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


S U M M A R Y


DIARY: January 23, 2007 06:10 AM Tuesday; Rod Welch

Millie went to Kaiser for more blood work to start treatment at UCSF.

1...Summary/Objective
2...Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare
3...Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix
4...Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix
5...UCSF Reports Kaiser Conflict with Medicare Subsidiary Not Resolved
6...Kaiser Authorization Office Coordinating with UCSF Resolve Problem
7...UCSF Frustrated Kaiser Has Not Submitted Authorization
8...Cascading Out of Control IBC Requires Treatment Authorization for UCSF
9...Treatment Needed Avoid IBC Cascading Out of Control Like Before
10...Doctor Notified Authorization for UCSF to Treat Millie Not Received
11...Doctor on Vacation Cannot Resolve Authorization Issue Until Next Week
12...UCSF Delays Treatment Pending Kaiser Authorization Account Number
13...CT Test Monitor Patient to Quickly Switch from Ineffective Treatment
14...Drug Trial Protocol Waiver Possible Use CT Test on 061227
15...Patient Better Served by Test Data Close to Treatment Start Date
16...Patient Help Expedite Kaiser Authorization Process
17...UCSF Suggests Patient Notify Kaiser Background Authorization Problem
18...Millie Implements Deferred Vacation Plans to Leave Town for Few Days
19...Laboratory Blood Test Performed Today Per Doctor's Order
20...CA 15-3 68 Cancer Marker Big Rise Elevates Need for Timely Treament


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

SUBJECTS
Treatment Clinical Study Cetuximab Carboplatin Drug Trial Millie Rea                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
5303 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5303 -    ..
5304 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
5305 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530501 - Follow up ref SDS 27 0000. ref SDS 26 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
530502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530503 - Millie got blood drawn for tests to start treatment today, or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530504 - tomorrow. ref SDS 0 AS6M  She wrote to Kaiser thanking Michelle for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530505 - coordinating resolution of treatment delays, ref SDS 0 C48M, and asked                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530506 - UCSF about the time for treatment today or tomorrow. ref SDS 0 YF6Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530507 - Jackie called in response to Millie letter and said that referral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530508 - authoriation has not been received from Kaiser, so there can be no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530509 - treatment today. ref SDS 0 4Q54  She was to call back later with the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530510 - time for Millie to get treatment tomorrow. ref SDS 0 4R31  Millie got                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530511 - a letter from Michelle reporting Kaiser progress on submitting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530512 - authorization for Millie to get treatment at UCSF. ref SDS 0 PR3V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530513 - Millie thanked Michelle again for coordinating efforts at Kaiser to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530514 - solve the problem. ref SDS 0 EG7K  Millie received a recent blood test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530515 - showing her cancer marker has increased significantly while waiting to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530516 - get treatment over the past 2 months. ref SDS 0 GK5B  In the late                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530517 - afternoon, Margaret called and said that UCSF has not been able to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530518 - obtain from Kaiser authorization documents for Millie's treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530519 - This was a long explanation of significant efforts UCSF has made to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530520 - arrange for Millie's treatment. ref SDS 0 MW4H  Margaret suggested                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530521 - Millie ask her doctor at Kaiser for support to solve the problem.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530522 - ref SDS 0 LC7I  Millie wrote a letter to her doctor asking for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530523 - assistance to end authorization delays so that cancer does not cascade                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530524 - out of control. ref SDS 0 J94L  Kaiser reported that Millie's doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530525 - is on vacation, and so there seems to be nobody who can take                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530526 - responsibility. ref SDS 0 LP4L  Jackie called and said that treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530527 - for tomorrow is now cancelled, and UCSF cannot schedule treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530528 - until referral authorization is received from Kaiser. ref SDS 0 J43I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530529 - Jackie further advised that delays to starting treatment will now                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530530 - require Millie to get another CT test to meet clinical study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530531 - requirements, which will further delay treatment. ref SDS 0 J438                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
530532 - Jackie asked Millie to ask Kaiser again to submit authorization for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530533 - treatment at UCSF. ref SDS 0 FS33  Millie decided to take a short                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530534 - vacation while Kaiser and UCSF resolve referall authorization issues.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530535 - ref SDS 0 PUPV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530536 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530537 -               [On 070124 Millie writes another letter requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530538 -               Arlette to assist in resolving authorization issues,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530539 -               ref SDS 30 YF8U, and then leaves town for short                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530540 -               vacation. ref SDS 30 KX9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530542 -                ..
530543 -               [On 070125 UCSF schedules Millie for treatment on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530544 -               070131. ref SDS 31 YF8U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530545 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530546 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530547 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530548 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530549 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530551 -  ..
5306 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5307 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5308 - Discussion                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5309 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530901 - Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530902 - Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530903 - Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530904 - 
530905 - Follow up ref SDS 27 YF8U, ref SDS 26 YF8U.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
530906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530907 - Millie submitted ref DIT 1 0001 to Michelle with copies to Arlette,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
530908 - and to Jackie at UCSF confirming understandings from Michelle's call                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530909 - yesterday, ref SDS 27 YF8U, and correspondence from the doctor,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530910 - ref DRP 6 0001, also received yesterday, ref SDS 27 LX8B, that Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530911 - has resolved problems which delayed treatment last week on Friday,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530912 - 070119. ref SDS 26 LW9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
530914 -  ..
530915 - Millie's letter to Michelle at Kaiser says...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530916 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530917 -    1.  Thanks very much for your call yesterday explaining progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530918 -        resolving conflicts so I can get treatment at UCSF with the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530919 -        drug trial that [my doctor] has prescribed. ref SDS 27 YF8U  I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530920 -        got a letter from the doctor last night saying he solved the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530921 -        problem, ref SDS 27 LX8B, following up collaboration with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
530922 -        Doctor Rugo last Friday on 070119, ref SDS 26 4R4M, as related                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530923 -        by Jackie in our meeting at UCSF. ref SDS 26 AS96, ref DIT 1                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530924 -        0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
530926 -         ..
530927 -    2.  By copy I am asking Jackie if I am supposed to come in this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530928 -        morning to meet with Doctor Rugo, and then get my first                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
530929 -        treatment.  In our meeting at UCSF last Friday [on 070119],                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
530930 -        Jackie indicated that Doctor Rugo wants treatment to start                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530931 -        today or at the latet tomorrow in order to comply with study                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
530932 -        protocol. ref SDS 26 AS5H, ref DIT 1 UP6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
530934 -  ..
530935 - Millie's letter to Arlette continues below explaining she got the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
530936 - blood work done this morning requested by UCSF for getting treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
530937 - today. ref SDS 0 AS6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
530938 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530939 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
530941 -  ..
5310 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5311 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5312 - 0842                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5313 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
531301 - UCSF Reports Kaiser Conflict with Medicare Subsidiary Not Resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
531302 - 
531303 - Jackie at UCSF called.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531305 -  ..
531306 - Jackie advised that insurance payment issues initially discussed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
531307 - between the primary care physician and Doctor Rugo on 071230,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
531308 - ref SDS 14 3X6K, have not been resolved between Kaiser and UCSF.  This                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
531309 - clarifies understandings from Kaiser yesterday, ref SDS 27 PN4I, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
531310 - submitted to UCSF this morning; Jackie says Millie cannot start                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531311 - treatment today, as discussed in Millie's letter, ref DIT 1 0001, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
531312 - Kaiser per shown above. ref SDS 0 YF8U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531314 -  ..
531315 - Jackie understands that Kaiser and UCSF are working hard to resolve                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
531316 - policy conflict.  Doctor Rugo expects this to occur today.  Jackie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
531317 - further indicated that Doctor Rugo expects to meet with Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
531318 - tomorrow, and then Millie can start treatments also tomorrow after the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531319 - meeting, as originally planned for 070119. ref SDS 26 AS96                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
531321 -  ..
531322 - Jackie will notify Millie later today confirming meeting and treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531323 - for tomorrow.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
531324 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531325 -        [...below, Michelle reports that Pam at Kaiser is coordinating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
531326 -        with Lisa at UCSF to resolve policy conflicts and avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
531327 -        delaying Millie's treatment. ref SDS 0 575F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
531329 -         ..
531330 -        [...below, Margaret reports UCSF has not received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
531331 -        authorization, and has been unable to make progress obtaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531332 -        required documentation from Kaiser. ref SDS 0 3S3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
531334 -         ..
531335 -        [...below, Jackie advises treatment scheduled for tomorrow on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
531336 -        060124 delayed until further notice after Kaiser submits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531337 -        authorization number for UCSF to get paid for treating Millie.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531338 -        ref SDS 0 J43I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531340 -         ..
531341 -        [On 070124 Pam reported Kaiser eventually made contact with a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
531342 -        Medicare representative; after several hours of discussions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
531343 -        throughout the day, Kaiser submitted an authorization account                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531344 -        number to UCSF. ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
531345 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531346 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531347 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531349 -  ..
5314 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5315 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5316 - 1143                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5317 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
531701 - Kaiser Authorization Office Coordinating with UCSF Resolve Problem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
531702 - 
531703 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531704 - Millie received ref DRT 1 0001 from Michelle responding to Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
531705 - letter, ref DIT 1 0001, submitted to Kaiser earlier this morning, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
531706 - above. ref SDS 0 C48M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531708 -  ..
531709 - Michelle at Kaiser says to Millie...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
531710 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531711 -        1.  Someone from our authizoration dept was to call Lisa in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531712 -            billing dept of UCSF this am to straighten every thing out.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531713 -            Pam in OA spoke with the medicare office yesterday, she was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531714 -            going to explain everything to Lisa at UCSF.  Medicare                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
531715 -            should pay for all care at UCSF. (labs, xrays to be done at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531716 -            Kaiser as ususal), ref DRT 1 S56F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
531718 -             ..
531719 -        2.  Hope all goes well, ref DRT 1 P56M,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531721 -  ..
531722 - The rest of Michelle's letter that relates to blood tests is reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531723 - below. ref SDS 0 GK5B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531725 -  ..
531726 - Michelle's explanation seems to align with communications on 061230,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531727 - when the primary care physician advised Doctor Rugo at UCSF that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
531728 - Kaiser would pay for standard of care, and that labs and testing would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
531729 - be done at Kaiser. ref SDS 14 3X6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
531730 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531731 -                [On 070124 Pam reported Kaiser eventually made contact                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
531732 -                with a Medicare representative; after several hours of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531733 -                discussions throughout the day, Kaiser was able to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
531734 -                submit an authorization account number to UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
531735 -                ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531737 -                 ..
531738 -                [On 070125 Jackie reported that UCSF did not receive an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
531739 -                authorization from Kaiser, and that Lisa in UCSF's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
531740 -                Business Office spent 6 hours talking to Medicare to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
531741 -                establish that UCSF would be paid for treating Millie.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
531742 -                ref SDS 31 4Y62                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
531743 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531744 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531745 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
531747 -  ..
5318 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5319 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5320 - 1226                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5321 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532101 - Millie submitted ref DIT 2 0001 thanking Michelle for the update with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
532102 - evident expectations of resolving policy conflicts in time to avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532103 - delaying treatment, per above. ref SDS 0 575F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532105 -  ..
532106 - Millie's response to Michelle at Kaiser says...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532107 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532108 -            1.  Great work reported in your letter today that Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532109 -                and UCSF are reaching agreement so that I can get                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532110 -                treatment. ref DIT 2 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
532112 -  ..
532113 - Millie's letter on blood work continues below. ref SDS 0 SY7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532115 -  ..
532116 - Concern about delaying treatment is elevated by blood test report                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532117 - today that CA 15-3 has jumped back up again to 67, after falling to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532118 - 56, per below. ref SDS 0 GK5B                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532119 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532120 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532122 -  ..
5322 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5323 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5324 - 1633                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5325 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532501 - UCSF Frustrated Kaiser Has Not Submitted Authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
532502 - 
532503 - Margaret called from UCSF Medical Center.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
532504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532505 - Thanked Margaret again for excellent work facilitating Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532506 - meetings with Doctor Benz, most recently on 060821. ref SDS 11 SM6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
532508 -  ..
532509 - Margaret said that she has been assisting Jackie today trying to get                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532510 - Millie's account set up for treatment tomorrow at UCSF.  The work plan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532511 - is for treatment on a clinical study with cetuximab and carboplatin,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532512 - which was prescribed by Millie's primary care physician at Kaiser as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532513 - the best treatment for Millie's condition of advancing IBC metastatic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532514 - disease reported by Kaiser on....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532515 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532516 -        Kaiser examination................. 061201, ref SDS 12 025H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
532517 -        Kaiser examination................. 061208, ref SDS 13 025H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
532518 -        Kaiser examination................. 070105, ref SDS 17 025H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
532520 -  ..
532521 - Margaret explained that UCSF has still not received authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532522 - documentation signed by Millie's primary care physician on 070119.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
532523 - She said the discussions between UCSF and Kaiser reported by the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532524 - primary care physician at Kaiser in a letter on 070122, ref SDS 27                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
532525 - PN4I, and further cited by Michelle this morning, per above,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532526 - ref SDS 0 PR3V, have not been successful.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
532528 -  ..
532529 - Margaret seemed to explain that either she, or someone in Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532530 - Rugo's office called Medicare today to attempt in good faith to carry                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532531 - out suggestions developed from discussions with Kaiser for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
532532 - establishing entitlement to payment through Medicare for USCF to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532533 - provide Millie's treatment prescribed by the primary care physician in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532534 - the meeting at Kaiser on 070105.  Margaret related that the UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532535 - person was on hold waiting to speak with someone at Medicare in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532536 - manner requested by Kaiser for about 20 minutes, then the line was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
532537 - dropped, and the standard phone company message was given to call                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532538 - back.  UCSF called Medicare back, and the same thing happened.  As a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532539 - result, UCSF has nothing that establishes the revenue stream on this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532540 - transaction.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532541 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532542 -     [On 070124 Pam reported Kaiser had similar experience, but                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
532543 -     eventually made contact with a Medicare representative, and after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532544 -     several hours of discussions, Kaiser submitted an authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532545 -     account number to UCSF. ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532547 -      ..
532548 -     [On 070125 Jackie reported UCSF did not receive an authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
532549 -     from Kaiser, and that Lisa in UCSF's Business Office spent 6 hours                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532550 -     talking to Medicare to establish that UCSF would be paid for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532551 -     treating Millie. ref SDS 31 4Y62                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
532553 -  ..
532554 - Margaret was frustrated.  She asked if Kaiser has a Patient Advocate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532555 - that Millie could notify for assistance, since UCSF has been unable                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532556 - to make progress.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532558 -  ..
532559 - Kaiser has several "assistant" roles...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
532560 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532561 -                1.  Physician Assistant...... 050215, ref SDS 7 DL6J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
532562 -                2.  Medical Assistant........                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532563 -                3.  Patient Advocate......... 990913, ref SDS 2 N48H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
532564 -                4.  Records Assistant........                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532565 -                5.  Technical Assistant......                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532566 -                6.  Engineering Assistant....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
532568 -  ..
532569 - Margaret advised that UCSF has not written a letter to Kaiser stating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532570 - what they require to treat Millie.   She seemed to indicate that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532571 - normally everything is handled by conversation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532573 -  ..
532574 - Margaret advised that UCSF has scheduled Millie for treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
532575 - tomorrow.  If UCSF writes a letter stating treatment is delayed until                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532576 - UCSF receives a particular document from Kaiser, then Millie can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532577 - notify her doctor precisely what is needed to resolve the problem.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
532579 -  ..
532580 - Margaret wants Millie to write the letters coordinating with Kaiser,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
532581 - and seemed to indicate that nobody at UCSF has time to write a letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532582 - on this, because Kaiser already knows what is needed.  She feels                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
532583 - Millie can contact her doctor without anything from UCSF, and say she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532584 - heard in a telephone call that treatment is denied because UCSF needs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532585 - something from Kaiser, but the patient does not know what it is except                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532586 - for the general phrase, "authorization number."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532588 -  ..
532589 - There was discussion that UCSF has spent about 20 minutes in this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
532590 - telephone call with Millie.  Writing a letter to Millie confirming the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532591 - problem, which Millie can then submit to Kaiser would take 5 mintues.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532593 -  ..
532594 - Margaret feels that writing a letter telling the patient why treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
532595 - is refuesed and what UCSF requires to proceed is either not necessary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532596 - or is otherwise objectionable for some reason.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
532598 -  ..
532599 - Thanked Margaret for the call, and advised a letter will be sent to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
532600 - the doctor at Kaiser to report understandings Margaret has presented.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
532601 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532602 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532603 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
532604 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5327 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Treatment Delay IBC Cascading Out of Control CA 15-3 Rising Kaiser D                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
5903 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5904 - 1702                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
590501 -  ..
590502 - Cascading Out of Control IBC Requires Treatment Authorization for UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
590503 - Treatment Needed Avoid IBC Cascading Out of Control Like Before                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
590504 - Doctor Notified Authorization for UCSF to Treat Millie Not Received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590505 - 
590506 - Millie submitted ref DIT 3 0001 to the primary care physician at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590507 - Kaiser explaining the problem Margaret presented, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590508 - ref SDS 0 3S3J, and clarifying the favorable understanding set out in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590509 - Millie's earlier letter to Michelle, earlier today, also, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590510 - ref SDS 0 EG7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
590511 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590512 -                    1.  I just got a call from Margaret Rubino, who                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590513 -                        works for Doctor Rugo at UCSF. ref DIT 3 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590515 -                         ..
590516 -                    2.  Margaret said UCSF has not received the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
590517 -                        authorization you signed on January 19th, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590518 -                        that UCSF requires an authorization account                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590519 -                        number from Kaiser.  Margaret said                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
590520 -                        collaboration between Kaiser and UCSF admin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590521 -                        staff on these matters has not been successful,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590522 -                        and so my doctor needs to facilitate Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590523 -                        referral to UCSF. ref SDS 0 3S3J, ref DIT 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
590524 -                        AK5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
590526 -                         ..
590527 -                    3.  I am concerned that CA 15-3 is rising without                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590528 -                        treatment since 061201, similar to before.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
590529 -                        Missing the current window for treatment at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590530 -                        UCSF will require another PET/CT test causing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590531 -                        increased costs and further delay. ref DIT 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
590532 -                        NK6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
590534 -  ..
590535 - Michelle at Kaiser reports in a letter today that CA 15-3 increased                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590536 - again, now to 68, per below. ref SDS 0 GK5B  This eliminates prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590537 - improvement reported on 070110. ref SDS 19 087J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590539 -  ..
590540 - Citation "...similar to before." references treatment ended on 041021,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590541 - and was denied on 041104 because Kaiser discovered pulmonary embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590542 - in Millie's CT test the day before.  Rather than continue treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590543 - with Taxol, which posed no evident risk, ref SDS 4 LP7F, there were                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
590544 - various delays for over 2 months, until treatment was resumed on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
590545 - 050105. ref SDS 6 0001  By then IBC was cascading out of control, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590546 - discussed in the case study on patient history listed on 041230.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
590547 - ref SDS 5 P19O  At that time, CA 15-3 continued to rise above 100                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
590548 - while being treated with AC until treatment was switched on 050329.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590549 - ref SDS 8 0001  A few weeks after starting treatment with Taxotere and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590550 - capecitabine (Xeloda), IBC rash dramatically subsided, and CA 15-3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590551 - dropped back to 67. ref SDS 9 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
590553 -  ..
590554 - High medical costs from mistakes reported on 990912, ref SDS 1 0001,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590555 - occur from delaying authorization that requires another medical test,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590556 - because treatment delayed from 061230 when primary care physician and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590557 - Doctor Rugo agreed Millie would get treatment at UCSF, ref SDS 14                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
590558 - 3X6K, and planning began on 070101 for Millie seeing Doctor Rugo.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
590559 - ref SDS 15 E23P  There was plenty of time then to work on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590560 - authorization and use the PET/CT test on 061227.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
590562 -  ..
590563 - Millie's letter to primary care physician continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590564 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590565 -                    4.  Can you please complete these arrangements, or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590566 -                        let me know what I can do to provide the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590567 -                        authorization number to UCSF? ref DIT 3 LK7H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
590569 -                ..
590570 -               [On 070124 Millie writes another letter requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590571 -               Arlette to assist in resolving authorization issues,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590572 -               ref SDS 30 YF8U, and then leaves town for short                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590573 -               vacation. ref SDS 30 KX9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
590575 -                ..
590576 -               [On 070124 Jackie called and left message for Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590577 -               indicating problem has been resolved; UCSF wants Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590578 -               to have another PET/CT test before starting treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590579 -               ref SDS 30 PQ4Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590581 -                ..
590582 -               [On 070124 Pam reported Kaiser had difficulty contacting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590583 -               Medicare, similar to Margaret's report today, per above,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590584 -               ref SDS 0 MW5Y, but eventually made contact with a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
590585 -               Medicare representative, and after several hours of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
590586 -               discussions, Kaiser was able to submit an authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590587 -               account number to UCSF. ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
590588 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590589 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590590 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590592 -  ..
5906 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5907 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5908 - 1717                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5909 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
590901 - Doctor on Vacation Cannot Resolve Authorization Issue Until Next Week                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590902 - 
590903 - Margaret at UCSF asked Millie to send a letter to the doctor on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590904 - coordinating referral, per above. ref SDS 0 L43U  After Millie sent a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590905 - letter to the doctor, also, per above, ref SDS 0 J94L, Kaiser reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590906 - that the primary care physician is on vacation until 070129.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590908 -  ..
590909 - Evidently, UCSF planning for Millie to start treatment tomorrow cannot                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590910 - be achieved, and so treatment of progressing disease is delayed at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
590911 - this time indefinetly.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
590913 -         ..
590914 -        [On 070124 Millie sent a letter to Arlette at Kaiser explaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590915 -        background ref SDS 30 YF8U, and asking for assistance.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590916 -        ref SDS 30 BA9Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590918 -         ..
590919 -        [On 070124 Arlette expedited coordination of resolution.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
590920 -        ref SDS 30 UE4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590922 -         ..
590923 -        [On 070124 UCSF notifies Millie referral problem solved; orders                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
590924 -        another CT test because treatment has been delayed too long to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
590925 -        use the last CT test on 061227. ref SDS 30 PQ4Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
590927 -         ..
590928 -        [On 070126 substitute doctor orders CT test requested by UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
590929 -        for Millie's treatment. ref SDS 32 Z24H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
590930 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590931 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590932 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590933 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
590935 -  ..
5910 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5911 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5912 - 1722                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
5913 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
591301 - UCSF Delays Treatment Pending Kaiser Authorization Account Number                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
591302 - 
591303 - Jackie called.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
591304 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
591305 - Jackie explained that she and others at UCSF have spent a lot of time                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591306 - and effort to make arrangements for Millie to get treatment tomorrow,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591307 - but this has not worked out.  She asked Margaret to call earlier and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
591308 - explore possible ways to assist Kaiser with pending authorization.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
591310 -  ..
591311 - Commended Margaret's past work helping Millie get a 2nd opinion from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
591312 - Doctor Benz, and that her call today was professional and helpful in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
591313 - all respects, per above. ref SDS 0 MW4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
591315 -  ..
591316 - Jackie explained that normally patients arrive at UCSF with a document                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591317 - that authorizes payment for treatment.  Dealing with Kaiser works                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
591318 - differently, and this causes delays and frustrations all around.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
591320 -  ..
591321 - Asked about getting the name of the document UCSF wants so that Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591322 - can asked her doctor about it?  Considered prospects again of Jackie,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591323 - Doctor Rugo, or someone at UCSF writing a letter explaining treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591324 - is denied and what is required to provide treatment, as discussed with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591325 - Margaret earlier. ref SDS 0 J96N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
591327 -  ..
591328 - Jackie feels that UCSF should not have to explain the problem in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
591329 - writing.  She asked if Millie has contacted Kaiser following the call                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591330 - from Margaret earlier today, per above? ref SDS 0 J98F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591332 -  ..
591333 - Reviewed Millie's letter to the primary care physician, ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
591334 - J94L, submitted to Kaiser after Margaret's call about 40 minutes ago,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591335 - per above. ref SDS 0 J94L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
591337 -  ..
591338 - Jackie explained that under the circumstances with no authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
591339 - from Kaiser and Medicare, Millie cannot get treatment tomorrow at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
591340 - UCSF, as planned originally on 070117, ref SDS 23 5S85, and then                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591341 - revised during the meeting at UCSF on 070119. ref SDS 26 AS5H  Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
591342 - Rugo wants to establish with documentation from Kaiser and Medicare                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
591343 - that neither UCSF nor Millie will get stuck with the bill, which is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
591344 - covered by Millie's health care entitlements and insurance premiums.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
591345 - We considered prospects of getting treatment on Thursday or Friday if                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
591346 - by some miracle difficult issues presented today are resolved in time?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591348 -         ..
591349 -        [On 070124 Pam reported Kaiser eventually made contact with a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
591350 -        Medicare representative, and after several hours of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
591351 -        discussions, Kaiser was able to submit an authorization account                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
591352 -        number to UCSF. ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
591353 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
591354 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
591355 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
591356 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
591357 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
5914 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
6003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
600401 -  ..
600402 - CT Test Monitor Patient to Quickly Switch from Ineffective Treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600403 - Drug Trial Protocol Waiver Possible Use CT Test on 061227                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
600404 - Patient Better Served by Test Data Close to Treatment Start Date                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600405 - 
600406 - Jackie seemed to indicate having discussed Millie's case with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600407 - Rugo today.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
600409 -  ..
600410 - The doctor apparently gave the impression to Jackie that UCSF could                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600411 - probably obtain a protocol waiver for Millie to get treatment this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600412 - week under the PET/CT test on 061227, since the requirements would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600413 - only be exceeded by a few days.  However, the doctor feels Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600414 - would be better served by having another PET/CT test if treatment is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600415 - delayed until next week.  Jackie understands from Doctor Rugo that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600416 - besides drug trial study requirements, tests closer in time to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600417 - date of starting treatments provide better diagnostics on patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600418 - benefits; so that, if treatment is not effective, the doctor can                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
600419 - switch the patient to another regimen in time to prevent disease from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600420 - cascading out of control.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
600422 -  ..
600423 - The primary care physician has cautioned strongly throughout Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600424 - care for breast cancer, and particularly with respect to IBC, that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600425 - accurate data to take action in time to avoid cancer from spinning out                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
600426 - of control is a critical criteria of treatment strategy, shown by case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
600427 - study on 041230. ref SDS 5 P19O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600429 -        [On 070124 Jackie leaves message that the doctor wants Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
600430 -        have another CT test. ref SDS 30 PQ4Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600432 -         ..
600433 -        [On 070125 Doctor Rugo orders updated CT test to begin new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600434 -        treatments at UCSF; request CT test for pulmonary embolism.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600435 -        ref SDS 31 Z24H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
600436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600437 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600440 -  ..
600441 - Patient Help Expedite Kaiser Authorization Process                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600442 - UCSF Suggests Patient Notify Kaiser Background Authorization Problem                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600443 - 
600444 - Jackie suggested that Millie submit a more detailed account of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
600445 - background on the scope and urgency of the authorization problem for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600446 - getting Millie into treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
600448 -  ..
600449 - Explained that Millie got a response to her letter 10 minutes ago                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600450 - after talking to Margaret, per above. ref SDS 0 MW4H  Kaiser reports                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600451 - that Millie's doctor is on vacation until next week. ref SDS 0 LP4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600452 - There may be nothing more that can be done until Millie's primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
600453 - physician returns from vacation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
600455 -  ..
600456 - Jackie said she will work the problem further tomorrow, and let Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
600457 - know about progress.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600459 -  ..
600460 - Millie will consider asking Arlette to get involved.  She has been a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600461 - strong support for good management at Kaiser, illustrated by the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
600462 - record on 060809. ref SDS 10 3J4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
600463 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600464 -        [On 070124 Millie sent a letter to Arlette at Kaiser explaining                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
600465 -        background ref SDS 30 YF8U, and asking for assistance.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600466 -        ref SDS 30 BA9Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
600468 -         ..
600469 -        [On 070124 Arlette expedited resolution with Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
600470 -        Authorization Department. ref SDS 30 UE4O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
600472 -         ..
600473 -        [On 070124 Pam reported Kaiser eventually made contact with a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
600474 -        Medicare representative; after many hours of discussion a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
600475 -        solution was arranged; Kaiser submitted an authorization                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600476 -        account number to UCSF. ref SDS 30 6K3L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600477 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600478 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600479 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600481 -  ..
6005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
6006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
6007 - 1801                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
6008 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
600801 - Millie Implements Deferred Vacation Plans to Leave Town for Few Days                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600802 - 
600803 - After Jackie's call explaining UCSF demand for administrative details                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600804 - from Kaiser, per above, ref SDS 0 J94O, Millie was very disappointed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600805 - and despondent that all the work the past month to expedite treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600806 - has failed.  She decided that to relieve emotional tension,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
600807 - frustration and anger, rather than sit around the house waiting for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600808 - phone calls and hearing endless explanations of treatment delayed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600809 - because people in various departments at Kaiser, UCSF and Medicare                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
600810 - failed to perform, got mixed up, or lost documents, she might as well                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600811 - take several days vacation previously planned, as reported on 070116,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600812 - ref SDS 22 VQ3G, but were then cancelled to accomodate cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600813 - treatments, which UCSF scheduled for tomorrow on 070124, as reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
600814 - on 070118, ref SDS 24 FA60, but are now on hold, or cancelled because                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
600815 - Kaiser and UCSF do not agree, as reported by Michelle, per above,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
600816 - ref SDS 0 3S3J, and confirmed by Jackie. ref SDS 0 J43I  It's another                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600817 - mess.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
600819 -      ..
600820 -     [On 070124 Millie travels to Seattle after treatment is delayed;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
600821 -     implements original plan. ref SDS 30 KX9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
600822 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600823 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600824 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
600825 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
6009 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Blood Test Performed Treatment Clinical Study Cetuximab Carboplatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
7003 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700401 -  ..
700402 - Laboratory Blood Test Performed Today Per Doctor's Order                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
700403 - 
700404 - Follow up ref SDS 27 AS6M, ref SDS 26 AS6M.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
700406 -  ..
700407 - Millie's letter from above, ref SDS 0 YF6Y, to Michelle at Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700408 - continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
700409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700410 -    3.  As well, per your call yesterday, I went to Kaiser at 0600 this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700411 -        morning and got additional blood tests ordered by [my doctor]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700412 -        yesterday that meet UCSF requirements for me to start                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
700413 -        treatment. ref SDS 27 LX6V, ref DIT 1 CQ6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700415 -         ..
700416 -    4.  When time permits, I need the report on the blood test which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700417 -        Kaiser submitted to UCSF OA 070119.  It should now show CA 15-3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700418 -        diagnostic, as noted in the letter last week to Kaiser.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
700419 -        ref SDS 26 0Z9P, ref DIT 1 XQ7I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
700421 -  ..
700422 - Michelle did not have time to discuss submitting blood test reports,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700423 - during the call yesterday. ref SDS 27 Z73H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
700424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700425 -            [On 070130 Millie scheduled for treatment at UCSF on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700426 -            070201. ref SDS 33 MP4H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
700427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700428 -            [On 070131 UCSF requests another blood test before starting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
700429 -            treatment on 070201. ref SDS 34 NZ4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700431 -  ..
700432 - The test today corrects mistakes in the test on 070118, ref SDS 24                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
700433 - HZ41, which were reported the next day on 070119 during a meeting at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700434 - UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700436 -  ..
700437 - Millie's letter to Michelle at Kaiser concludes...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700439 -    5.  Thanks also to Arlette for coordinating everything.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
700440 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700443 -  ..
7005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
7006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
7007 - 1143                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
7008 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700801 - CA 15-3 68 Cancer Marker Big Rise Elevates Need for Timely Treament                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700802 - 
700803 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700804 - Michelle at Kaiser letter to Millie continues...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700805 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700806 -        3.  I am putting in the mail today (which will go out tomorrow)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700807 -            a copy of the labs from 1/18.  The CA 15-3 was 68.  UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700808 -            already has these results.  I will check the computer this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700809 -            afternoon to see if your results from today are back yet.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700810 -            If they are I will fax to UCSF.  If not Arlette will fax                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700811 -            them tomorrow am. ref DRT 1 0001                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
700813 -  ..
700814 - CA 15-3 rising from 56 to 68 loses most of the improvement reported on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700815 - 070110. ref SDS 19 087J  Rising cancer marker underscores urgency of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
700816 - starting treatment, ended on 061201.  Millie cited rising CA 15-3 in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700817 - letter to primary care physician on authorizing treatment at UCSF, per                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700818 - above. ref SDS 0 SX5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700820 -  ..
700821 - Millie responded to Michelle at Kaiser....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
700823 -  ..
700824 - This letter continues from the section on delayed treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
700825 - ref SDS 0 EG8T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
700826 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700827 -            2.  If it is not too much touble, rather than mail                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700828 -                documents to me, can you cut and past the lab report on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700829 -                blood tests (both today and last week) in an email so I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700830 -                don't have to type everything over again?  If you send                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700831 -                me a printed document, then I have to key it in.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700832 -                ref DIT 2 2W5M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700834 -                 ..
700835 -            3.  Arlette and [my doctor] for example use cut and past to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700836 -                send the Medical Chart report on meetings, CT test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
700837 -                reports, ect., via email. ref DIT 2 HW6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700839 -                 ..
700840 -            4.  I realize that sometimes tasks which sound fast and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
700841 -                easy turn out to be difficult and time consuming, and I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700842 -                don't want to add to your work.  But, if it is just as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700843 -                fast for you to send the blood test results by return                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
700844 -                email that would save me a lot of time and effort to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
700845 -                manage the record. ref DIT 2 TW6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700847 -  ..
700848 - Michelle submitted the blood test report in a follow up letter.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700849 - During this time the email program failed. ref SDS 29 6180  Various                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
700850 - solutions were attempted, resulting in using a Netscape upgrade called                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700851 - variously Mozilla or Thunderbird. ref SDS 29 L49K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
700853 -  ..
700854 - Eventually, email functionality was restored.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700856 -  ..
700857 - This process resulted in losing some correspondence.  One was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
700858 - Michelle's letter that submitted the blood test report.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
700860 -  ..
700861 - Since UCSF ordered another blood test, and blood was drawn this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700862 - morning, per above, ref SDS 0 AS6M, will try to avoid asking Michelle                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
700863 - to resubmit the blood test, since it was incomplete.  If the test                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
700864 - today is complete, rather than just supplementing the prior test, then                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
700865 - the report the test today will be adequate for patient history.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700866 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700867 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700868 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700869 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700870 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700871 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
700872 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
7009 -