CONTACTS 

SUBJECTS
CT Scan Test 060930 Receive Report Findings Pulmonary Emboli from Ka                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0903 -    ..
0904 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0905 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090501 - Follow up ref SDS 30 0000. ref SDS 29 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090503 - CT scan imaging test diagnoses pulmonary embolism again.  Research                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090504 - indicates 45% of patients die who suffer recurrence of pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090505 - embolism die, suggesting Millie landed in the lucky 55% group while                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090506 - off treatment since 051007. ref SDS 0 294Q  Test results continue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090507 - patient history showing no evidence of distant metastasis. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090508 - 1Y8G  Enlarged right ventricle presents a new issue of heart problems.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090509 - ref SDS 0 7E5L  The analyst failed to compare current conditions with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090510 - prior test that found pulmonary embolism on 041103, contrary to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090511 - doctor's order for trend analysis.  Failing to provide comparisons for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090512 - analysis of emerging problems in time for effective treatment presents                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090513 - continuing problems in medical practice. ref SDS 0 2935  Lay analysis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090514 - comparing current with original PE findings may indicate a less severe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090515 - problem because now only the lower lobe of the right lung has blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090516 - clots, whereas on 041103 both upper and lower lobes had involvement;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090517 - new issue of enlarged right ventricle requires professional comment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090518 - ref SDS 0 7E7G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
090519 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090520 -            [On 061013 Millie submits letter thanking Arlette for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
090521 -            submitting the report. ref SDS 31 UR7K and ref SDS 31 I79W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090522 -            and asking questions for clarification. ref SDS 31 US6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090524 -             ..
090525 -            [On 061015 received a letter from Arlette reporting that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090526 -            the leter today was submitted to the primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090527 -            physician. ref SDS 32 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090529 -             ..
090530 -            [On 061201 Kaiser prescribes Procrit to treat anemia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090531 -            diagosed from low hemoglobin reported in one blood test,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090532 -            where Procrit was not prescribed previously with low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090533 -            hemoglobin in 10 blood tests, and presents a small risk of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
090534 -            blood clots, and cardiovascular problems, ref SDS 39 OU9G,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090535 -            that compound patient profile diagnosed on 061012 with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090536 -            pulmonary embolism, and enlarged right ventricle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090537 -            ref SDS 0 294Q,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090539 -             ..
090540 -            [On 070102 report received for PET/CT scan test on 061227;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090541 -            shows not distant metastasis; Millie's problem local                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090542 -            regional at most. ref SDS 42 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090543 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090544 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090545 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090546 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090547 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090549 -  ..
0906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0908 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090901 - On 060929 the doctor ordered a CT test for pulmonary emboli.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090902 - ref SDS 25 DY5M  The test was performed the next day on 061030, and on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090903 - 061002 the doctor called and advised that pathology from the test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090904 - shows findings of pulmonary emboli recurrence. ref SDS 27 MI5I  Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090905 - sent a letter asking the doctor to submit a copy of the CT test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090906 - report. ref SDS 27 JM9W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090908 -  ..
090909 - The next day on 061003 the doctor responded that the report was not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090910 - yet available for distribution. ref SDS 28 J05V  Millie asked again on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
090911 - 061006 for the CT test report. ref SDS 29 OQ40  Yesterday, on 061011                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090912 - Millie submitted ref DIP 1 0001 to Arlette, who works in the Oncology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
090913 - Clinic with the primary care physician, and asking for assistance                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090914 - getting the CT test report, with the aim of reducing the burden on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090915 - doctor to perform administrative tasks. ref SDS 30 WV6Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
090917 -  ..
090918 - Today, Millie received the report from the doctor answering her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090919 - earlier letters, per above. ref SDS 0 AD5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090921 -  ..
090922 - Millie also received the report from Arlette attached to a letter,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090923 - ref DRT 1 0001, saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090924 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090925 -    1.  Please note that this has not been authenticated. In other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090926 -        words, this was dictated, but the dictating doctor has not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090927 -        signed it or read it for errors.  So, don't hold me to this.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090929 -  ..
090930 - The report is shown below.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
090931 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090932 -           [On 061013 Millie submits letter thanking Arlette for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
090933 -           submitting the report. ref SDS 31 UR7K and ref SDS 31 I79W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090934 -           and asking questions for clarification. ref SDS 31 US6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090936 -  ..
090937 - Arlette's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090938 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090939 -    2.  I am glad my report helped you out.  I think he dropped the two                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090940 -        hundred dollars because he knew you were paying out of your own                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090941 -        pocket.  But, thank you for the compliment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090943 -  ..
090944 - Arlette comments on Millie's letter commending her work improving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090945 - Kaiser's records management that saved time and money, reported in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
090946 - letter yesterday. ref SDS 30 WW4Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
090948 -  ..
090949 - Arlette's analysis overlooks patient history working with UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090950 - Stanford, and others where the customer has consistently paid full                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090951 - price for many prior 2nd opinions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
090953 -  ..
090954 - Arlette's letter continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090955 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090956 -    3.  I am so glad you don't have to take the Lovenox any more!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
090957 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090959 -  ..
090960 - Millie also received ref DRT 2 0001 from the primary care physician                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090961 - saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
090963 -         ..
090964 -    1.  [Responding to your letters on October 2, 2006, and follow up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090965 -        request on October 6,2006]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090967 -         ..
090968 -    2.  I have been away a few days. Here is your report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
090969 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090971 -  ..
090972 - Arlette and the doctor submitted the following...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
090973 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090974 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090975 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
090976 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Distant Metastasis No Findings CT Test 061012 Report No Findings Lef                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
1703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
170401 -         ..
170402 -        Test History No Evidence Distant Metastasis ant Metastasis No Evidence 5 Years Imaging Tests                                                                                                                                                                                                                                                                                                                                                                                                                                                              
170403 -        
170404 -        Follow up ref SDS 17 SJ65.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
170405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170406 -         Type    Date               Received          Source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170407 -          CT     060930 reported on 061012........... ref SDS 0 284J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
170408 -          MRI    060708 reported on 060711........... ref SDS 18 PT4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170409 -          Xray   060623 reported on 060711........... ref SDS 18 WJ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170410 -          CT     060505 reported on 060523........... ref SDS 17 009L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170411 -          PET    060414 reported on 060428........... ref SDS 16 WJ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170412 -          PET    060120 reported on 060126........... ref SDS 15 WJ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170413 -          PET/CT 051005 reported on 051007........... ref SDS 14 WJ6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170414 -          CT     050530 reported on 050610........... ref SDS 13 G75L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170415 -          CT     050325 reported on 050422........... ref SDS 12 G75L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170416 -          CT     041217 reported on 041230........... ref SDS 11 G75L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
170417 -          CT     041103 reported on 041104........... ref SDS 2 NL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170418 -          CT     040921 reported on 041005........... ref SDS 9 NL4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170419 -          CT     040710 reported on 040811........... ref SDS 3 DU9I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170420 -          CT     040410 reported on 040416........... ref SDS 7 HX4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170421 -          CT     040307 reported on 040318........... ref SDS 4 LK5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170422 -          CT     031031 reported on 031205........... ref SDS 5 IG9K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170423 -          CT     030626 reported on 030710........... ref SDS 4 AL6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170424 -          CT     030428 reported on 030508........... ref SDS 3 LK5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170425 -          PET    021218 reported on 030109........... ref SDS 2 LK5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170426 -          PET    020529 reported on 020603........... ref SDS 1 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170428 -  ..
170429 - CT test on 060930 finds no evidence of disease in any of the three                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
170430 - regions where cancer has previously been investigated, as shown below,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
170431 - ref SDS 0 2967, and no evidence of cancer anywere else, as previously                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
170432 - reported on 060523. ref SDS 17 3Y5M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
170433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170435 -     ..
170436 -    CT SCAN - CHEST  (Digital)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
170439 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170440 -    ******* R E P O R T  N O T  A U T H E N T I C A T E D *******                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
170442 -     ..
170443 -    TECHNIQUE:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
170444 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170445 -        A CT pulmonary angiogram was performed.  No complications from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
170446 -        administration of intravenous contrast agent.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
170447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170449 -     ..
170450 -    ** HISTORY **                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
170451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170452 -        History of inflammatory breast cancer.  Previously had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
170453 -        pulmonary embolus in 2004, now with similar symptoms.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
170454 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
170457 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
1705 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
CT Scan Test 060930 Kaiser Imaging Department Failed Perform Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
3703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370401 -     ..
370402 -    Comparison:  05/05/06 and 05/30/05.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370403 -    
370404 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370405 - On 060929 the primary care physician ordered comparison with the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370406 - examination on 041103 which previously found pulmonary embolism.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370407 - ref SDS 25 DY75                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370409 -            [On 061024 case study medical practice computer access                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370410 -            limited even with everything on the computer, people can't                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370411 -            find details stored in parts of the computer (software                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370412 -            modules) that are not frequently used. ref SDS 35 JD9L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370414 -  ..
370415 - Why was comparison requested by the doctor not performed?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370417 -  ..
370418 - On 060126 analyst reported comparison could not be performed because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370419 - Kaiser could not find the record in organizational memory for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370420 - prior tests. ref SDS 15 XF3K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370422 -  ..
370423 - Lay comparison seems to indicate current problem is less severe than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370424 - when pulmonary embolism was diagnosed originally on 041102, per below.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370425 - ref SDS 0 7E7G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370427 -  ..
370428 - Was failure to perform a comparison ordered by the doctor for the CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370429 - test on 060930 a computer problem, where the file for the test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370430 - 041103 was not readily available, and so the effort to find the file                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370431 - seemed like unnecessary overkill in light of the primary finding of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370432 - pulmonary emboli that triggers treatment?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370434 -            [On 061013 letter to Kaiser asks how to get comparison                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370435 -            ordered by the doctor for effective trend analysis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370436 -            ref SDS 31 I75V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370438 -             ..
370439 -            [On 061015 received a letter from Arlette reporting that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370440 -            the leter on 061013 asking about this issue was submitted                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370441 -            to the primary care physician. ref SDS 32 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370443 -             ..
370444 -            [On 061020 Oncology Infusion Clinic reported multiple                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370445 -            software programs create confusion treating patients,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370446 -            requiring transfering data manually between programs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370447 -            ref SDS 33 TR53                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370449 -             ..
370450 -            [On 061020 Oncology Pharmacy did not have ready access to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370451 -            the doctor ordering treatment with Coumadin for pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370452 -            emboli, and so was unaware until the patient reported this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370453 -            change in pharmacology protocol. ref SDS 33 T650                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370455 -             ..
370456 -            [On 061020 primary care physician did not have time to make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370457 -            comparison during examination. ref SDS 34 N96N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370459 -             ..
370460 -            [On 061026 Coagulation Treatment Clinic uses software that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370461 -            requires accessing another part of Kaiser's computer system                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370462 -            to coordinate patient treatments; such access requires                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370463 -            training, and time for performance; therefore direct notice                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370464 -            from the doctor and support staff in Oncology Pharmacy, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370465 -            occurred on 061020, ref SDS 33 VE57, and by the patient, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370466 -            encouraged by the pharmacist, also, on 061020, ref SDS 33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370467 -            S69H, assists the Coagulation Treatment Clinic in making an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370468 -            accurate and effective balance of treatments for pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370469 -            embolism with chemotherapy treatments for cancer using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370470 -            capecitabine (Xeloda) in this case. ref SDS 35 TZ4I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370472 -             ..
370473 -            [On 061208 doctor ordered PET scan test to set new baseline                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370474 -            for changing chemotherapy to treat IBC; and added to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370475 -            order request for analysis of pulmonary embolism, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370476 -            enlarged right ventricle by comparing and contrasting with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370477 -            prior CT tests on 041103 and on 060930, even though CT scan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370478 -            tests are a better diagnostic for this comparison.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370479 -            ref SDS 40 ZY5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370481 -             ..
370482 -            [On 070102 doctor's order ignored for comparison PET/CT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370483 -            test on 061227. ref SDS 42 AK9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370485 -             ..
370486 -            [On 070517 doctor reports Kaiser changed the policy to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370487 -            analyse only 20% of test data, and fail to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370488 -            progression of disease by making comparisons with prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370489 -            test results. ref SDS 46 OS5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370491 -             ..
370492 -            [On 070524 CT test on 070520 failed to cite patient history                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370493 -            of lung and heart disorders, and failed to perform                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370494 -            comparison to assess progression of pulmonary embolism and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370495 -            enlarged right ventricle. ref SDS 47 0136                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370496 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370497 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370498 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370500 -  ..
370501 - Case Study Ignore Doctor's' Order for Patient Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370502 - 
370503 - The record on 040416 reviews medical mistakes generally in Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370504 - patient history. ref SDS 7 GN7J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370506 -  ..
370507 - This study shows growing trends failing to perform doctor's orders on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370508 - scope of medical care to test, evaluate, diagnose, prescribe, deliver                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370509 - and evaluate treatment based on patient history for progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370510 - disease...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370512 -         ..
370513 -    1.  PET scan test 060120 omits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370514 -        comparison prior test because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370515 -        Kaiser cannot find report for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370516 -        test on 051005....................... 060126, ref SDS 15 XF3K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370518 -         ..
370519 -    2.  PET scan test on 060414 fails to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370520 -        make comparison with prior test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370521 -        on 060120 that reported findings                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370522 -        of likely esophagitis; did prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370523 -        findings disappear, get worse,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370524 -        was it a mistake, what                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370525 -        happened?............................ 060428, ref SDS 16 OX62                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370527 -         ..
370528 -    3.  CT test on 060505 ordered for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370529 -        contrast study with PET scan test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370530 -        on 060414 failed to perform the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370531 -        comparison, and instead compared                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370532 -        with a test a year                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370533 -        earlier.............................. 060523, ref SDS 17 009L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370535 -         ..
370536 -    4.  MRI test on brain omitted comparison                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370537 -        with prior test on 020617 because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370538 -        analyst could not find the prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370539 -        report............................... 060711, ref SDS 18 QPRT                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370541 -         ..
370542 -    5.  CT test on 060930 ordered comparison                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370543 -        with prior test on 041103 that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370544 -        previously discovered pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370545 -        embolism; analyst ignored request                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370546 -        compared only with most recent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370547 -        CT test on 060505 which did not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370548 -        report PE, so comparison                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370549 -        was useless.......................... 061012, ref SDS 0 2935                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370550 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370551 -            [On 151019 0930 VA Radiology proposed ignoring doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370552 -            referral in Cardiology to perform CCTA with calcium score                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370553 -            for patient who had prior CABG +4 surgery, 6 years earlier.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370554 -            ref SDS 61 XX3O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370556 -         ..
370557 -    6.  PET/CT test on 061227 ordered comparison                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370558 -        with prior PET test on 060120 to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370559 -        likely esophagitis; comparison with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370560 -        CT test on 060505 to evaluate nodes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370561 -        in right paratrachael; comparison prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370562 -        CT test on 041103 and recent test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370563 -        060930 to evaluate progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370564 -        Pulmonary embolism, and of heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370565 -        disorder Cor Pulmonale enlarged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370566 -        right ventrical...................... 070102, ref SDS 42 9X9S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370568 -         ..
370569 -    7.  CT test on 070131 failed to present                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370570 -        patient history, and comparison with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370571 -        prior findings to assess progression                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370572 -        of lung and heart disease and risk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370573 -        of prescribing treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370574 -        cetuximab that has documented                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370575 -        history of causing lung                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370576 -        and heart disorders in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370577 -        some cases........................... 070202, ref SDS 44 0Z6O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370578 -        Comparison section cites only test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370579 -        on 060505, and omits much more recent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370580 -        tests on 061229, and on 060930                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370581 -        which diagnosed recurrence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370582 -        of lung and heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370583 -        disorders............................ 070202, ref SDS 44 0136                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370585 -         ..
370586 -    8.  CT test on 070326 doctor's order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370587 -        ignored for spiral CT test to evaluate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370588 -        pulmonary embolism and enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370589 -        ventricle with comparison of pior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370590 -        tests on 041103, 041217, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370591 -        on 060930............................ 070329, ref SDS 45 0136                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370593 -         ..
370594 -    9.  Doctor represents having authority to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370595 -        order comparisons, which conflicts with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370596 -        this case study; presents policy issue                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370597 -        that benefits do not justify costs of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370598 -        trend analysis for evaluating progression                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370599 -        of lung and heart disorders which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370600 -        reduces time for testing other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370601 -        patients............................. 070517, ref SDS 46 OS5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370603 -         ..
370604 -   10.  CT test 070520 fails to present patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370605 -        history for scope of analysis and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370606 -        ignored planning to evaluate progression                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370607 -        of lung and heart disorders with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370608 -        comparision of findings on 060930                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370609 -        that diagnosed pulmonary embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370610 -        and enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370611 -        ventricle............................ 070524, ref SDS 47 0136                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370613 -         ..
370614 -   11.  CT scan report for on test 080212 omits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370615 -        patient history recurrent pulmonary embolism,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370616 -        enlarged right ventrical (cor pulmonale),                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370617 -        enlarged heart, esophigitis; fails to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370618 -        perform comparison with prior test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370619 -        findings............................. 080215, ref SDS 50 IX4F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370621 -         ..
370622 -   12.  Collaboration failure referral coordination                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370623 -        blood test at UCSF on 080306 sent to Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370624 -        on 080307 was not evaluated for emergency                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370625 -        care at Kaiser on 080409; Kaiser compared                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370626 -        blood test on 080409 with data on 071017                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370627 -        because nobody entered 6 months of test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370628 -        data in Kaiser computer; if data is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370629 -        not in the computer it does not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370630 -        exist................................ 080409, ref SDS 51 439L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370632 -         ..
370633 -   13.  Someone at Kaiser changed the doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370634 -        order for Millie's urgent care on referral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370635 -        to UCSF scheduled to start tomorrow on 081113,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370636 -        because someone at Kaiser feels Kaiser has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370637 -        no responsibility for Millie's care, if                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370638 -        the doctor orders treatment in a clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370639 -        trial, even in this case when the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370640 -        orders continuing care the past 2 years                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370641 -        at UCSF because Kaiser has no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370642 -        more treatments for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370643 -        Millie............................... 081112, ref SDS 55 P28U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370644 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370645 -            [On 151019 0930 VA Radiology proposed ignoring doctor's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370646 -            referral in Cardiology to perform CCTA with calcium score                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
370647 -            for patient who had prior CABG +4 surgery, 6 years earlier.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370648 -            ref SDS 61 XX3O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370650 -         ..
370651 -   14.  Michelle in Kaiser's claims Department                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370652 -        advised that Millie's primary care doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370653 -        is in charge of her care.  The doctor is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370654 -        responsible to perform case management                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370655 -        under section 2 of Kaiser's EOC including                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370656 -        referral for Millie's treatment to UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370657 -        She said that Kaiser is required to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370658 -        implement the doctor's order for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370659 -        oncology care covered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370660 -        by the EOC........................... 081112, ref SDS 55 PR35                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370662 -         ..
370663 -   15.  CT test on 081107 was compared with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370664 -        test on 080718, rather than the most                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370665 -        recent test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370666 -        080911............................... 081112, ref SDS 56 RV49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370668 -         ..
370669 -   16.  CT test on 081107 resulted in 2 separate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370670 -        reports issued days apart, which caused                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370671 -        confusion in patient care and conveyed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370672 -        false impression of error because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370673 -        report on neck findings were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370674 -        issued separately.................... 081113, ref SDS 57 RU6R                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370675 -        case study patient history shows 11                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370676 -        CT and PET studies were performed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370677 -        including neck, chest, abdomen, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370678 -        pelvis, and all test findings were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
370679 -        always consolidated into a single                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
370680 -        report............................... 081113, ref SDS 57 HV4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370682 -         ..
370683 -   17.  CT test ordered in Kaiser's computer on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370684 -        081210 to be performed on 081230 included                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370685 -        the neck, and required using Millie's Power                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370686 -        Port with support from the Chemotherapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370687 -        Clinic and Interventional Services to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370688 -        access the port for injecting contrast                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370689 -        medium, and further specified a consolidated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370690 -        report to avoid mistakes; none of these                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370691 -        requirements were in the computer referral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
370692 -        order reviewed on 081219, indicating that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370693 -        somone changed the doctor's order in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370694 -        computer without inquiry nor notice;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
370695 -        the doctor corrected mistakes in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
370696 -        the computer to conform with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370697 -        patient requirements................. 081219, ref SDS 58 WP30                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370699 -         ..
370700 -   18.  CT findings for next test on 081230 again                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370701 -        published in 2 separate reports ignored                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370702 -        doctor's order for consolidated report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
370703 -        to maintain a well ordred record that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
370704 -        helps reduce medical mistakes;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
370705 -        doctor confused submits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370706 -        only 1 of 2                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
370707 -        reports.............................. 090109, ref SDS 59 V53J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370709 -         ..
370710 -   19.  Blood test for cancer marker CA 15-3 ordered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370711 -        in Kaiser's computer by the doctor on 090213                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370712 -        for lab on 090309; Kaiser failed to perform,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
370713 -        and on 090312 report that computer does                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370714 -        not show cancer marker in the order for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
370715 -        the lab on 090309; Doctor feels something                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
370716 -        funny occurred changing medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
370717 -        orders for Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370718 -        care................................. 090325, ref SDS 60 WV4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
370719 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370720 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370721 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370722 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370723 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370724 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
370725 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
3708 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Findings CT Scan Test 060930 Pulmonary Embolism Filling Defects Arte                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450401 -  ..
450402 - CT Scan Test Pathology Diagnosis Recurrent Pulmonary Embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450403 - Pulmonary Embolism Recurrence Diagnosis CT Scan Test Pathology                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450404 - Pulmonary Defects Arteries Subsgemental Branches Right Lower Lobe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450405 - 
450406 - Follow up ref SDS 10 QP6S.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450408 - CT Test report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450410 -     ..
450411 -    ** FINDINGS **:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450414 -        Exam was technically adequate to determine presence of a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450415 -        pulmonary embolism.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450417 -         ..
450418 -        There are filling defects within the subsegemental branches of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450419 -        the right lower lobe pulmonary arteries.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450421 -  ..
450422 - How serious is pulmonary embolism - slight or severe?  Can degree of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450423 - severity be evaluated, say on scale of 1 - 10?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450425 -  ..
450426 - Findings confirm notice from the doctor on 061002 of pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450427 - embolism recurrence, ref SDS 27 MI5I, and further reconcile symptoms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450428 - of fatigue, shortness of breath, heavy chest, dizziness (see below,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450429 - ref SDS 0 IR46) reported on 060929, ref SDS 25 B56N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450431 -  ..
450432 - Research on enlarged right ventricle, Cor Pulmonale heart disorder,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450433 - also reported in test findings, ref SDS 0 7E5L, shows symptoms are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450434 - similar to pulmonary embolism, fatigue and shortness of greath, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450435 - below. ref SDS 0 LG9L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450437 -            [On 061201 Kaiser prescribes Procrit to treat anemia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450438 -            diagosed from low hemoglobin reported in one blood test,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450439 -            where Procrit was not prescribed previously with low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450440 -            hemoglobin in 10 blood tests, and presents a small risk of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450441 -            blood clots, and cardiovascular problems, ref SDS 39 OU9G,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450442 -            that compound patient profile diagnosed on 061012 with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450443 -            pulmonary embolism, and enlarged right ventricle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450444 -            ref SDS 0 294Q,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450446 -             ..
450447 -            [On 080507 Millie reports spike in heart beat (pulse) while                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450448 -            laying down in bed; case study shows occassional spike in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450449 -            pulse reported by heart monitor during exercise, evaluated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450450 -            previously as defective equipment. ref SDS 52 CK4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450452 -             ..
450453 -            [On 081012 pulse elevated to maximum of 224, and remained                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450454 -            high for most of 2 laps, then returned to normal on the 3rd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450455 -            lap. ref SDS 53 FL7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450457 -             ..
450458 -            [On 081105 Millie notified that primary care physician                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450459 -            orders Muga test for heart damage prior to starting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450460 -            sunitinib clinical study that has some heart related side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450461 -            effects. ref SDS 54 WO72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450463 -  ..
450464 - Research on 060722 indicates that 45% of patients die who suffer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450465 - recurrent pulmonary embolism, ref SDS 19 BI5J, indicates Millie is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450466 - fortunate to be among 55% of people who survive after being removed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450467 - from treatment for pulmonary embolism on 051007. ref SDS 14 RZ4I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450469 -  ..
450470 - CT Test report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450471 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450472 -        The main pulmonary artery is in the upper limits of normal.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450474 -         ..
450475 -        Interventricular septum bows normally.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
450476 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450478 -         ..
450479 -        Enlarged Right Ventricle Heart Disorder                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450480 -        Heart Disorder Enlarged Right Ventricle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450481 -        Right Ventrical Enlarged Pulmonary Embolism CT Test Findings                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450482 -        
450483 -        However, the right ventricle is enlarged measuring greater                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450484 -        diameter at the level of the tricuspid valve and the left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450485 -        ventricle at the level of the mitral valve.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450487 -  ..
450488 - How serious is enlarged right ventricle - slight or severe?  Can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450489 - degree of severity be evaluated, say on scale of 1 - 10?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450491 -  ..
450492 - Research indicates that enlarged right ventricle presents a serious                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450493 - heart disorder, reviewed below. ref SDS 0 L35J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450494 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450495 -            [On 061228 primary care physician Kaiser advises enlarged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450496 -            right ventricle heart disorder Cor Pulmonale most likely                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450497 -            due to pulmonary embolism, ref SDS 41 0M6O, after treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450498 -            ended a year earlier on 051007. ref SDS 14 RZ4I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450500 -             ..
450501 -            [On 071213 CT test reports slighly enlarged heart; does not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450502 -            correlate to CT test on 060930 findings of enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450503 -            ventricle. ref SDS 49 SR5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450505 -             ..
450506 -            [On 080507 Millie reports spike in heart beat (pulse)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450507 -            while laying down in bed; case study shows occassional                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450508 -            spike in pulse reported by heart monitor during                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450509 -            exercise, evaluated previously as defective equipment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450510 -            ref SDS 52 CK4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450512 -             ..
450513 -            [On 081012 pulse elevated to maximum of 224, and remained                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450514 -            high for most of 2 laps, then returned to normal on the 3rd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450515 -            lap. ref SDS 53 FL7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450517 -             ..
450518 -            [On 081105 Millie notified that primary care physician                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450519 -            orders Muga test for heart damage prior to starting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
450520 -            sunitinib clinical study that has some heart related side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450521 -            effects. ref SDS 54 WO72                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450523 -  ..
450524 - For some reason, the doctor did not disclose enlarged right ventricle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450525 - disorder in notifying the patient on 061002 on findings of pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450526 - embolism. ref SDS 27 MI5I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450528 -  ..
450529 - How enlarged is the right ventricle?  How much greater does the right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450530 - ventrical measure than the left one?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450531 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450532 -            [On 061013 letter to advice nurse at Kaiser asks how to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450533 -            assess severity of enlarged right ventricle. ref SDS 31                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
450534 -            US6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450536 -             ..
450537 -            [On 061015 received a letter from Arlette reporting that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450538 -            the leter today was submitted to the primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450539 -            physician. ref SDS 32 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450541 -             ..
450542 -            [On 061020 primary care physician at Kaiser asked how                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450543 -            enlarged is the right ventricle, how serious is pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450544 -            emboli? ref SDS 34 VJ4J; initially doctor was not aware of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450545 -            enlarged right ventricle findings in the CT test report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450546 -            ref SDS 34 3Z9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450548 -             ..
450549 -            [On 061027 Millie letter advises Kaiser that pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450550 -            embolism symptoms continue fatigue, shortness of breath;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450551 -            Millie asks about prognosis for getting back in the gym to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450552 -            improve fitness, which previously were attributed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450553 -            symptoms for pulmonary embolism. ref SDS 36 K24K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450555 -             ..
450556 -            [On 061108 denial compounds "wicked problems," after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450557 -            starting treatment with coumadin, patient has continuing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450558 -            symptoms that relate to enlarged right ventricle, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
450559 -            pulmonary embolism, cough clearing throat, fatigue; patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450560 -            is reluctant to notify doctor because this places a focus                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450561 -            on mortality that is easier to manage emotionally when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450562 -            suppressed, commonly called denial. ref SDS 37 VR6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450564 -             ..
450565 -            [On 061110 severity of PE symptoms reported to the doctor,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
450566 -            and consideration of enlarged right ventrical discussed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450567 -            again. ref SDS 38 CV5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
450569 -             ..
450570 -            [On 061110 doctor cites So2 blood test 98% shows good                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
450571 -            cardio pulmonary performance, indicating enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
450572 -            ventricle not impacting patient health at the present time;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
450573 -            does not address rate of deterioriating condition for risk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450574 -            assessment. ref SDS 38 HT3M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450576 -             ..
450577 -            [On 061201 Kaiser prescribes Procrit to treat anemia                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450578 -            diagosed from low hemoglobin reported in one blood test,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
450579 -            where Procrit was not prescribed previously with low                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450580 -            hemoglobin in 10 blood tests, and presents a small risk of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
450581 -            blood clots, and cardiovascular problems, ref SDS 39 OU9G,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
450582 -            that compound patient profile diagnosed on 061012 with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
450583 -            pulmonary embolism, and enlarged right ventricle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
450584 -            ref SDS 0 294Q,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
450585 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450586 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450587 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450588 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
450589 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
CT Test 060930 Comparison Prior Test 041103 Lungs Right Side Involve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
4803 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
480401 -  ..
480402 - Comparison Current Test with Prior Findings PE in CT Test on 041103                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480403 - 
480404 - Since the analyst for the CT test on 060930 failed to compare with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480405 - prior related test, per above, ref SDS 0 2935, a general review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480406 - comparing the CT test on 041103, which was received the next day on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480407 - 041104 and reported initial discovery of pulmonary embolism in this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480408 - case, ref SDS 10 RZ4I, indicates...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
480409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480410 -            CT Test 041103...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
480411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480412 -            ...filling defects within the primary branches of the right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480413 -            upper lobe and right lower lobe pulmonary arteries                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
480414 -            consistent wtih pulmonary emboli.  A small hiatal hernia is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480415 -            identified. ref SDS 10 QP6S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
480417 -  ..
480418 - Pulmonary embolism in both tests showed right side involvement.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480420 -     [On 061020 primary care physician did not have time to make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480421 -     comparison during examination. ref SDS 34 N96N and further on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
480422 -     pulmonary embolism review. ref SDS 34 UQ5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480424 -     [On 061110 hectic schedule again, doctor did not have time to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
480425 -     review initial comparison of test reports. ref SDS 38 HB3K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480427 -  ..
480428 - There is an impression that the current problem is less severe than on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480429 - 041103, since at that time both the right upper and lower lobes showed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480430 - filling defects, and the test on 060930 seems to involve only the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
480431 - right lower lobe. ref SDS 0 M435                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
480433 -  ..
480434 - Prior test did not cite "subsegmental arteries" presented in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
480435 - current test, ref SDS 0 M435, nor evident multiple "embolisms" (see                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480436 - also Impressions, ref SDS 0 T978), which are cited in the current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
480437 - test, possibly indicating increased severity of the current problem.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480439 -  ..
480440 - No hiatal hernia is identified at this time, as occurred previously                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480441 - in the test on 041103.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480443 -  ..
480444 - The prior test on 041103 did not discuss the main pulmonary artery                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480445 - which is now on the upper limit of normal, suggesting a future                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
480446 - problem.  As well, the prior test did not report the right ventrical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480447 - being enlarged, as it is now.  Are these actual differences indicating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480448 - advancing disease, or simply unreported similarities?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
480450 -  ..
480451 - Evaluation of comparisons and assessment of implications requires                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
480452 - professional review.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480453 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480454 -            Diagram of heart, lung, pulmonary circulatory system...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
480455 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
480458 -  ..
480459 - Research on the Internet says in part...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
480460 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480461 -            American Heart Association                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
480462 -            Circulation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480463 -            Cardiology Patient Page                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480465 -             ..
480466 -            Pulmonary Embolism and Deep Vein Thrombosis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
480467 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480468 -              http://circ.ahajournals.org/cgi/content/full/106/12/1436                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
480470 -             ..
480471 -            Figure 1.  The arterial (red) and venous systems (blue) are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480472 -            depicted.  The left ventricle (LV) ejects oxygenated blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
480473 -            into the aorta, which circulates blood to vital organs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480474 -            Deoxygenated blood travels through the venous system to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
480475 -            right atrium, right ventricle, and pulmonary artery.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480476 -            Adapted with permission from MediClip, Clinical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
480477 -            Cardiopulmonary Images 1997, CCP01026.TIF, Williams &                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
480478 -            Wilkins, Baltimore, Md.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
480479 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480480 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480481 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480482 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
480483 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
4805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Heart Problem Cor Pulmonale Disorder From Pulmonary Hypertension Art                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
5303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530401 -  ..
530402 - Enlarged Right Ventricle Research Heart Problem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530403 - Research Enlarged Right Ventricle Heart Problem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530404 - Heart Disorder Research Enlarged Right Ventricle Problem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530405 - 
530406 - Following up findings of enlarged right ventricle in the CT test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530407 - 060929 presented above. ref SDS 0 7E5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530408 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530409 - Research on "enlarged right ventricle shows...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530411 -             ..
530412 -            The Merck Manuals                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530413 -            Online Medical Library                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530415 -             ..
530416 -            Date:  030201 (last reviewed/revised)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530418 -             ..
530419 -            Pulmonary Hypertension                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530421 -               ..
530422 -              http://www.merck.com/mmhe/sec04/ch054/ch054a.html                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530424 -             ..
530425 -            Cor Pulmonale: Heart Disorder From Pulmonary Hypertension                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530426 -            
530427 -            Cor pulmonale is a disorder in which the right ventricle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530428 -            of the heart becomes enlarged and thickened, eventually                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530429 -            resulting in heart failure.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530431 -             ..
530432 -            Cor pulmonale has only one cause: pulmonary hypertension.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530434 -             ..
530435 -            In time, pulmonary hypertension leads to thickening of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530436 -            pulmonary arteries and narrowing of the passageways                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530437 -            through which blood flows. Once pulmonary hypertension                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530438 -            develops, the right side of the heart works harder to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530439 -            compensate, but the increased effort causes it to become                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530440 -            enlarged and thickened. These changes can lead to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530441 -            right-sided heart failure (usually heart failure stems                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530442 -            from problems with the left side of the heart).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
530443 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530444 -               [On 061108 Millie experiences continued symptoms that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
530445 -               may relate to enlarged right ventricle, and pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530446 -               embolism, cough clearing throat, fatigue, after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530447 -               treatment with coumadin. ref SDS 37 VR6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530449 -                ..
530450 -               [On 061208 cor pulmonale noted by primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530451 -               physician. ref SDS 40 J14I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530453 -             ..
530454 -            The enlarged right ventricle places a person at risk for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530455 -            pulmonary embolism because blood tends to pool in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530456 -            ventricle and in the legs.  If clots form in the pooled                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530457 -            blood, they may eventually travel and lodge in the lungs,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530458 -            with disastrous consequences.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530460 -  ..
530461 - Research on 060722 indicates death can strike suddenly with no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530462 - symptoms of pulmonary embolism, and that 45% of patients die who                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530463 - suffer recurrance. ref SDS 19 BI5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530464 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530465 -                [On 070105 Kaiser proposes deferring referral to hear                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530466 -                specialist for examination of enlarged right ventricle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530467 -                in combination with findings of pulmonary embolism in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530468 -                CT test on 060930, until clinical relevance which make                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530469 -                take years for symptoms to become life threatening.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530470 -                ref SDS 43 XR4I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530472 -  ..
530473 - Research continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530475 -             ..
530476 -            Cor Pulmonale Symptoms Similar Pulmonary Embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530477 -            Shortness of Breath Fatigue Symptoms Cor Pulmonale                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530478 -            Dizziness Lightheadedness Mild Symptoms Pulmonary Emboli                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530479 -            Normal Exertion Causes Fatigue Lightheadedness Dizziness                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530480 -            
530481 -            There are often no symptoms until cor pulmonale is quite                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530482 -            advanced. Then the symptoms are still those of pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530483 -            hypertension: shortness of breath upon exertion,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530484 -            lightheadedness, fatigue, and chest pain. Symptoms of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530485 -            heart failure, such as swelling (edema) in the legs and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530486 -            progressively worse shortness of breath, develop.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530488 -  ..
530489 - Lightheadedness is often associated with dizziness, and so complements                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530490 - research on 060722 listing symptoms of pulmonary embolism. ref SDS 19                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530491 - VS4F  Another article...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530493 -  ..
530494 - Research continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530495 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530496 -                  Pulmonary Hypertension: Causes, Symptoms,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
530497 -                  Diagnosis, Treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530499 -                   ..
530500 -                  Published by the Cleveland Clinic Health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530501 -                  Information Center...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530503 -                     http://www.clevelandclinic.org/health/health-info/docs/0600/0622.asp?index=6530                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
530504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530505 - ...says in part...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530507 -                   ..
530508 -                  The first symptom of pulmonary hypertension is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530509 -                  usually shortness of breath with everyday activities,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530510 -                  such as climbing stairs.  Fatigue, dizziness, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530511 -                  fainting spells also can be symptoms.  Swelling in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530512 -                  the ankles, abdomen or legs; bluish lips and skin,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530513 -                  and chest pain may occur as strain on the heart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530514 -                  increases.  Symptoms range in severity and a given                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530515 -                  patient may not have all of the symptoms.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
530517 -  ..
530518 - Millie reported continuing and mild dizziness beginning on 060217,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530519 - eventually leading to an MRI of the brain which was negative for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530520 - cancer, reported on 060711 ref SDS 18 PT4K  Symptoms finally ended on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530521 - 060825. ref SDS 24 PT4K  Millie has had some of the symptoms for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530522 - enlarged right ventricle, ref SDS 0 GQ4K, for a long time, leading to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530523 - CT test report today finding pulmonary embolism with enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530524 - ventricle. ref SDS 0 294Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530526 -  ..
530527 - Research continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530528 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530529 -            A number of tests are available to help a doctor diagnose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530530 -            cor pulmonale, but the diagnosis is often suspected on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530531 -            basis of the physical examination. By listening through a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530532 -            stethoscope, a doctor can hear certain characteristic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530533 -            heart sounds that occur when the right ventricle becomes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530534 -            enlarged. Chest xrays can show the enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530535 -            ventricle and pulmonary arteries. The doctor evaluates the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530536 -            function of the left and right ventricle with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530537 -            echocardiography, radionuclide studies, and cardiac                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530538 -            catheterization.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530540 -  ..
530541 - Stethoscope examination reveals enlarged right ventricle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530542 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530543 -                [On 061020 patient reports symptoms enlarged right                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530544 -                ventricle - shortness of breath, fatigue, ref SDS 34                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530545 -                VD4G; doctor was not aware of CT test findings,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530546 -                ref SDS 34 VD44; examination with stethoscope reports                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
530547 -                no findings of symptoms. ref SDS 34 PC6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530549 -  ..
530550 - Article continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
530551 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530552 -            Treatment is usually directed at the underlying lung                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530553 -            disease. Measures to relieve right-sided heart failure are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530554 -            also taken. Because people with cor pulmonale are at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530555 -            increased risk of pulmonary embolism, a doctor may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530556 -            prescribe an anticoagulant to be taken long-term.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530558 -  ..
530559 - Another article...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530560 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530561 -            Assessment of Cardiac Stress...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530562 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530563 -            American College of Chest Phyicians                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530564 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530565 -              http://www.findarticles.com/p/articles/mi_m0984/is_2_120/ai_77806148                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530567 -             ..
530568 -            August 2001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530569 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530570 -            ...right ventricular (RV) strain...may have more than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530571 -            trivial importance, ...might predict the severity of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530572 -            pulmonary hypertension,[4] which appears to correspond to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530573 -            the presence of RV dysfunction with PE.[5]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530574 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530575 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530576 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Findings CT Scan Test 060930 Aorta Athersclerotic Calcified Plaque L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
5703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
570401 -  ..
570402 - Aorta Athersclerotic Calcified Plaque RM Lobe Pulmonary Nodule                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570403 - 
570404 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570405 - CT Test report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570407 -        No pericardial or pleural effusion.  The aorta and its branches                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
570408 -        are normal except for atherosclerotic calcified plaque.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
570410 -         ..
570411 -        Left apical bronchiectasis and fibrotic scarring consistent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
570412 -        with radiation changes are stable.  Calcified right middle lobe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
570413 -        pulmonary nodule.  No new pulmonary nodules or masses.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
570414 -        Hypodensities within the dome of the liver again seen.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
570415 -        Significant splenic artery calcifications are again identified.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
570416 -        Punctate calcifications within the spleen identified.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
570418 -         ..
570419 -        Mild degenerative changes of the regional skeleton.  No focal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
570420 -        osseous abnormalities.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
570421 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
570424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5705 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
CT Test 060930 Left Axillary Right Axillary Left Supraclvaicular No                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
6703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
670401 -  ..
670402 - Supraclavicular Regional Distant Metastatic Disease Not Found                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
670403 - Axillary Regional Distant Metastatic Disease Not Found                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
670404 - 
670405 - Follow up ref SDS 17 4R82.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
670406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670408 -        The patient is status post left mastectomy.  No enlarged                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670409 -        axillary, hilar or mediastinal lymph nodes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
670411 -  ..
670412 - This seems like very good news for not finding distant nor regional                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
670413 - metastatic disease.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
670415 -  ..
670416 - While mentioning axillary regions, the analyst does not expressly say                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
670417 - the left supraclavicular area was reviewed.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
670418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670419 -               [On 061020 meeting with doctor at Kaiser, primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
670420 -               physician seems to concur that CT test on 060930 shows                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
670421 -               no evidence of distant metastasis, nor of local nor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
670422 -               regional disease. ref SDS 34 LP5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
670424 -  ..
670425 - This test extends patient history of testing never having identified                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
670426 - distant metastasis, per history above. ref SDS 0 1Y8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
670428 -  ..
670429 - CT Test report continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670430 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670431 -    ** IMPRESSION **:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
670432 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670433 -        1.  Examination is positive for a right lower lobe pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
670434 -            embolism.  These embolisms are located within subsegmental                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
670435 -            arteries of the right lower lobe.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
670437 -             ..
670438 -        2.  The rest of the exam is stable.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
670440 -     ..
670441 -    Message was left with the patient's ordering physician about this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
670442 -    result.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
670444 -  ..
670445 - Distant metastasis not found reviewed above. ref SDS 0 1Y8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
670446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670447 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670448 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670449 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670450 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
670452 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
6705 -