THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: January 18, 2007 08:51 AM Thursday; Rod Welch

Jackie called finalize plans Millie start treatment at UCSF.

1...Summary/Objective
2...1st Treatment Takes Longer to Evaluate Side Effects Start 070119
3...Cetuximab Carboplatin Clinical Drug Trial UCSF Initial Discussion
4...Blood Test Laboratory Analysis for Treatment UCSF 070119
5...Treatment May be Delayed Paperwork Nobody Can Find
6...Payment Authorization UCSF Cannot Find Documentation May Halt Treatment
7...Payment Authorization Form Notify Kaiser UCSF Following Up Tomorrow
8...Kaiser Advised Treatments Start 070119


..............
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CONTACTS 

SUBJECTS
Cetuximab Carboplatin Clinical Study Drug Trial UCSF Schedule Millie

2003 -
2003 -    ..
2004 - Summary/Objective
2005 -
200501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
200502 -
200503 - Millie can get dental work done on Monday, after starting treatment
200504 - tomorrow.  Jackie has scheduled Millie to meet with Doctor Rugo at
200505 - 1100 tomorrow before treatment. ref SDS 0 FA4J  Millie notified the
200506 - primary care physician about change in schedule from 070124 moved up
200507 - to tomorrow. ref SDS 0 638H  Jackie called back late in the afternoon
200508 - and said treatment may be delayed because Kaiser forgot to submit
200509 - authorization documentation over the past two weeks. ref SDS 0 YF8U
200510 - Tomorrow morning Jackie will coordinate with Kaiser to submit required
200511 - documentation. ref SDS 0 YF42  Millie notified the primary care
200512 - physician about the problem with authorization, and that UCSF will
200513 - call tomorrow to make arrangements so that treatment can proceed on
200514 - schedule prescribed by Doctor Rugo. ref SDS 0 PK6M
200516 -             ..
200517 -            [On 070119 Kaiser signed authorization for Millie to get
200518 -            treatment at UCSF; treatment delayed because there was not
200519 -            enough time for doctors to resolve policy conflict between
200520 -            Kaiser business units involving Medicare. ref SDS 14 AS4K
200521 -
200522 -
200524 -  ..
2006 -
2007 -
2008 - Progress
2009 -
200901 - 1st Treatment Takes Longer to Evaluate Side Effects Start 070119
200902 - Cetuximab Carboplatin Clinical Drug Trial UCSF Initial Discussion
200903 -
200904 - Follow up ref SDS 12 1G3K, ref SDS 11 1G3K.
200905 -
200906 -     [On 070118 followed up. ref SDS 13 VI5H
200907 -
200908 - Jackie received Millie's letter, ref DIP 3 0001, submitted yesterday,
200909 - 070117, ref SDS 12 G155, responding to UCSF's letter from Jackie,
200910 - ref DRP 3 0001, received earlier in the afternoon. ref SDS 12 0346
200911 - This hopefully resolves problems with mail delivery reported
200912 - yesterday. ref SDS 12 Y25Q
200914 -  ..
200915 - Jackie checked with Doctor Rugo, and the doctor said it is okay for
200916 - Millie to get dental work done scheduled next Monday, 070122.  Doctor
200917 - Rugo will provide antibiotics to protect Millie from risks dental work
200918 - presents when performed concurrently with chemotherapy.
200920 -  ..
200921 - Jackie advised that Millie is scheduled to meet with Doctor Rugo
200922 - tomorrow morning at 1100.
200924 -  ..
200925 - After the meeting, Millie will start treatment.  The first treatment
200926 - will take longer so that a doctor can monitor Millie's reaction on the
200927 - treatment with respect to severe side effects, as discussed by Jackie
200928 - yesterday. ref SDS 12 3E8J
200929 -
200930 -     [On 070118 Millie notified Kaiser Coagulation Treatment Clinic of
200931 -     change in medications that affect treatment with warfarin
200932 -     Coumadin. ref SDS 13 VI5H
200934 -  ..
200935 - Jackie will make arrangements between Kaiser and UCSF on payments, per
200936 - understandings between Millie's primary care physician at Kaiser and
200937 - Doctor Rugo in correspondence on 061230, ref SDS 3 3X6K, and reported
200938 - in the letter to UCSF last night. ref SDS 12 5F4Y
200939 -
200940 -     [...below, Jackie reports Kaiser forgot to prepare authorization
200941 -     for UCSF to treat Millie following agreement with Doctor Rugo 2
200942 -     weeks ago. ref SDS 0 YF8U
200944 -      ..
200945 -     [On 070119 Millie travels to San Francisco for meeting with Doctor
200946 -     Rugo, and get 1st treatment.  Jackie reports that Millie's primary
200947 -     care physician at Kaiser signed authorization for referral to
200948 -     UCSF; but, treatment was deferred because there was not enough
200949 -     time to resolve policy conflict between Kaiser business units to
200950 -     submit the doctor's referral authorization for UCSF to get paid
200951 -     for Standard of Care. ref SDS 14 AS9L
200953 -  ..
200954 - Millie confirmed that she cancelled travel plans for next week, which
200955 - were discussed with UCSF on 070116, ref SDS 11 VQ3G, and cited in
200956 - Millie's letter to UCSF yesterday. ref SDS 12 5F9W  Treatments can go
200957 - forward on regular schedule for Thursdays, per planning yesterday for
200958 - Millie to change her work schedule to Monday - Wednesday.
200959 -
200960 -
200961 -
200962 -
200963 -
2010 -

SUBJECTS
Blood Test Laboratory Analysis for Treatment UCSF Start 070119 Clini

2503 -
250401 -  ..
250402 - Blood Test Laboratory Analysis for Treatment UCSF 070119
250403 -
250404 - Jackie said that Millie will need blood work by the Laboratory at
250405 - Kaiser to meet protocol requirements for treatment starting tomorrow
250406 - with the cetuximab carboplatin clinical study, as planned today, per
250407 - above. ref SDS 0 1B5F
250409 -  ..
250410 - Millie advised that she went to Kaiser this morning and had a complete
250411 - lab done, including CBC ordered by the doctor during the meeting at
250412 - Kaiser on 070105 to prepare for treatment at UCSF. ref SDS 6 NX9N
250414 -  ..
250415 - Jackie will coordinate on getting results of the lab from Kaiser in
250416 - time for Millie to meet with Doctor Rugo tomorrow.
250417 -
250418 -            [...below, Millie submits letter advising Kaiser everything
250419 -            ready to start treatment tomorrow; thanks Arlette for
250420 -            coordination. ref SDS 0 HZ9H
250422 -             ..
250423 -            [On 070119 blood test incomplete, ref SDS 14 AS6M; Jackie
250424 -            coordinating with Kaiser. ref SDS 14 Q95H
250426 -             ..
250427 -            [On 070119 letter to Kaiser asks Arlette to check on
250428 -            submitting complete blood test to UCSF for treatment.
250429 -            ref SDS 14 0Z6T
250431 -             ..
250432 -            [On 070122 Kaiser ordered additional blood tests; still
250433 -            need report from Kaiser on test results, including CA 15-3.
250434 -            ref SDS 15 AS6M
250436 -             ..
250437 -            [On 070123 Millie went to Kaiser to get blood tests needed
250438 -            to start treatment at UCSF. ref SDS 16 AS6M
250440 -             ..
250441 -            [On 070123 treatment delayed at UCSF need referral
250442 -            authorization for payment from Kaiser. ref SDS 16 J43I
250444 -             ..
250445 -            [On 070130 Millie scheduled for treatment at UCSF on
250446 -            070201. ref SDS 17 MP4H
250448 -             ..
250449 -            [On 070131 UCSF requests another blood test before starting
250450 -            treatment on 070201. ref SDS 18 NZ4N
250451 -
250452 -
250454 -  ..
2505 -
2506 -
2507 - 1641
2508 -
250801 - Jackie called.
250802 -
250803 - She called to get results of blood tests, but was told the lab report
250804 - will not be available until tomorrow morning.
250805 -
250806 -
250807 -
250808 -
250809 -
2509 -

SUBJECTS
Payment Authorization Kaiser Not Enough Time UCSF Cannot Find Docume

5903 -
590401 -  ..
590402 - Treatment May be Delayed Paperwork Nobody Can Find
590403 - Payment Authorization UCSF Cannot Find Documentation May Halt Treatment
590404 -
590405 - Jackie needs authorization from Kaiser for UCSF to perform the work.
590406 - She called for the doctor at Kaiser, but has not made contact.  Jackie
590407 - asked the Oncology department nurses at Kaiser for assistance.  The
590408 - nurses were not aware that the doctor arranged for Millie to get
590409 - treatment at UCSF.
590411 -  ..
590412 - Jackie said this happens often.  People forget to prepare documents in
590413 - time to manage the work, even when the work takes only a few minutes.
590414 - She said UCSF needs a number of some kind, possibly a billing or
590415 - authorization account.  She talked to Doctor Rugo, who recalls there
590416 - was agreement with Millie's primary care physician in a letter on
590417 - 061230 for Kaiser to pay any costs not covered by the trial.
590418 - ref SDS 3 3X6K  Since then, neither UCSF nor Kaiser has had time to
590419 - prepare authorization which requires the doctor to sign a document.
590421 -  ..
590422 - Snafus in medical management are reviewed on 040416. ref SDS 1 GN7J
590423 -
590424 -            [On 070119 Millie travels to San Francisco for meeting with
590425 -            Doctor Rugo, and get 1st treatment.  Jackie reports that
590426 -            Millie's primary care physician at Kaiser signed
590427 -            authorization for referral to UCSF; but, treatment was
590428 -            deferred because there was not enough time to resolve
590429 -            policy conflict between Kaiser business units to submit the
590430 -            doctor's referral authorization for UCSF to get paid for
590431 -            Standard of Care. ref SDS 14 AS9L
590433 -  ..
590434 - Follow up on this matter was discussed with the priamry care physician
590435 - at Kaiser during the meeting on 070105.  At that time, Millie's
590436 - request for Kaiser to submit reminders to UCSF about making timely
590437 - arrangements for Millie's treatment was described as conflicting with
590438 - professional protocol, and so would be embarrassing and insulting,
590439 - since everyone knows what needs to be done.  Jackie feels that even
590440 - though people know what needs to be done, critical details are omitted
590441 - because they are not needed immediately, there is plenty of time to
590442 - perform tasks later, and other tasks require immediate attention.
590443 - These kinds of tasks, commonly pending "action items," are hard to
590444 - manage.
590446 -  ..
590447 - Arranging for patients to be treated by other health care providers is
590448 - a familiar process at Kaiser.  Arlette's letter to Millie on 060809
590449 - reported that doctors routinely sign athorization to sends patients
590450 - out for treatment by other providers. ref SDS 2 NT9X
590452 -  ..
590453 - Now that Millie is scheduled to get treatment tomorrow, preparing
590454 - authorization, which could been done anytime during the past 2 weeks,
590455 - becomes another crisis task that requires immediate attention which
590456 - will push other tasks that are critical but not needed until later
590457 - into a crisis when later eventually arrives, as with the current
590458 - crisis.
590460 -  ..
590461 - Jackie plans to follow up in the morning to obtain authorization from
590462 - Kaiser.  She will call before 0930 to advise of any delays with the
590463 - paperwork, and in that case treatment scheduled for tomorrow will be
590464 - deferred to next week while authoriztion documentation is submitted by
590465 - Kaiser.
590466 -
590467 -
590469 -  ..
5905 -
5906 -
5907 - 0825
5908 -
590801 - Payment Authorization Form Notify Kaiser UCSF Following Up Tomorrow
590802 -
590803 - Millie submitted ref DIT 2 0001 to the primary care physician that
590804 - Kaiser needs to provide authorization tomorrow morning in order for
590805 - Millie to get treatment, per Jackie's call above. ref SDS 0 YF8U
590807 -  ..
590808 - Millie's letter to primary care physician at Kaiser says...
590809 -
590810 -    1.  Doctor Rugo's assistant, Jackie called this morning and said
590811 -        they want me to start treatment tomorrow.  I'm supposed to meet
590812 -        with Doctor Rugo at 1100, then get treatment. ref SDS 0 1G3K
590813 -        I'm planning to leave here at 0930 to get there on time.
590814 -        ref DIT 2 0001
590816 -         ..
590817 -    2.  Jackie called back about 5pm and said UCSF cannot find some
590818 -        paperwork needed from Kaiser.  She called the Oncology
590819 -        department at Kaiser, but the person she talked to was unable
590820 -        to help. ref SDS 0 YF8U ref DIT 2 UU6G
590821 -
590822 -            [On 070119 primary care physician at Kaiser signed
590823 -            authorization; new Medicare regulations are confusing;
590824 -            Kaiser and UCSF are working to resolve the problem.
590825 -            ref SDS 14 4R4M
590827 -         ..
590828 -    3.  This is a heads up that Jackie plans to call your office again
590829 -        first thing in the morning for authorization, and if there is a
590830 -        snag, then everything will be delayed. ref SDS 0 YF42  I recall
590831 -        seeing one of Doctor Rugo's letters saying UCSF would make all
590832 -        the arrangements.  Hopefully, there will be time in the morning
590833 -        to resolve everything. ref DIT 2 JU6M
590835 -  ..
590836 - The record on 070101 indicates that UCSF was planning to make
590837 - arrangements for Millie to meet with Doctor Rugo and get treatment.
590838 - ref SDS 4 E23W
590839 -
590840 -            [On 070119 Kaiser signed authorization for Millie to get
590841 -            treatment at UCSF; treatment delayed because there was not
590842 -            enough time for doctors to resolve policy conflict between
590843 -            Kaiser business units involving Medicare. ref SDS 14 AS4K
590844 -
590845 -
590846 -
590847 -
5909 -

SUBJECTS
Notify Kaiser Oncology Schedule Treatment UCSF Clinical Study Drug T
Blood Test Laboratory Analysis for Treatment UCSF Start 070119 Clini

7904 -
7905 - 1137
790601 -  ..
790602 - Kaiser Advised Treatments Start 070119
790603 -
790604 - Follow up ref SDS 12 638H, ref SDS 9 II4R.
790605 -
790606 - Millie submitted ref DIT 1 0001 to Arlette, the Advice Nurse for
790607 - Oncology submitting a copy of Millie's letter, ref DIP 3 0001, to
790608 - Jackie at UCSF sent yesterday, ref SDS 12 G155, and responding to the
790609 - letter from Jackie, ref DRP 3 0001, sent earlier on 070117 to confirm
790610 - planning for Millie to start treatment tomorrow on 070119. ref SDS 12
790611 - 0346
790613 -  ..
790614 - Millie's letter to Kaiser says...
790615 -
790616 -    1.  Just want to thank you for all your help coordinating support
790617 -        from UCSF.  [My primary care physician at Kaiser] has been
790618 -        excellent making arrangements with Doctor Rugo, and now I am
790619 -        scheduled to start treatments tomorrow, after meeting with
790620 -        Doctor Rugo at 1100, per telecon with Jackie this morning.
790621 -        ref SDS 0 1G3K, ref DIT 1 0001
790623 -         ..
790624 -    2.  I went to Martinez early this morning and had blood work done,
790625 -        so that is all set, ref SDS 0 5S6L, and thanks to [the primary
790626 -        care physician] for expediting everything, I don't have to get
790627 -        another PET or CT test done because we are still in the window
790628 -        for using the last test on 061227. ref DIT 1 U25O
790629 -
790630 -            [On 070119 UCSF reports blood test incomplete. ref SDS 14
790631 -            AS6M
790633 -             ..
790634 -            [On 070122 additional blood testing ordered by Kaiser
790635 -            primary care physician. ref SDS 15 LX6V
790637 -             ..
790638 -            [On 070123 Millie went to Kaiser to get blood tests needed
790639 -            to start treatment at UCSF. ref SDS 16 AS6M
790641 -             ..
790642 -            [On 070123 treatment delayed at UCSF need referral
790643 -            authorization for payment from Kaiser. ref SDS 16 J43I
790645 -         ..
790646 -    3.  Please let [the primary care physician] know I am starting
790647 -        treatment tomorrow, per telecon this morning, and
790648 -        correspondence with UCSF yesterday, ref SDS 12 G155, responding
790649 -        to Jackie's letter on the same date. ref SDS 12 0346,
790650 -        ref DIT 1 376N
790652 -         ..
790653 -    4.  Thanks again.
790654 -
790655 -
790657 -  ..
7907 -
7908 -
7909 - 1316
7910 -
791001 - Millie received ref DRT 1 0001 from Arlette at Kaiser responding to
791002 - the letter, ref DIT 1 0001, submitted earlier this morning, per above.
791003 - ref SDS 0 638H
791004 -
791005 -    1.  Dear Millie,
791007 -         ..
791008 -    2.  Your welcome!  Good Luck! ref DRT 1 0001
791010 -         ..
791011 -    3.  Arlette
791012 -
791013 -
791014 -
791015 -
791016 -
791017 -
7911 -