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: October 14, 2004 11:02 AM Thursday; Rod Welch

Picked up medical records at Kaiser for meeting 2nd opinion on Monday.

1...Summary/Objective
2...Organized Medical Records for Submission to UCSF
3...Doctor's Notes on Meeting with Patient Sparse, Illegible, No Planning
4...Records Missing and Incorrect from Kaiser's Submission
5...Case Study Medical Chart Missing Incorrect Reporting Patient History
6...Patient History Medical Chart Missing Incorrect Reporting Case Study


..............
Click here to comment!

CONTACTS 

SUBJECTS
2nd Opinion Metastatic Cancer Treatment Chemotherapy New Trial Drug
600 Dollars Patients Must Pay for 2nd Opinion Metastatic Cancer Trea
Medical Records Transfer Authorize from Kaiser to UCSF Breast Care C
2nd Opinion Requested from UCSF, Stanford, UC Davis Cancer Centers
Medical Records Mistake Business Office Failed Follow Procedure Not

1207 -
1207 -    ..
1208 - Summary/Objective
1209 -
120901 - Follow up ref SDS 21 0000. ref SDS 20 0000.
120902 -
120903 - Picked up Millie's medical records from Kaiser, per Millie's request
120904 - on 041007. ref SDS 20 GI9F  Corrected errors and omissions in the
120905 - record while at Kaiser.  Reviewed medical records, and added
120906 - organization requested by UCSF. ref SDS 0 PF7I  Found more errors and
120907 - omissions. ref SDS 0 T49J
120908 -
120909 -     [On 041018 Doctor Benz at UCSF did not examine imaging scan films,
120910 -     ref SDS 26 L246, and the doctor did not review meeting notes and
120911 -     other handwritings by Kaiser professional staff. ref SDS 26 EN63
120913 -      ..
120914 -     [On 050826 applied experience from using medical records for the
120915 -     1st 2nd opinion to order a reduced set of medical records for the
120916 -     2nd opinion #2. ref SDS 30 668F
120918 -      ..
120919 -     [On 050907 picked up medical records from Kaiser; problems getting
120920 -     submittals, ref SDS 31 FA98, in organization and getting wrong
120921 -     records. ref SDS 31 028E
120923 -      ..
120924 -     [On 060810 head nurse in Oncology ordered and assembled packet
120925 -     of documents for 2nd opinion #3. ref SDS 32 U76O
120927 -      ..
120928 -     [On 060810 head nurse in Oncology ordered and assembled packed
120929 -     of documents for 2nd opinion #3. ref SDS 32 U76O
120931 -      ..
120932 -     [On 061011 commend Kaiser and Arlette for extra work providing a
120933 -     packet of documents to facilitate 2nd opinion #3 review by UCSF,
120934 -     reducing the cost by 30%. ref SDS 34 QY4I
120935 -
120936 -
120937 -
120939 -  ..
1210 -
1211 - 1136 Visited Business Office.............. 925 295 4935
1212 -
121201 - Received two packets of documents, per request on 041007 for
121202 - assembling medical records to get a 2nd opinion. ref SDS 20 GI9F
121203 -
121204 - Today, Tangi was not in the Business Office.  There were two (2) other
121205 - attendants.  They advised that only the patient can pick up the
121206 - records, unless the patient calls ahead and designates someone to
121207 - pickup medical records.  This means the plan for me to pick up the
121208 - medical records while Millie is getting chemotherapy would have
121209 - failed, or encountered delays.  Since we had time this morning to
121210 - visit the Business Office prior to starting chemotherapy, Millie was
121211 - able to visit the Business Office to pick up the medical records, so
121212 - another problem was averted.
121213 -
121214 -
121215 -
121217 -  ..
1213 -
1214 -
1215 - Visited Pathology Department...... 925 295 4789
1216 -
121601 - Talked to Nancy.
121602 -
121603 - She submitted two packets of pathology slides, per telecon on 041011.
121604 - ref SDS 21 RR3O, per planning on 041007 when Millie signed the
121605 - authorization. ref SDS 20 GI9F
121606 -
121607 -     [On 041021 Millie returned pathology slides to Patty. ref SDS 27
121608 -     RR3O
121609 -
121610 -
121611 -
121612 -
121614 -  ..
1217 -
1218 -
1219 - Visited Imaging (Xray) Department........ 925 295 4789
1220 -
122001 - Talked to receptionist.  She took Millie's Kaiser account number, and
122002 - then went and got two packets of films, per discussion with Nicole on
122003 - 041012. ref SDS 23 TC6X
122005 -  ..
122006 - The receptionist handed us two packets, one each for UCSF and for
122007 - Stanford.  The packets were closed, and there was no inventory
122008 - submitted.
122010 -  ..
122011 - I took all the medical records to the car in the garage, and Millie
122012 - went to get blood drawn at the Infusion Clinic.
122014 -  ..
122015 - Based on prior difficulties, decided we need to verify that Nicole has
122016 - included films for Nuclear Medicine on PET and Bone scans, per
122017 - planning on 041012. ref SDS 23 7Z64
122018 -
122019 -     [...below PET scans were missing, and so were added by Nuclear
122020 -     Medicine. ref SDS 0 0254
122021 -
122022 -
122023 -
122025 -  ..
1221 -
1222 -
1223 - 1237 Visited Nuclear Medicine.
1224 -
122401 - After Millie finished getting blood drawn for treatment today,
122402 - reported in another record, ref SDS 25 407N, we took the samples to
122403 - the lab for processing.  After submitting the samples, we walked down
122404 - the hall and took the elevator to the basement level, and visited
122405 - Nuclear Medicine.
122407 -  ..
122408 - The receptionist, Jessica, checked Kaiser's computer and found no
122409 - record that Nicole, or anyone else, has checked out PET and Bone scans
122410 - on Millie's account, contrary to planning yesterday. ref SDS 23 7Z73
122411 - She called the Xray Department and asked for Nicole, however she was
122412 - at lunch, and no one else in the Xray Department knew anything about
122413 - work on assembling records for Millie.
122415 -  ..
122416 - Jessica went to another room across the hall.  She came back in about
122417 - 5 minutes and said that the PET scans are still in the file folder,
122418 - and there are no notes in the file folder that shows anyone has ever
122419 - checked anything out, which aligns with the record in the computer.
122420 - Jessica held up a PET scan to show the general size and appearance
122421 - with a notice on the film saying "PET."
122423 -  ..
122424 - We decided to go to lunch, and after that will bring the film
122425 - packages back to Nuclear Medicine, where an inventory can be made to
122426 - verify status, and correct any problems.
122427 -
122429 -  ..
1225 -
1226 -
1227 - 1309
1228 -
122801 - After lunch, Millie went to the Chemotherapy Clinic to wait for
122802 - treatment.
122804 -  ..
122805 - I walked back to the car in the garage on the 4th floor.
122807 -  ..
122808 - Looked in one of the two packets received earlier from the Medical
122809 - Imaging (Xray) Department, received earlier, per above. ref SDS 0 UR4K
122810 - There was no transmittal listing what is included.  There did not
122811 - appear to be any films like Jessica showed for PET scans, earlier in
122812 - the afternoon.
122814 -  ..
122815 - Took the two (2) sets of films, received from the Imaging Department,
122816 - back to the Nuclear Medicine Department.
122817 -
122819 -  ..
1229 -
1230 -
1231 - 1318 Visited Nuclear Medicine
1232 -
123201 - Jessica was at lunch.
123202 -
123203 - There was a nurse or administrator working at a desk inside a room
123204 - leading from the reception area.  Jessica had briefed this person on
123205 - the the film problem matter.
123207 -  ..
123208 - The attendant prepared a film transmittal envelope and marked on it
123209 - that contents are two (2) PET scans, with the dates.
123210 -
123211 -     [On 041021 Millie returned two PET scans to Jessica. ref SDS 27
123212 -     ZE3J
123214 -  ..
123215 - The attendant could not determine from examining the scans in the
123216 - envelopes prepared by the Xray Department, if the contents were Xrays
123217 - or CT tests.
123218 -
123220 -  ..
1233 -
1234 -
1235 - 1340 Visited Xray Department
1236 -
123601 - Talked to Daniello Romero................ 925 295 4789
123602 -
123603 - She opened one of the packages received earlier, per above,
123604 - ref SDS 0 TC6X, and confirmed that we have CT tests.  She looked
123605 - through the stack, and could not find the most recent test done in
123606 - late September 2004, a few weeks ago.  Daniello further noticed that
123607 - the CT test films seemed to out of date order.
123609 -  ..
123610 - Daniello took the stack of films back into a room behind the
123611 - receptionist area to collate.
123613 -  ..
123614 - About 15 minutes later Nichole came out to the receptionist area and
123615 - introduced herself.  She explained that because of the error by the
123616 - Business Department, cited by Tina on 041011, ref SDS 21 PQUP, there
123617 - wasn't enough time to collate the films, so they are in chronological
123618 - order.  Nicole said that Daniello has collated the 1st set, and Nicole
123619 - demonstrated how to read the films to determine the date so that the
123620 - patient can collate the 2nd set.
123621 -
123623 -  ..
1237 -
1238 -
1239 - 1356
1240 -
124001 - Daniello completed collating the first set of films.
124002 -
124003 - Thanked her and Nicole for extra effort.
124004 -
124005 -
124006 -
124007 -
1241 -

SUBJECTS
Medical Chart Illegible Sparse Handwritten Notes Cryptic Unreadable
2nd Opinion Medical Records Review Organize to Facilitate 2nd Opinio

2204 -
2205 - 1930
220601 -  ..
220602 - Organized Medical Records for Submission to UCSF
220603 - Doctor's Notes on Meeting with Patient Sparse, Illegible, No Planning
220604 -
220605 - Review Medical Records
220606 -
220607 - Medical Legal.
220609 -  ..
220610 - This appears to be primarily test results in chronological order, but
220611 - without separation by category, requested by UCSF, reported on 041006,
220612 - ref SDS 17 WL4Q, submitting an oncology check list. ref DRP 2 7R8Y
220614 -  ..
220615 - After the section with test results, Doctor notes with the patient are
220616 - generally in chronological order; some are out of order, and some are
220617 - upside down, not fully copied.
220619 -  ..
220620 - Added tabs with notes that index biopsys, CT and PET tests, and
220621 - identify doctor visits with the patient, per Sheridan's request on
220622 - 041012. ref SDS 22 HW4R
220623 -
220624 -     [On 041018 Doctor Benz at UCSF used the tabs to prepare a patient
220625 -     time line. ref SDS 26 QZ4F
220627 -      ..
220628 -     [On 060819 2nd opinion #3 has fewer documents to organize, so
220629 -     fewer problems. ref SDS 33 PL6M
220631 -  ..
220632 - The doctor's notes on meeting with the patient, consulting, and
220633 - performing examinations are handwritten, illegible, cursory, and
220634 - disconnected from chronology, and context, which aligns with the
220635 - reporting on 990912, ref SDS 2 4T4H, citing failed communication as a
220636 - major cause of medical mistakes. ref SDS 2 0960  On 020402 Michele
220637 - reported there is not enough time for legible communications.
220638 - ref SDS 4 C24N  On 040614 the doctor confirmed that limited time
220639 - prevents receiving legible writings from the patient using em