CONTACTS 

SUBJECTS
Scope of Work Priority Payments Work Plan to Fit Budget

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 6 0000, ref SDS 5 0000.
040502 -
040503 - Steve provided constructive comments on meeting budget objectives.
040504 - Doctor Allen Hasse was outstanding performing root canal to stabalize
040505 - the current emergency.   The doctor's practice offering a running
040506 - commentary explaining work in progress is an important first step for
040507 - quality control. ref SDS 0 YN4L  After completing work today, decided
040508 - to pay current charges, and review the scope of remaining tasks to set
040509 - a priority that fits the budget. ref SDS 0 MM5O
040511 -      ..
040512 -     [On 050520 called Lyn to discuss limiting work to fit the budget.
040513 -     ref SDS 8 6194
040515 -      ..
040516 -     [On 050525 Lyn scheduled work on the 2 crowns to be performed on
040517 -     050615. ref SDS 9 0001
040518 -
040519 -
040521 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Work Plan and Scope of Work Review
040902 -
040903 - Follow up ref SDS 6 F85G.
040904 -
040905 - Initially, visited with Steve to discuss the scope of work.
040906 -
040907 - Advised that we cannot afford the $10K or so in Lyn's work up received
040908 - yesterday. ref SDS 6 F85G  So far we have commited to spend $2,600 for
040909 - emergency work yesterday, and for preliminary work today that treats
040910 - the infection discovered in tooth #19.  We can only afford $4K, and
040911 - might be able to reach $4,500.
040913 -  ..
040914 - Steve will review Lyn's estimate to determine a priority that fits the
040915 - budget.
040916 -
040917 -
040918 -
040919 -
0410 -

SUBJECTS
Root Canal Tooth #19 Remove Infection and Prepare for New Crown

0503 -
050401 -  ..
050402 - Root Canal Tooth #19 Remove Infection and Prepare for New Crown
050403 -
050404 - Steve introduced Doctor Allen Hasse to perform the root canal on tooth
050405 - #19, which is an essential predicate to repair the immediate problem,
050406 - reported on 050516. ref SDS 5 QT5I
050408 -  ..
050409 - The doctor explained the root canal work process to remove infection
050410 - discovered in the jaw below tooth #19 yesterday. ref SDS 6 F79R
050412 -  ..
050413 - Work began with a numbing agent using Novocaine administered in at
050414 - least 4 separate shots, possibly more.  Several shots were given, and
050415 - then more were given after some numbing occurred.  A mechanism was
050416 - used that slightly vibrated the teeth and jaw as a distraction to
050417 - minimize pain from the shot procedure.
050419 -  ..
050420 - The doctor installed a temporary barriar comprised of a pliable
050421 - plastic shield stretched flat with a wire frame.  A whole in the
050422 - middle of the shield permitted access to the work area, while sealing
050423 - off the rest of the mouth.  The shield prevents water and debris
050424 - during the work from flowing into the mouth and down the throat.  This
050425 - reduced the maintenance effort by the attendant, and further solved
050426 - the problem encountered yesterday by Russ when water from the work
050427 - process escapes maintenance efforts by the aide, and flows into the
050428 - throat, which in my case was more problematic. ref SDS 6 F77O
050429 -
050430 -
050432 -  ..
050433 - Contemporaneous Verbal Account Aids Quality Control, Lessons Learned
050434 -
050435 - The doctor offered to provide a running verbal account of work in
050436 - progress, and this was accepted.
050438 -  ..
050439 - Continuous spoken commentary during work procedures is a good
050440 - real-time quality control cross-check for the doctor and aide that
050441 - helps recognize gaps on procedure.  It complements visual observation
050442 - for taking immediate action to correct errors.  Verbally explaining
050443 - tasks while performing tasks fits the model of double entry
050444 - verification, ref OF 6 3I8M, cited in POIMS for a contemporaneous
050445 - record that is part of the scientific method. ref OF 5 2300
050447 -  ..
050448 - Capturing a transcript of the verbal account enables debriefing to
050449 - discover gaps in procedure that escape notice in the "fog of war"
050450 - during daily work.  Connecting a transcript into an SDS record with
050451 - links to prior work improves discovery and follow up, and further
050452 - yields organizational memory for lessons learned.  This supports
050453 - continual improvement for the firm that benefits customers, and, also,
050454 - provides case studies for professional training, illustrated by the
050455 - record on 040517 showing lessons learned for timely diagnosis of
050456 - inflammatory breast cancer (IB). ref SDS 4 PW8F
050457 -
050458 -        [On 050520 Doctor Johnson at Kaiser demonstrated efforts to
050459 -        strengthen medical practice by capturing a contemporaneous
050460 -        record of patient communications, examination, diagnosis and
050461 -        prescription. ref SDS 7 HX6J
050463 -  ..
050464 - The doctor explained the first step drills out decay discovered by
050465 - Steve yesterday. ref SDS 6 YV6N
050466 -
050467 -
050469 -  ..
050470 - Root Canal Tasks
050471 -
050472 - Root canal tasks to remove infection deep into the tooth root
050473 - structure, also, found by Steve yesterday, ref SDS 6 F79R, involved
050474 - several steps....
050475 -
050476 -        1.  Identify roots - 4 branches found.
050477 -
050478 -            The doctor commented that normally he would expect to find
050479 -            2 root branches into the jaw bone, but in this case tooth
050480 -            #19 has 4 separate branches.
050482 -             ..
050483 -        2.  Determine depth of the roots.
050484 -
050485 -            This seems to entail drilling and testing.  The description
050486 -            today during the procedure seemed to explain using a form
050487 -            of sonar technology for measuring depth.
050489 -             ..
050490 -        3.  Drill 4 roots to the depth determined in step 2.
050491 -
050492 -            This step was meticulous and therefore slow.
050494 -             ..
050495 -            The mechanics of controlling the depth were not clear from
050496 -            the running narrative.
050498 -             ..
050499 -        4.  Bleaching drilled out roots that removes infection.
050500 -
050501 -            Verbal commentary seemed to indicate that bleaching may
050502 -            have been performed in stages during the drilling, rather
050503 -            than after all 4 roots were drilled to the target depth.
050505 -             ..
050506 -        5.  Drill 4 roots to enlarge the cross-section to depth in step
050507 -            2.
050509 -             ..
050510 -            The doctor showed several different sized drills, which
050511 -            are very fine titanium-like instruments.
050513 -             ..
050514 -        6.  Bleaching re-drilled roots to fully disinfect roots.
050515 -
050516 -            The commentary seemed to suggest that a specific cleaning
050517 -            agent was also used, in addition to bleach, once all 4
050518 -            roots were fully opened with drilling.
050520 -             ..
050521 -        7.  Roots filled and packed.
050522 -
050523 -            Once the doctor was satisfied that all infection was
050524 -            removed and/or treated, a filling material was packed into
050525 -            the 4 roots to close the holes drilled for the treatement.
050527 -             ..
050528 -        8.  Xray shows infection removed
050529 -
050530 -            This step may have been performed before the roots were
050531 -            packed in step 7, because if infection is still shown with
050532 -            xray, the packing would have to be drilled out in addition
050533 -            to further drilling to removed the infection.
050535 -             ..
050536 -            The doctor showed the xray of the treated tooth #19, and
050537 -            compared this with the xray taken yesterday.  He was
050538 -            satisfied that a material difference in the xrays showed
050539 -            the root canal was successful.  The basis of this
050540 -            conclusion was not visually evident from comparing the
050541 -            xrays in that yesterday infection was identified as a
050542 -            darkened area between the roots of tooth #19 and the
050543 -            adjacent tooth. ref SDS 6 F79R  Today, there appeared to be
050544 -            the same darkened area of the xray today on the same tooth
050545 -            after treatment.
050547 -             ..
050548 -        9.  Build up
050549 -
050550 -            This provides a foundation for the crown work to finish
050551 -            repair of tooth #19, in the scope of work reviewed by Steve
050552 -            yesterday, ref SDS 6 FB83, and listed in the work plan
050553 -            received from Lyn. ref SDS 6 ZZ4M
050554 -
050555 -
050557 -  ..
050558 - Pain Treatment to Relieve Aftermath of Root Canal Procedure
050559 -
050560 - The doctor advised that there may be pain resulting from the work
050561 - today after the Novocaine wears off in a few hours.  He provided pain
050562 - two (2) types of pain medication.
050563 -
050564 -        Turned out later this evening, there was no evident pain,
050565 -        except the tongue seemed swelled, and so was sore from rubbing
050566 -        against the new work put in place today.  As a result, pain
050567 -        medication was not used.
050568 -
050569 -
050570 -
050571 -
050572 -
050573 -
050574 -
0506 -

SUBJECTS
Scope of Work Priority Payments Work Plan to Fit Budget

0603 -
0604 - 1407
060501 -  ..
060502 - Priortize Work to Align with Budgeting
060503 -
060504 - Follow up ref SDS 6 F85G.
060505 -
060506 - After completion of root canal work, Steve came by to discuss next
060507 - steps.
060509 -  ..
060510 - He feels strongly that prices Lyn submitted yesterday are competitive,
060511 - and that no adjustments are possible.
060513 -  ..
060514 - Steve further recommended getting at least 2 crowns, one for tooth
060515 - #19, and another for the adjacent tooth.  He feels this work is
060516 - complementary because of proximity, and expects that failure to repair
060517 - the crown on the adjacent tooth will cause infection in that tooth,
060518 - leading to additional cost of $1,600 for another root canal, as
060519 - performed today.
060521 -  ..
060522 - When asked about cost for the minimum amount needed for next steps,
060523 - Steve seemed to say this will increase total costs to $6K, which
060524 - exceeds available funding of $4K, discussed this morning, per above.
060525 - ref SDS 0 QT5I
060526 -
060527 -     [On 050520 Lyn indicated that Steve concurs with limiting initial
060528 -     next steps to repairing 2 crowns, making total cost of $5K, and
060529 -     final payment in the July payables cycle. ref SDS 8 5Q9O
060531 -      ..
060532 -     [On 050525 Lyn scheduled work on the 2 crowns to be performed on
060533 -     050615. ref SDS 9 0001
060535 -  ..
060536 - After further discussion, Steve said that the initial emergency has
060537 - now been stabalized.  We decided to proceded with payment of work
060538 - through today, which is approximately $2,600, shown in analysis
060539 - yesterday. ref SDS 6 ZZ4M
060541 -  ..
060542 - More review of the work plan is needed to develop a path for
060543 - accomplishing next steps.
060545 -  ..
060546 - Visited briefly with Lyn, following up discussions yesterday.
060548 -  ..
060549 - Lyn asked when Steve can get a check to pay for the work today?
060551 -  ..
060552 - We reviewed standard practice for Steve to submit an invoice, and
060553 - payment will be issued with other payables for May.  Explained that
060554 - Mil has offered to make this payment.  Lyn seemed worried.  We called
060555 - Millie at N&P upstairs on the 27th floor.  Lyn talked to Millie, and
060556 - they decided that Lyn will mail an invoice for services through today,
060557 - and Mil make prompt payment, rather than wait for the normal payment
060558 - cycle.
060560 -  ..
060561 - Lyn asked about scheduling remaining work.
060563 -  ..
060564 - We decided to discuss this next week.
060566 -  ..
060567 - Lyn will call to follow up.
060568 -
060569 -     [On 050520 Lyn indicated that Steve concurs with limiting initial
060570 -     next steps to repairing 2 crowns, making total cost of $5K, and
060571 -     final payment in the July payables cycle. ref SDS 8 5Q9O
060572 -
060573 -     [On 050525 Lyn scheduled work on the 2 crowns to be performed on
060574 -     050615, ref SDS 9 0001, with completion on 050705 and the next day
060575 -     on 050706. ref SDS 9 HT7F
060577 -      ..
060578 -     [On 050629 called and moved the meeting on 050706 to 050707 1100
060579 -     in order to avoid conflict with meeting in Martinez on 050706 at
060580 -     1030. ref SDS 10 YR4H
060581 -
060582 -
060583 -
060584 -
060585 -
060586 -
060587 -
060588 -
060589 -
060590 -
060591 -
060592 -
0606 -