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


S U M M A R Y


DIARY: May 11, 2007 10 37 Friday; Rod Welch

Millie blood test at Kaiser for CT test on 070520, ordered CA 15-3.

1...Summary/Objective

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1...This record suggests coordination between Kaiser and referral hospital

CONTACTS 

SUBJECTS
CT Scan Test Schedule Changed 070520 Correct Mistakes Kaiser Align W

1603 -
1603 -    ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 4 DT8I, ref SDS 3 3M6V.
160502 -
160503 -
160504 -
160505 -
160506 -
160508 -  ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - Millie received a call from Kaiser this morning requesting that she
160902 - have another blood test, because the test UCSF did on 070426 was
160903 - missing some results Kaiser needs in connection with Millie getting
160904 - the CT test, which Jackie coordinated and is currently scheduled
160905 - incorrectly on 070514. ref SDS 2 075H  Millie gathered during the call
160906 - that Kaiser wants an updated test for creatinine, however, this was
160907 - part of the test on 070426. ref SDS 2 4B5G
160909 -  ..
160910 - This record suggests coordination between Kaiser and referral hospital
160911 - was not effective for hundreds of blood tests performed at UCSF which
160912 - affect patient history also under review at Kaiser.
160913 -
160914 -        [On 070517 Kaiser objects to reviewing a few CT films to assess
160915 -        patient's risk of lung and heart disorders on grounds of saving
160916 -        time and money to assist other patients, yet shows no concern
160917 -        to avoid wasteful duplication of hundreds of blood tests.
160918 -        ref SDS 8 3T9G
160920 -         ..
160921 -        [On 070525 Kaiser's medical chart shows results of the blood
160922 -        test at Kaiser today on 070511, but does not list results at
160923 -        UCSF on 070426. ref SDS 9 128S
160925 -         ..
160926 -        [On 070611 communications on coordinating care and treatment
160927 -        plans between Kaiser and UCSF did not reach concensus, and
160928 -        reasons for differences are not presented. ref SDS 11 JQ6F
160930 -  ..
160931 - During this call, Millie asked to change the date of the test from
160932 - 070514 to 070520 to better align with requirements of the cetuximab
160933 - clinical study for testing on 8 week intervals, discussed with UCSF
160934 - yesterday on 070510. ref SDS 4 V36R  Kaiser changed the date as
160935 - requested, and without protest, contrary to expectations at UCSF
160936 - yesterday. ref SDS 4 V36O
160937 -
160938 -        [On 070516 Millie notified UCSF schedule changed to meet
160939 -        requirements of clinical study. ref SDS 6 EF9M
160941 -  ..
160942 - Millie went to Kaiser in Park Shadelands for the extra blood test, per
160943 - Kaiser's request to support the CT test.  She also ordered another PT
160944 - and INR test for coagulation control to treat pulmonary embolism, and
160945 - she ordered a test for CA 15-3 to support the meeting with the primary
160946 - care physician scheduled for 070525, and cross-check work at the UCSF
160947 - Labs, showing remarkable improvement in the cancer marker.  On 070307
160948 - this seemed "too good to be true." ref SDS 1 U85L
160950 -         ..
160951 -        [On 070514 Millie asks primary care physician at Kaiser for
160952 -        results of CA 15-3 test today. ref SDS 5 IN5P
160954 -         ..
160955 -        [On 070516 Kaiser notifies Millie CA 15-3 56 and describes this
160956 -        result as "stable," ref SDS 6 QN6M, which conflicts with
160957 -        testing at UCSF. ref SDS 6 WV6L
160959 -         ..
160960 -        [On 070516 Millie asks Kaiser to verify accuracy of CA 15-3
160961 -        test on 070511, and to notify UCSF to be prepared for meeting
160962 -        with the patient on 070524. ref SDS 6 ZJ9N
160964 -         ..
160965 -        [On 070516 Millie notified UCSF CA 15-3 56 substantial rise in
160966 -        test at Kaiser. ref SDS 6 J55T
160968 -         ..
160969 -        [On 070517 Kaiser advised that UCSF uses a different
160970 -        calibration method for CA 15-3 that cannot be compared to the
160971 -        Kaiser test results, like comparing apples and oranges.
160972 -        ref SDS 8 NT3O
160974 -         ..
160975 -        [On 070517 Nurse's Notes show nurse practitioner ordered
160976 -        another blood test to verify elevated CA 15-3 56 reported in
160977 -        Kaiser's test on 070511; but did not perform the test, and
160978 -        decided to wait another week to address the issue. ref SDS 7
160979 -        FG6H
160981 -         ..
160982 -        [On 070517 Brigid discloses that coordinating divided
160983 -        responsibilities on referral projects is difficult; and that
160984 -        UCSF recommends limiting laboratory work rather than
160985 -        cross-checking tests for accuracy. ref SDS 8 466H
160987 -         ..
160988 -        [On 070524 Kaiser's medical chart lists Millie's blood work on
160989 -        070511, without listing the date, and does not list any of the
160990 -        blood tests submitted to Kaiser reported by UCSF, demonstrating
160991 -        a gap in coordination for case management of referral work.
160992 -        ref SDS 9 128S
160994 -         ..
160995 -        [On 070531 UCSF not concerned results of blood test today show
160996 -        CA 15-3 37 rising 30% from the prior report on 070426, because
160997 -        CT scans show no metastatic cancer, and IBC inflammation
160998 -        appears to be subsiding. ref SDS 10 NQ6K
160999 -
161000 -
161001 -
161002 -
161003 -
1611 -