THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: October 11, 2006 05:46 PM Wednesday; Rod Welch

Millie letter to Kaiser asking for CT test on pulmonary emboli.

1...Summary/Objective
2...UCSF Reduced Cost for 2nd Opinion by $200 Thanks to Kaiser
3...Commend Arlette Kaiser Good Work Makes UCSF 2nd Opinion Faster Easier


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CONTACTS 

SUBJECTS
CT Scan Test 060930 Findings Pulmonary Emboli Request Received from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0903 -    ..
0904 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090501 - Follow up ref SDS 10 OQ40, ref SDS 9 J05V.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090506 -  ..
0906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0908 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090901 - On 060929 the doctor ordered a CT test for pulmonary emboli.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090902 - ref SDS 6 DY5M  The test was performed the next day, and on 061002 the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090903 - doctor called and reported that pathology findings from the test show                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090904 - pulmonary emboli recurrence. ref SDS 8 MI5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090906 -  ..
090907 - Millie submitted a letter requesting a copy of the CT test report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090908 - ref SDS 8 JM9W  The next day on 061003 the doctor responded that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090909 - report was not yet available for distribution. ref SDS 9 J05V  Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090910 - asked again on 061006 for the CT test report. ref SDS 10 OQ40                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090912 -  ..
090913 - Today, Millie submitted ref DIT 1 0001 to Arlette, who works in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090914 - Oncology Clinic with the primary care physician, and asking the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090915 - following...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090916 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090917 -    1.  Doctor Johnson called and left a message a week or so ago [on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090918 -        061002, ref SDS 8 MI5I] saying he got a CT test report saying I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090919 -        have pulmonary emboli again -- when it rains it pours!!!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090920 -        ref DIT 1 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090922 -         ..
090923 -    2.  The CT test was on Sep 30.  I asked the doctor for the report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090924 -        He wrote back saying the analyst had not put it in the system.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090925 -        I followed up a week or so later, and the doctor has not had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090926 -        time to respond.  I suspect he is really backed up with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090927 -        patients, meetings, etc. ref DIT 1 RH5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090929 -         ..
090930 -    3.  If you get a chance, can you please send me the report, and let                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090931 -        the doctor know, so he is not burdened with it.  Just cut and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090932 -        paste it into an email so I can get it into patient history for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090933 -        review.  Be sure and include report ID stuff - date time, who                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090934 -        did the report and so on. ref DIT 1 2A6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090936 -         ..
090937 -    4.  Thanks for your help. ref DIT 1 NP7F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090939 -         ..
090940 -    5.  Incidentally, I got good news today.  Gloria called from the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090941 -        Coagulation Treatment Clinic and said I can stop those awful                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090942 -        shots of Lovenox.  They had me doing 2 weeks instead of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090943 -        usual 1 week, but Gloria said my INR numbers are good, so I can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090944 -        stop Lovenox.  Last time it took months to get the numbers                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090945 -        within range.  I feel blessed to have such a great team at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090946 -        Kaiser. ref DIT 1 XP7I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090948 -         ..
090949 -    6.  How are you recovering from the eye operation?  Hope all is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090950 -        well with you. ref DIT 1 OP8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090951 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090952 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090953 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090954 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
UCSF Reduced Cost for 2nd Opinion by 30% Saved Customer $200 Thanks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
460401 -  ..
460402 - UCSF Reduced Cost for 2nd Opinion by $200 Thanks to Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
460403 - Commend Arlette Kaiser Good Work Makes UCSF 2nd Opinion Faster Easier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
460404 - 
460405 - Follow up ref SDS 7 0000, ref SDS 5 0001.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
460406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460407 -    7.  Another quick note:  Doctor Benz at UCSF really liked the way                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
460408 -        you put together an organized and concise packet of documents                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
460409 -        for a 2nd opinion.  Made the meeting on Aug 21 go a lot better.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
460410 -        I just the got the bill today, and they knocked off more than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
460411 -        $200, over 30% from the quoted price.  Maybe its because of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
460412 -        your good work making their work faster and easier. ref DIT 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
460413 -        FQ8J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
460414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460415 -            [On 061012 Arlette appreciated commendation; feels part of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
460416 -            credit is owed to Kaiser's failure to perform requirements                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
460417 -            for 2nd opinions. ref SDS 11 PW4S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
460419 -  ..
460420 - On 060725 UCSF quoted a price of $700 for a 2nd opinion.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
460422 -  ..
460423 - On 060809 Margaret, the new patient coordinator, called and said that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
460424 - getting medical records organized would be a big help, and save UCSF a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
460425 - lot of time. ref SDS 2 I73H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
460427 -  ..
460428 - Well ordered record is inherent in SDS design to manage chronology,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
460429 - context and connections that aids understanding causation with links                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
460430 - to original sources, explained in POIMS, ref OF 6 8555, and cited in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
460431 - early analysis on 890523 0650. ref SDS 1 TP8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
460433 -  ..
460434 - On 060814 Arlette assembled a packet of documents from Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460435 - medical records for Millie to get a 2nd opinion at UCSF. ref SDS 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
460436 - 407N  A week later, on 060819 these Kaiser documents received from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
460437 - Arlette were organized to facilitate understanding patient history.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
460438 - ref SDS 4 LK4M  This was submitted to UCSF on 060821, ref SDS 5 UE6H,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
460439 - and Doctor Benz used these during the meeting with the patient.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460440 - ref SDS 5 TQ5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
460441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
460442 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
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4605 -