771720 - issued separately..................... 081113, ref SDS G8 RU6R
771721 - case study patient history shows 11
771722 - CT and PET studies were performed
771723 - including neck, chest, abdomen, and
771724 - pelvis, and all test findings were
771725 - always consolidated into a single
771726 - report................................ 081113, ref SDS G8 HV4H
771728 - ..
771729 - 151. CT test ordered in Kaiser's computer on
771730 - 081210 to be performed on 081230 included
771731 - the neck, and required using Millie's Power
771732 - Port with support from the Chemotherapy
771733 - Clinic and Interventional Services to
771734 - access the port for injecting contrast
771735 - medium, and further specified a consolidated
771736 - report to avoid mistakes; none of these
771737 - requirements were in the computer referral
771738 - order reviewed on 081219, indicating that
771739 - somone changed the doctor's order in the
771740 - computer without inquiry nor notice;
771741 - the doctor corrected mistakes in
771742 - the computer to conform with
771743 - patient requirements.................. 081219, ref SDS G9 WP30
771745 - ..
771746 - 152. CT test 081107 report on neck fails
771747 - to perform comparisons saying there are
771748 - prior studies to compare; overlooks
771749 - patient history of 11 prior studies
771750 - that included the
771751 - neck.................................. 081113, ref SDS G8 RV49
771753 - ..
771754 - 153. Communication glitch delayed changing
771755 - Millie's treatment to prevent cancer
771756 - from cascading out of
771757 - control............................... 090130, ref SDS H2 AY8Q
771759 - ..
771760 - 154. Kaiser explains multiple reports for the
771761 - same CT test that increase time, cost, and
771762 - medical mistakes was implemented in order
771763 - to increase revenue by billing for
771764 - miltiple reports for each time
771765 - the CT equipment makes a
771766 - pass.................................. 090109, ref SDS H0 SV8O
771768 - ..
771769 - 155. CT findings for next test on 081230 again
771770 - published in 2 separate reports ignored
771771 - doctor's order for consolidated report
771772 - to maintain a well ordred record that
771773 - helps reduce medical mistakes;
771774 - doctor confused submits
771775 - only 1 of 2
771776 - reports............................... 090109, ref SDS H1 V53J
771778 - ..
771779 - 156. Communication glitch referral coding
771780 - problem at Kaiser delayed starting urgent
771781 - treatment quickly enough to be
771782 - effective at UCSF..................... 090202, ref SDS H3 9Y5I
771784 - ..
771785 - 157. Communication glitch delays initial meeting
771786 - for 3 weeks to start urgent
771787 - treatment............................. 090202, ref SDS H4 XO7G
771789 - ..
771790 - 158. Doctor orders urgent treatment
771791 - required to start
771792 - quickly............................... 090202, ref SDS H5 Y15J
771793 - UCSF advances initial examination
771794 - 2 weeks............................... 090205, ref SDS H6 0001
771796 - ..
771797 - 159. Treatment with hyperthermia which can be
771798 - given with Doxil to increase effectiveness,
771799 - delayed 2 more weeks in order to create
771800 - essential molds and perform layout
771801 - for complementary low-dose
771802 - radiation treatment................... 090209, ref SDS H7 RF7L
771803 - delayed treatment placing risks
771804 - enabling cancer to cascade out of
771805 - control, opening prospect treatment
771806 - will not occur in time to be
771807 - effective............................. 090209, ref SDS H7 RF84
771808 -
771809 -
771810 -
771811 -
771812 -
771813 -
771814 -
771815 -
771816 -
7719 -
SUBJECTS
CT Test 040410 Shows Cancer Lymph Nodes No Increase Size Growing No
7803 -
780401 - ..
780402 - CT Test report continues...
780403 -
780404 - The heart is normal in size.
780405 -
780406 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
780407 -
780408 - The liver cyst and splenic granulomata are stable. The pancreas
780409 - and adrenal glands are normal. The kidnesy are unremarkable aside
780410 - from a tiny cyst. The aorta is normal in caliber. There is no
780411 - adenopathy and no evidence of free fluid. The pelvis is
780412 - unremarkable.
780414 - ..
780415 - There are degenerative skeletal changes.
780416 -
780417 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
780419 - ..
780420 - Impression
780422 - ..
780423 - Adenopathy as described. The brain is normal. There is no change
780424 - in the chest and abdomen.
780426 - ..
780427 - A Fisch MD
780429 - ..
780430 - DD: 040415 DTL 040415 AYF
780431 -
780432 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
780433 -
780434 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
780435 -
780436 - ** ADDENDUM ** ADDED ON 040416 BY WCRHYY **
780437 - ** ADDENDUM ** ADDED ON 040415 BY WCRDXN **
780439 - ..
780440 - CT OF HEAD, NECK, CHEST AND ABDOMEN 040410
780442 - ..
780443 - TECHNIQUE: Intravenous as well as oral contrast was used.
780444 -
780445 - ** A D D E N D U M E X I S T S B U T N O T F I N A L I Z E D**
780447 - ..
780448 - Comparison Previous study on 040307
780449 -
780450 - Prior tests....
780451 -
780452 - 040307 reported on 040318.............. ref SDS 65 LK5L
780453 - 031031 reported on 031205.............. ref SDS 60 IG9K
780454 - 030626 reported on 030710.............. ref SDS 57 AL6N
780455 - 030428 reported on 030508.............. ref SDS 53 LK5L
780457 - ..
780458 - Evaluation of the head shows normal configuration of the
780459 - ventricels and sulci. No abnormal collection of intra or extra
780460 - axial fluid is seen. No focal parenchymal abnormality is
780461 - detected. No abnormal enhancing lesion is seen. The visualized
780462 - orbits and paranasal sinuses are unremarkable. No osseous
780463 - abnormalities were detected. Evlauation of the mandibular region
780464 - is limited by extensive streak artifact from the patient's dental
780465 - apparatus. Nevertheless, the parotid glands appear unremarkable.
780466 - Submandibular glands are also unremarkable. There is a 13 x 7 mm
780467 - lymph node seen within the left posterior triangle, best seen on
780468 - image #26. There are also multiple subcentimeter adjacent lymph
780469 - nodes also detected. Again also noted is an 11 x 10 mm node in
780470 - the high left supraclavicular region seen on image #31. This has
780471 - not significantly changed.
780473 - ..
780474 - The report received on 040318 has a specific category for "Neck,"
780475 - which is missing from the report received today. ref SDS 65 WB8Q The
780476 - report today says the "neck" was tested along with many other major
780477 - components. ref SDS 0 799I The report today of a...
780478 -
780479 - 13 x 7 mm lymph node seen within the left posterior
780480 - triangle, best seen on image #26. ref SDS 0 7U4O
780481 -
780482 - ...appears to support the report received on 040318 that says...
780483 -
780484 - 11 x 7 mm node in the left posterior cervical triangle
780485 - (image #28). ref SDS 65 WB8Q
780486 -
780487 - ...suggesting expansion of the condition during the 4 weeks that
780488 - separate the test dates.
780490 - ..
780491 - The report today...
780492 -
780493 - 11 x 10 mm node in the high left supraclavicular region seen
780494 - on image #31. ref SDS 0 7U4O
780495 -
780496 - ...appears to support the report received o 040318 that says...
780497 -
780498 - 11 x 9 mm node in the high left supraclavicular region
780499 - (image #32). ref SDS 65 WB8Q
780500 -
780501 - ...suggesting expansion of the condition during the 4 weeks that
780502 - separate the test dates.
780504 - ..
780505 - In order to optimize review by the physician caring for a patient,
780506 - this section of the report, needs rework to maintain a consistent
780507 - format and descriptions that associate the problem of cancer with
780508 - common diagnosis and treatment patterns, e.g., brain, neck, breast,
780509 - lung, etc., per above, ref SDS 0 PTSX, so that understanding is
780510 - express rather than implied, because implications are tenuous, when
780511 - people are pressed for time, per study above. ref SDS 0 PTSX
780513 - ..
780514 - CT Test report continues...
780515 -
780516 - Again seen is what appears to be a nonspecific 5 mm low density
780517 - focus within the right thyroid lobe. This is without interval
780518 - change.
780520 - ..
780521 - The report received on 040318 describes...
780522 -
780523 - nonspecific 5 mm low density lesion in the right lobe of the
780524 - thyroid.
780525 -
780526 - "Lesion" somehow sounds more ominous than "focus," however in medical
780527 - practice they mean the same thing?
780529 - ..
780530 - CT Test report continues...
780531 -
780532 - Evaluation of the chest reveals multiple axillary lymph nodes, the
780533 - largest on the right measuring 15 x 9 mm and the largest on the
780534 - left measuring 14 x 10 mm. Post operative changes are again noted
780535 - within the left axillary region and the breast. No significant
780536 - mediastinal or hilar lymphadenopathy is appreciated. The lung
780537 - windows again show left apical scarring with fibrotic changes.
780538 - Also again noted are simple, very small subpleural nodules in the
780539 - right midlung zone. There is no evidence for mass and there is no
780540 - infiltrate or effusion.
780542 - ..
780543 - The report received on 040318 does not describe lymph nodes measuring
780544 - 15 x 9 mm and 14 x 10 mm; but that report found lymph nodes in the
780545 - neck that are much smaller than those in the chest reported today, yet
780546 - have cancer. ref SDS 65 VM7I
780548 - ..
780549 - CT Test report continues...
780550 -
780551 - Evaluation of the abdomen again shows a stable appearing 13 mm
780552 - cyst within the dome of the liver. Also again noted are multiple
780553 - splenic granulomas. The gallbladder, pancreas and adrenal glands
780554 - are unremarkable. There are again multiple subcentimeter what
780555 - appear to be cysts within the kidneys, unchanged. There is no
780556 - retroperitoneal lymphadenopathy appreciated. No free fluid is
780557 - noted. There is moderate ectasia of the iliac vessels. There is
780558 - diverticulosis of the sigmoid colon. No mass is seen in the
780559 - pelvis.
780561 - ..
780562 - Impression
780564 - ..
780565 - Multiple prominent cervical and supraclavicular lymph nodes.
780566 - Stable fibrotic at left apex. Stable right liver cysts.
780567 -
780568 -
780570 - ..
780571 - Distant Metastasis Cancer Neck Only Evidence of CT Scan Shows
780572 -
780573 - Follow up ref SDS 67 ZE5O, ref SDS 65 ZE5O.
780574 -
780575 - The doctor indicated the report shows that cancer is limited to the
780576 - neck area. ref SDS 0 IG9K While this is not expressly stated in the
780577 - report, the findings appear to show there has been some expansion of
780578 - lymph nodes in the neck, since the prior report received on 040318,
780579 - per above. ref SDS 0 7U6O
780581 - ..
780582 - What are implications from rate of growth for lymph nodes in the neck
780583 - -- normal, below or above average?
780585 - ..
780586 - What are implications of nodes in the chest that seem to be larger
780587 - than the nodes in the neck that have been diagnosed as cancer?
780588 - ref SDS 0 7V3R
780590 - ..
780591 - What is the disposition of lymph nodes under the arm, discussed on
780592 - 040318, ref SDS 65 HC7F, and that seem to be missing from the CT
780593 - tests? ref SDS 0 7V3R
780594 -
780595 - [On 040419 biopsy taken to evaluate redness. ref SDS 73 789F
780597 - ..
780598 - [On 040429 pathology on biopsy found cancer that may require
780599 - surgery for masectomy. ref SDS 75 F66N
780601 - ..
780602 - [On 040517 pathology report on biopsy submitted to patient, shows
780603 - diagnosis of inflammatory breast cancer (IBC). ref SDS 77 7D6F
780605 - ..
780606 - [On 040517 research on IBC shows that swollen lymph nodes under
780607 - the arm are a symptom of IBC. ref SDS 77 6M9H
780609 - ..
780610 - We need to see the final version of the CT test, because the report
780611 - received today has a notice that there is another addendum.
780612 - ref SDS 0 EG57
780613 -
780614 - [On 040517 the doctor advised that the version submitted today
780615 - is the final version, and that the notice in the report that an
780616 - addendum exists, and so the report is not finalized, is a mistake.
780617 - ref SDS 77 NL6J
780619 - ..
780620 - The doctor noted the current version of the report found no cancer
780621 - in the brain. (see "Impression" - ref SDS 0 7M63)
780622 -
780623 -
780624 -
7807 -
SUBJECTS
Redness Returns to Left Breast Diagnosed as Cellulitus Treated with
Breast Softer Change May Indicate Recovery from Trauma of Surgery
Diagnosis Changed from Cellulitus to Radiation Reaction Treated with
Cancer Treatment Delayed Cellulitus Diagnosed Treated with Antibioti
Breast Redness Returns to Left Breast Diagnosed as Cellulitus Treate
Breast Redness Diagnosis Changed from Cellulitus to Radiation Reacti
8708 -
870901 - ..
870902 - Chemotherapy Cleared to Start Avastin Trials
870903 - Treatment Proceeds Diagnosis Cellulitus Changed to Radiation Reaction
870904 - Redness Breast Diagnosis Changed from Cellulitus to Radiation Reaction
870905 - Radiation Reaction Redness Breast Diagnosis Changed from Cellulitus
870906 -
870907 - Follow up ref SDS 67 IM6J, ref SDS 65 IM6J.
870908 -
870909 - The doctor examined the breasts and commented that redness on the left
870910 - side seems to have reduced slightly from examination on 040402.
870912 - ..
870913 - The doctor noted there is nothing in the CT test today that suggests
870914 - cancer in the left breast, see above. ref SDS 0 WE7N
870916 - ..
870917 - Treatment for reaction to radiation with steriods was ended today, and
870918 - so chemotherapy treatment with Taxol and Avastin, which was previously
870919 - delayed on 040318 to treat cellulitus, ref SDS 65 PY4N, can commence
870920 - on 040420, as reported in the call from Rosalie on 040407. ref SDS 68
870921 - 3S6L
870922 -
870923 - [On 040419 biopsy taken to evaluate redness. ref SDS 73 789F
870925 - ..
870926 - [On 040429 pathology on biopsy found inflammatory breast cancer
870927 - (IBC), may require surgery for masectomy. ref SDS 75 F66N
870929 - ..
870930 - [On 051021 mastectomy surgery performed left breast based on
870931 - biopsy tests performed on 051012, which found no evidence of IBC,
870932 - and inflammation consistant with minimal to mild radiation effect.
870933 - ref SDS A1 7B4O
870934 -
870935 -
870936 -
870937 -
870938 -
8710 -
SUBJECTS
Blood Tests Painful Conditions Requires Higher Skilled Technician to
Port for New Treatments Administered Intravenously Avoids Pain and D
Port Will Provide Partial Releif from Excessive Needle Insertions in
9405 -
940601 - ..
940602 - Blood Tests Causing Painful Condition on Right Arm
940603 - Port to Support New Treatments Administered Intravenously
940604 -
940605 - Follow up ref SDS 67 CO3G, ref SDS 65 CO3G.
940606 -
940607 - On 040409 Millie asked about a "dual port" system. ref SDS 69 7J96
940608 -
940609 - Surgery scheduled for 040419, per report on 040414. ref SDS 70 YP8I
940610 -
940611 - On 040407 Rosalie called and explained that Kaiser does not use a
940612 - "dual" port procedure. ref SDS 68 3S6L
940613 -
940614 -
940615 -
940616 -
940617 -
940618 -
940619 -
940620 -
940621 -
940622 -
9407 -