CONTACTS 
0201 - Nixon Peabody LLP                                                                                                                                                  O-00000429 0308
020101 - Mr. Timothy R. Blevins; Office Administrator
020103 - Personnel                                                                                                                                                        O-00000429 0308

SUBJECTS
Millie Released from Hospital Gets Final Drip Treatment Administrati

0503 -
0503 -    ..
0504 - Summary/Objective
0505 -
050501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
050502 -
050503 -
050505 -  ..
0506 -
0507 -
0508 - Progress
0509 -
050901 - Millie called.
050902 -
050903 - She is not sure now whether she will be released today.
050905 -  ..
050906 - She wants Lisa San Jaun at the the N&P office to call Millie at the
050907 - hospital again this morning, and so she needs Millie's new phone
050908 - number, following up the request yesterday. ref SDS 13 023G
050910 -  ..
050911 - Called Lisa and left voice mail to call Millie.
050912 -
050913 -
050914 -
050916 -  ..
0510 -
0511 -
0512 - 0917
0513 -
051301 - Millie called.
051302 -
051303 - She just saw the doctor and will be released.  Her white blood cell
051304 - count is up above 5, and the infection in her hand seems nearly gone.
051306 -  ..
051307 - Mil said to meet her at 1000 for discharge by 1100, otherwise they
051308 - will charge another $200 for the day.
051310 -  ..
051311 - She talked to the nurses, and they said to park in the Emergency Room
051312 - parking lot for discharged patients.
051314 -  ..
051315 - Took Millie's close, purse, etc, which are still in the bag from
051316 - admittance to the hospital last Saturday, 050212. ref SDS 11 5265
051317 -
051318 -
051319 -
051321 -  ..
0514 -
0515 -
0516 - 1003
0517 -
051701 - Arrived at Kaiser Walnut Creek.  The attendant said to park parallel
051702 - in the patient drop off and pick up area, which is immediately in
051703 - front of the entry door to ER.
051705 -  ..
051706 - Upstairs Millie was anxious to go.  She said the nurse, Coquese, just
051707 - stepped out to get discharge papers, including prescriptions.
051708 -
051710 -  ..
0518 -
0519 -
0520 - 1021
0521 -
052101 - After about 15 minutes, Millie decided to take a shower and dress, so
052102 - that she is ready to go when the nurse returns.
052104 -  ..
052105 - While Millie was in the shower, Coquese came into the room, and said
052106 - that Doctor Kim had ordered another drip treatment of antibiotic,
052107 - before Millie leaves the hospital.  She said this will delay release
052108 - by about 30 minutes.
052110 -  ..
052111 - Coquese then noticed that the doctor had not filled out certain
052112 - instructions and signed the release documents.  She left the room and
052113 - said she would be back in a moment to hook up the antibiotic for
052114 - Millie's treatment.
052115 -
052117 -  ..
0522 -
0523 -
0524 - 1028
0525 -
052501 - Millie finishes showering, and dresses to leave.
052502 -
052503 -
052505 -  ..
0526 -
0527 -
0528 - 1047
0529 -
052901 - Coquese has not returned.
052902 -
052903 - Visited with nurses at the common administration area.
052905 -  ..
052906 - Coquese is evidently working with another patient.  A nurse says the
052907 - car will not be towed from in front of the ER entry, despite prolonged
052908 - parking from 1000.
052910 -  ..
052911 - Another nurse volunteers to expedite the work by connecting Millie to
052912 - the drip treatment delivered earlier by Coquese.
052913 -
052914 -
052916 -  ..
0530 -
0531 -
0532 - 1053
0533 -
053301 - Millie connected to drip treatment for antibiotic.
053302 -
053304 -  ..
0534 -
0535 -
0536 - 1113
0537 -
053701 - Coquese returns to the room.
053702 -
053703 - She explains that Doctor Kim is treating another patient and so cannot
053704 - take time to sign documents for Millie's release scheduled for 1000,
053705 - but that to save time the patient can be released without the required
053706 - signature, or that the nurse can sign for Doctor Kim, and that the
053707 - doctor will fill out the details later.
053709 -  ..
053710 - Coquese submitted two documents.  One shows instructions for follow
053711 - up medications the patient will take after release.
053713 -  ..
053714 - Millie complements Coquese's necklace.
053716 -  ..
053717 - Coquese thanks Millie, and said it is a recent Christmas gift, and
053718 - that she had wanted this jewelry for a long time and is very pleased.
053720 -  ..
053721 - Coquese says to let her know when the drip treatment ends, which will
053722 - be indicated by the number on the equipment changing from 200 to 30,
053723 - and should occur in about 10 minutes.
053724 -
053726 -  ..
0538 -
0539 -
0540 - 1125
0541 -
054101 - Equipment showing 30.
054102 -
054103 - Millie calls for Coquese.
054104 -
054106 -  ..
0542 -
0543 -
0544 - 1146
0545 -
054501 - Visit in the common area with another nurse.  Did not get his name.
054502 -
054503 - The nurse came into the patient's room and inspected the drip
054504 - equipment.  He concluded the status showing treatment has completed is
054505 - an error, and resets the equipment for continued treatment, saying
054506 - this might take another 5 minutes or so.
054508 -  ..
054509 - Another nurse comes into the room and says that Coquese is helping
054510 - anthother patient.  She notices that the saline container connected in
054511 - tandem with the antibiotic is, also, dripping.  She concludes that
054512 - treatment with antibiotic has ended and that Millie is ready for
054513 - discharge.
054515 -  ..
054516 - Male nurse concurs and leaves.
054518 -  ..
054519 - The female nurse disconnects apparatus.  She removes the IV connection
054520 - and flushes the port with heprin.  Then the nurse places a bandage on
054521 - the port area.
054523 -  ..
054524 - She advises Millie there is some slight swelling in the port area,
054525 - perhaps due to frequent use the past 3 days.  The nurse had Millie
054526 - feel the blistered area with her fingers, and explained this should
054527 - not be popped nor treated, but should be allowed to heal on its own,
054528 - commenting that the antibiotics Millie just received, and will
054529 - continue to take over the next 9 days should heal the blister.
054531 -  ..
054532 - During this time, another woman, Tammy, came into the room.
054534 -  ..
054535 - Tammy had visited with Millie yesterday, and asked how Millie is doing
054536 - today.
054538 -  ..
054539 - Millie is pleased to be going home, and notes highly professional care
054540 - by Kaiser.
054541 -
054542 -
054543 -
0546 -

SUBJECTS
Physician's Assistant PA New Work Role in Health Care Less Education

1503 -
150401 -  ..
150402 - PA New Work Role in Health Care Less Education Less Training
150403 -
150404 - Millie asks Tammy about her assignment with Kaiser?
150406 -  ..
150407 - Tammy is training to be a Physician Assistant, and expects to graduate
150408 - as a PA within the next few months.  She is getting cross training at
150409 - various Kaiser facilities.
150410 -
150411 -     [On 061227 Sally's daughter Katie is studying to become physician
150412 -     assistant. ref SDS 14 N47G
150414 -  ..
150415 - Differientation of tasks between PA, doctor and nurse were not clear
150416 - from the discussion.  Tammy was not familiar with communciation
150417 - support for the doctor/patient partnership called out in Kaiser's
150418 - Healthwise Handbook, reviewed on 990625, ref SDS 4 3190, so evidently
150419 - this is not expressly part of PA duties.  The Healthwise Handbook does
150420 - say that Physician Assistants and nurses play an important role
150421 - communicating with the patient to avoid mistakes and strengthen
150422 - services for health care. ref SDS 4 7H6J
150424 -  ..
150425 - Good to see doctors getting support for something, along the lines of
150426 - a para legal, and the Project Analyst role at PG&E reported on 941010.
150427 - ref SDS 1 7777
150428 -
150429 -     [On 061227 discussions with Millie's primary care physician on
150430 -     leveraging doctor patient partnership to improve accuracy of
150431 -     medical practice and reduce mistakes that saves lives, time, and
150432 -     money. ref SDS 14 T86F
150434 -  ..
150435 - Other common support roles are...
150436 -
150437 -            Assistant project manager
150438 -            Aide Commanding General
150439 -            Clerk Supreme Court Justice
150441 -  ..
150442 - Each of these roles relieve some of the burden of cognitive overhead
150443 - performing research to ensure accurate understandings, and often
150444 - writing drafts of correspondence, preparing summaries to save time for
150445 - the leadership role, and proof reading and authenticating sources to
150446 - increase accuracy, avoid mistakes, etc.
150448 -  ..
150449 - Physician assistant should provide similar support for doctors to
150450 - avoid mistakes, shown by case study on 040416. ref SDS 6 GN7J
150452 -  ..
150453 - Research on the Internet describes PA scope....
150454 -
150455 -               http://my.webmd.com/hw/health_guide_atoz/ps2091.asp
150456 -
150457 -           Physician's assistants are health professionals who practice
150458 -           medicine under a doctor's supervision.
150460 -            ..
150461 -           Physician's assistants can provide care in both medical and
150462 -           surgical practices. Physician's assistants can:
150463 -
150464 -            •  Perform routine examinations.
150465 -            •  Order laboratory work and X-rays.
150466 -            •  Prescribe medications.
150467 -            •  Counsel people about health practices
150469 -            ..
150470 -           After graduating from a 2-year program, physician's
150471 -           assistants are eligible to take the Physician's Assistant
150472 -           National Certification Examination (PANCE).
150474 -  ..
150475 - Another source says....
150476 -
150477 -           U.S. Department of Labor
150478 -           Bureau of Labor Statistics
150479 -           Occupational Outlook Handbook
150480 -
150481 -               http://www.bls.gov/oco/ocos081.htm#nature
150483 -            ..
150484 -           Physician assistants (PAs) provide healthcare services
150485 -           under the supervision of physicians. They should not be
150486 -           confused with medical assistants, who perform routine
150487 -           clinical and clerical tasks. (medical assistants are
150488 -           discussed elsewhere in the Handbook.) PAs are formally
150489 -           trained to provide diagnostic, therapeutic, and preventive
150490 -           healthcare services, as delegated by a physician. Working
150491 -           as members of the healthcare team, they take medical
150492 -           histories, examine and treat patients, order and interpret
150493 -           laboratory tests and x rays, make diagnoses, and prescribe
150494 -           medications. They also treat minor injuries, by suturing,
150495 -           splinting, and casting. PAs record progress notes, instruct
150496 -           and counsel patients, and order or carry out therapy. In 47
150497 -           States and the District of Columbia, physician assistants
150498 -           may prescribe medications. PAs also may have managerial
150499 -           duties. Some order medical and laboratory supplies and
150500 -           equipment and may supervise technicians and assistants.
150501 -
150502 -
150504 -         ..
150505 -        PA Leverages Doctor's Cost Does Not Improve Quality of Care
150506 -
150507 -        This gets more practitioners in the field in less time and less
150508 -        cost, and leverages the skill and cost of a physician across
150509 -        many more patients.
150511 -         ..
150512 -        Scope for recording progress notes may relate to Kaiser
150513 -        requirementss for communication support, however, the primary
150514 -        aim here is lower of cost medical care, with faster turn around
150515 -        in schooling.
150517 -         ..
150518 -        The opportunity to assist a physician in the manner that Todd
150519 -        and Denise assisted Doctor Guardino at Stanford on 041019,
150520 -        ref SDS 8 ID5Q, and further, ref SDS 8 ER6F, does not seem to
150521 -        be contemplated by the PA system.  In effect, the profession is
150522 -        attempting to reduce cost by replacing project managers with
150523 -        team leaders, reported on 950705. ref SDS 3 2165
150524 -
150525 -
150526 -
150527 -
1506 -

SUBJECTS
Tempearture Rises at Home after Release from Hospital Then Temperatu

1603 -
1604 - 1202
160501 -  ..
160502 - Hospital Check-out Temperature Rises at Home, then Falls to Normal
160503 -
160504 - Left the hospital room.
160506 -  ..
160507 - Millie feels a little wobbly after 3 days in bed.
160509 -  ..
160510 - Visited the Admitting room in the main lobby and paid the bills,
160511 - about $550.
160513 -  ..
160514 - Visited pharmacy and filled prescriptions.
160515 -
160517 -  ..
1606 -
1607 -
1608 - 1247
1609 -
160901 - Lunch at Cocos on Treat Blvd in Concord.
160902 -
160903 - Millie has a bowl of broccile soup, and we split a cheese burger.
160905 -  ..
160906 - She is concerned about eating the lettuce and tomato, but recalls the
160907 - nurse saying that Doctor Kim removed restrictions from her diet, which
160908 - were cited on Saturday, 050212. ref SDS 11 ET3W
160909 -
160910 -
160911 -
160913 -  ..
1610 -
1611 -
1612 - 1743
1613 -
161301 - Millie's temperature rises to 99.4
161302 -
161303 - Her forehead is quite warm to the touch.
161305 -  ..
161306 - She is drinking water, and takes Vicadin, which Doctor Kim prescribed
161307 - on Tuesday to relieve back pain reaction to nupogin, given to
161308 - increase white blood cell count.
161310 -  ..
161311 - Prepare dinner.
161313 -  ..
161314 - Appetite seems okay.
161315 -
161317 -  ..
1614 -
1615 -
1616 - 1818
1617 -
161701 - Millie takes antibiotic in pill form, per prescription twice a day
161702 - after meals.
161703 -
161705 -  ..
1618 -
1619 -
1620 - 1906
1621 -
162101 - Temperature drops to normal.
162102 -
162103 - Millie takes Coumodin, and goes to bed.
162105 -  ..
162106 - Watches television for an hour or so, and falls to sleep.
162107 -
162108 -
162110 -  ..
1622 -
1623 -
1624 - 2203
1625 -
162501 - Check on Millie.
162502 -
162503 - Take her glasses off.  She is resting comfortably.
162504 -
162505 -
162506 -
162507 -
162508 -
162509 -
162510 -
162511 -
1626 -