Welch Company
San Francisco, CA


S U M M A R Y


DIARY: June 11, 2007 08:21 AM Monday; Rod Welch

Millie Cellulitis IV treatment, coordination UCSF and Kaiser.

1...Summary/Objective
....UCSF Notified Cellulitis Improved Clarify Cellulitis Treatments
....Kaiser Request Clarification Cellulitis Treatments
2...Cellulitis 3rd Treatment Ceftriaxone IV 2gms Kaiser Martinez
....Port Catheter Avoided Nurse Substitutes Needle Penetration for IV
....IV Needle Penetration Mimimal Damage Substitute for Port Catheter
3...Reasons Not Presented Disagreement Treatment Cellulitis
4...UCSF Kaiser Communication Coordination Disagree on Treatment
5...070607 Chronology Time Line
6...070608 Chronology Time Line
7...Mental Maps Read What is Expected Not What is Written
8...Kaiser Proposes Oral Antibiotics That Have Not Been Prescribed
9...Clarification Prescription for Cellulitis Complete IV Treatment
10...Confirm UCSF Medical Team Coordinating with Kaiser on Patient Care
........Conflict Treatments Antibiotics with Cetuximab Coumadin
........Complete IV Treatments Unless Conflict Other Treatments


..............
Click here to comment!

CONTACTS 
SUBJECTS
Examination Treatment Cetuximab 3rd Treatment 4th Cycle Chemotherapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 85 0000. ref SDS 84 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040505 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040506 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040507 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040509 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - Temperature 98.6.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040902 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040903 - This continued no fever status from yesterday. ref SDS 85 UW5L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040905 -  ..
040906 - No Tylenol since Saturday, as previously reported yesterday, 070610.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040907 - ref SDS 85 1V7K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040909 -  ..
040910 - Arm shows no signs of worsening Cellulitis; improvement reported with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040911 - arm nearly normal seems stable today, with very slight inflammation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040912 - on upper inner arm, and lower arm. ref SDS 85 MV7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
040914 -  ..
040915 - Energy seems back to normal now, thinking about getting things done.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040916 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040918 -     ..
040919 -    UCSF Notified Cellulitis Improved Clarify Cellulitis Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040920 -    
040921 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040922 - Millie sent a letter to UCSF...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040923 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040924 -        Subject:  Cellulitis Seems Resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040926 -         ..
040927 -        Date:  June 11, 2007 1108                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040929 -         ..
040933 -         ..
040934 -        I'm just leaving for Kaiser in Martinez to get the 3rd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040935 -        treatment for Cellulitis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040937 -         ..
040938 -        At this time, I seem to be mostly recovered, as shown in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040939 -        record yesterday. ref SDS 85 PR4W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040941 -         ..
040942 -        [The primary care physician] reported in a letter yesterday                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040943 -        that communication channels are now open between UCSF and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040944 -        Kaiser on case management of my referral. ref SDS 85 OG7F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040946 -         ..
040947 -        Thanks for taking the initiative on this in your letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040948 -        070608. ref SDS 83 035H  [this was actually a call from Brigid]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040950 -         ..
040951 -        As you can see, he also states in part that I should "now be                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040952 -        back on oral antibiotics," ref SDS 85 ST90, which seems to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040953 -        conflict with the record on 070608 that IV antibiotics are                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040954 -        scheduled through Wednesday. ref SDS 83 AL39, Did you hear                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040955 -        anything different?  Is the oral antibiotics Keflex, as Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040956 -        Rugo discussed on 060707? ref SDS 82 ZI35                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040957 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040958 -            [...below, UCSF responds "great!!" ref SDS 0 3E4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040960 -             ..
040961 -            [...below, Millie requests clarification from UCSF on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040962 -            clarifying treatments. ref SDS 0 JQ6M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040964 -         ..
040965 -        [The primary care physician at Kaiser] advised in his letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040966 -        yesterday that you submitted results of the blood culture to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040967 -        Kaiser, ref SDS 85 834N, which was performed at UCSF on 070607.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040968 -        ref SDS 82 8J51  When time permits, please submit the record on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040969 -        the blood culture to me.  If you cannot easily send it with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040970 -        email, I can get a copy from Catherine on Thursday.  Just let                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040971 -        me know.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040973 -         ..
040974 -        Notice I have developed 3 cold sores on my lip, shown in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040975 -        record yesterday on 070610. ref SDS 85 LG4L  Is this part of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040976 -        Cellulitis, a side effect of cetuximab, or of the antibiotics                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040977 -        to treat Cellulitis, or is something else entirely?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040978 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040979 -            [...below, Millie requests comments on cold issue from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040980 -            primary care physician. ref SDS 0 GJ5J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040982 -             ..
040983 -            [...below, UCSF responds "great!!" ref SDS 0 3E4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040985 -             ..
040986 -            [...below, Millie requests clarification from UCSF on cold                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040987 -            sore issue. ref SDS 0 JQ8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040988 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040990 -         ..
040991 -        Thanks.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
040992 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040993 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040995 -     ..
040996 -    Kaiser Request Clarification Cellulitis Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040997 -    
040998 -    Follow up ref SDS 85 OG7F.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040999 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041000 - Millie submitted a letter to Kaiser requesting clarification of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041001 - doctor's letter yesterday saying to continue with oral antibiotics,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041002 - which conflicts with the record of IV antibiotics prescribed, and no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041003 - prescription for oral antibiotics at this time. ref SDS 85 OG9G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041004 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041005 -        Subject:  Clarify Cellulitis Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041007 -         ..
041008 -        Date:  June 11, 2007 0904                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041010 -         ..
041011 -        Please see the record yesterday reviewing your letter saying to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041012 -        now be back on oral antibiotics. ref SDS 85 OG7F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041013 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041014 -            [On 070612 primary care physician at Kaiser clarifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041015 -            treatment plan to start Keflex oral antibiotics after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041016 -            completing IV medications. ref SDS 86 QE4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041018 -         ..
041019 -        I seem to be pretty much recovered from Cellulitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041020 -        inflammation, thanks very much. ref SDS 85 0T6K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041022 -         ..
041023 -        Also, I have 3 cold sores, any comments. ref SDS 85 LG4L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041024 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041025 -            [...see above Millie asks UCSF about correlations with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041026 -            cetuximab treatments and cellulitis. ref SDS 0 JP3O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041028 -  ..
041029 - Millie received an immediate response from Kaiser reporting that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041030 - primary care physician is out of the office and cannot reply.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041031 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041032 -            [...see below primary care physician responds. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041033 -            QE5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041034 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041035 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041036 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041038 -  ..
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0413 - 0900                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041401 - Cellulitis 3rd Treatment Ceftriaxone IV 2gms Kaiser Martinez                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041402 - 
041403 - Millie went to Kaiser in Martinez to get the 3rd IV treatment of 5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041404 - total treatments for Cellulitis prescribed on 070607, ref SDS 82 8L46,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041405 - and scheduled the next day on 070608. ref SDS 83 AL39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041408 -     ..
041409 -    Port Catheter Avoided Nurse Substitutes Needle Penetration for IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041410 -    IV Needle Penetration Mimimal Damage Substitute for Port Catheter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041411 -    
041412 -    Follow up ref SDS 83 VQ5L.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041413 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041414 - Millie advised that the nurse was proactive this morning volunteering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041415 - to use the port catheter, and did this work very effectively.  this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041416 - solved the problem that occurred last Friday on 070608, when Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041417 - insisted on giving treatment with conventional needle IV methods,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041418 - based on limited training. ref SDS 83 VQ5L  Since the same nurse gave                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041419 - treatment today with the port catheter, the previous problem was not a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041420 - training issue.  May have related to limited time, and so, like                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041421 - everyone, the nurse was trying to save time and money using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041422 - conventional methods that turned out to be harmful to the patient.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041427 -  ..
0415 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0416 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0417 - 1220                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0418 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041801 - Millie tired; taking a nap.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041802 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041804 -  ..
0419 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0420 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0421 - 1310                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0422 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042201 - Millie awake.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042202 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042203 - Temperature 97.8.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042204 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042206 -  ..
0423 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0424 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0425 - 1429                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0426 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042601 - Brigid responded to Millie's letter this morning requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
042602 - clarification of treatment for Cellulitis, ref SDS 0 JO6I, requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042603 - the report on blood cultures sent to Kaier, ref SDS 0 JP3G, and asking                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042604 - if cold sores are side effects of cetuximab, Cellulits treatments,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042605 - etc., ref SDS 0 JP3O,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042607 -  ..
042608 - The UCSF letter says...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
042609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042610 -        Subject:  Cellulitis Seems Resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
042611 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042612 -        Date:  June 11, 2007 1259                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042613 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042614 -        Great!!                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042615 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042617 -  ..
042618 - Since this does not respond to issues in Millie's letter, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042619 - ref SDS 0 VM9H; Millie sent a follow up saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042620 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042621 -        Subject:  Cellulitis Seems Resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
042622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042623 -        Date:  June 11, 2007 1438                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042625 -         ..
042628 -         ..
042629 -        Thanks for your letter earlier today on recovering from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042630 -        Cellulitis. ref SDS 0 3E4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042632 -         ..
042633 -        I also asked if UCSF and Kaiser have collaborated on my                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042634 -        treatment, as set out in [the primary care physician's] letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042635 -        yesterday, ref SDS 0 JO5J; and, is it your understanding I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
042636 -        should switch to oral antibiotic before completing 5 days of IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042637 -        treatment? ref SDS 0 JO6I  I sent a letter to [the primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042638 -        physician] this morning, ref SDS 0 OG7F, and got a reply that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042639 -        he is out of town.  Can you help clarify treatment based on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042640 -        communications with Kaiser? ref SDS 85 IY3J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
042642 -         ..
042643 -        Also, I requested a copy of the report on the blood culture,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042644 -        ref SDS 0 JP3G, which the doctor reported UCSF submitted to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042645 -        Kaiser. ref SDS 85 834N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042647 -         ..
042648 -        I also reported in my letter this morning that I have developed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
042649 -        3 cold sores on my lip. ref SDS 85 LG4L, and asked if this new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
042650 -        condition is a side effect of cetuximab,  or possibly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042651 -        cellulitis related?  Will the antibiotics clear it up or just                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042652 -        let nature takes its course? ref SDS 0 JP3O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042653 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042655 -  ..
0427 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0428 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0429 - 1613                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0430 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043001 - Millie received a call from Brigid responding to Millie's letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043002 - earlier today, per above. ref SDS 0 JQ5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043004 -  ..
043005 - Brigid did not discuss the blood culture which Millie requested,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043006 - ref SDS 0 JQ8J, and, she did not discuss the new problem of cold                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043007 - sores, also, raised in Millie's letter. ref SDS 0 JQ8O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043008 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043009 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043011 -  ..
043012 - Reasons Not Presented Disagreement Treatment Cellulitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043013 - UCSF Kaiser Communication Coordination Disagree on Treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043014 - 
043015 - Brigid reported during the call today that last week she and Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043016 - Rugo called and collaborated with the primary care physician at Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043017 - on the course of treatment that Millie should get for Cellulitis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043018 - UCSF recommended to Kaiser that, following IV treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043019 - Ceftriaxone at UCSF on 070607 at 1152, ref SDS 82 8J9R, Millie should                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043020 - be treated only with Keflex pills, which Doctor Rugo had discussed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043021 - initially on 070607 at 0800, when Millie was examined and Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043022 - diagnosed Cellulitis. ref SDS 82 ZI37  Millie gathered from Brigid's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043023 - explanation today, that Kaiser decided that treatment for recurrent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043024 - Cellulitis in this case should start using outpatient IV medication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043025 - with Ceftriaxone, and not with Keflex proposed by UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043027 -  ..
043028 - Communication differences today reflect coordination challenges on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043029 - referral projects that occur in aligning test results between Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043030 - and UCSF, reported on 070511. ref SDS 81 T76M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043031 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043039 -  ..
043040 - Brigid did not present today in the call with Millie reasons UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043041 - proposed only Keflex for continuing treatment of Cellulitis, nor any                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043042 - reasons Kaiser presented for continuing treatment with Ceftriaxone.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043043 - On 041230 the primary care physician at Kaiser explained that reasons                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043044 - for treatment prescriptions are important to patient care. ref SDS 10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043045 - XQ84  Importance of reasons for conflict and disagreement is presented                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043046 - further in NWO. ref OF 2 PXWX                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043048 -  ..
043049 - Brigid did not say today, and the record is not clear when discussion                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043050 - between Brigid, Doctor Rugo, and the primary care physician at Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043051 - occurred, either on 070607, or the next day on 070608.  Review of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043052 - patient history indicates the call occurred on Friday, 070608 between                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043053 - 1153 and 1743. ref SDS 0 QD6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043054 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043055 -            [...below Millie received a letter from Kaiser; primary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043056 -            care physician says to complete full course of oral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043057 -            antibiotics, which conflicts with the record of no course                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043058 -            having been prescribed for oral antibiotics, and current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043059 -            prescription for 5-days of IV anbiobiotics. ref SDS 0 QE5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043061 -             ..
043062 -            [...below Millie requests clarification of treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043063 -            Cellulitis from Kaiser. ref SDS 0 QE4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043065 -             ..
043066 -            [...below Millie responds to call from UCSF, ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043067 -            VW4L, and notifies UCSF of decision to complete IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043068 -            treatment for Cellulitis. ref SDS 0 VW65                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043070 -             ..
043071 -            [On 070612 Millie gets 4th IV treatment for Cellulitis at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043072 -            Kaiser in Martinez. ref SDS 86 ZG84                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043073 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043075 -  ..
043076 - 070607 Chronology Time Line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043077 - 
043078 - Chronology of events on 070607 indicates there was likely no call                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043079 - between the medical team at UCSF and the primary care physician at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043080 - Kaiser...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043081 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043082 -        1.  Diagnosis during examination at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043083 -            UCSF; initial treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043084 -            Keflex prescribed.................. 0800, ref SDS 82 ZI37                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043086 -             ..
043087 -        2.  Millie treated in Infusion Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043088 -            UCSF with cetuximab for cancer;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043089 -            Cellulitis condition worsens Vicodin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043090 -            treatment given to relieve pain;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043091 -            patient history of Cellulitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043092 -            reviewed........................... 0905, ref SDS 82 PSWS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043094 -             ..
043095 -        3.  Catherine sends email notifying                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043096 -            Brigid in Breast Care Clinic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043097 -            that Millie's condition                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043098 -            worsens............................ 0930, ref SDS 82 8J33                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043100 -             ..
043101 -        4.  Kaiser called independently via cell                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043102 -            phone by patient assistant; Arlette                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043103 -            notified Millie suffers recurrent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043104 -            Cellulitis; UCSF medical team prescribes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043105 -            outpatient oral antibiotics with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043106 -            Keflex;, ref SDS 0 JR3H; Arlette                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043107 -            will discuss with primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043108 -            physician and coordinate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043109 -            with UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043110 -            team............................... 0930, ref SDS 82 GY41                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043112 -             ..
043113 -        5.  Cellulitis worsens, temperature rises,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043114 -            Millie in distress; Catherine notifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043115 -            Brigid in Breast Care Center again of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043116 -            advancing disease; UCSF approves                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043117 -            treating Millie with ceftriaxone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043118 -            IV 2gms, and take blood                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043119 -            culture............................ 1030, ref SDS 82 8J51                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043121 -             ..
043122 -        6.  Kaiser called patient assistant at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043123 -            UCSF on cell phone; Arlette advises that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043124 -            primary care physician concurs with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043125 -            UCSF initial prescription to treat                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043126 -            recurrent Cellulitis with Keflex                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043127 -            oral antibiotics................... 1048, ref SDS 82 0J70                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043129 -             ..
043130 -        7.  Kaiser advised Millie's condition                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043131 -            worsened; UCSF changed prescription                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043132 -            and will treat recurrent Cellulitis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043133 -            immediately at UCSF with IV antibiotics,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043134 -            and take blood culture; Arlette will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043135 -            notify primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043136 -            physician.......................... 1048, ref SDS 82 8J80                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043138 -             ..
043139 -        8.  UCSF begins treatment Cellulitis with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043140 -            Ceftriaxone IV 2gms, after Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043141 -            completes cetuximab IV treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043142 -            for cancer......................... 1152, ref SDS 82 8J9R                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043144 -             ..
043145 -        9.  Cellulitis IV treatment completed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043146 -            Millie's temperature 101.4; UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043147 -            releases Millie to go                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043148 -            home............................... 1310, ref SDS 82 8J5C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043150 -             ..
043151 -       10.  Millie home from UCSF for treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043152 -            on clinical study for cancer with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043153 -            cetuximab, and after getting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043154 -            exitent IV treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043155 -            Cellulitis at UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043156 -            temperature 100.4.................. 1415, ref SDS 82 8L85                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043158 -             ..
043159 -       11.  Kaiser called; Arlette asks for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043160 -            name of IV treatment UCSF gave                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043161 -            this morning for Cellulitis;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043162 -            Millie reports treatment listed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043163 -            in UCSF Nurse's Notes is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043164 -            Ceftriaxone........................ 1428, ref SDS 82 8L8H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043166 -             ..
043167 -       12.  Kaiser called; Arlette advises that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043168 -            primary care physician at Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043169 -            orders 5-days out-patient IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
043170 -            treatment for Cellulitis at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043171 -            Kaiser Martinez.................... 1503, ref SDS 82 8L46                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043173 -             ..
043174 -       13.  Kaiser Martinez calls schedules                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043175 -            outpatient IV treatment tomorrow                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043176 -            0900............................... 1526, ref SDS 82 8L8Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043178 -  ..
043179 - This record suggests that since Kaiser did not know the name of the IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043180 - treatment at UCSF until this was requested from Millie at 1428, there                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043181 - may have been a discussion between Kaiser and UCSF after 1428 and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043182 - before Kaiser entered a prescription for the same drug at 1503 on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043183 - 070607. ref SDS 0 SE52                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043185 -  ..
043186 - 070607 1430 would have been a good time for collaboration discussions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043187 - between Kaiser and UCSF to coordinate Millie's treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043189 -  ..
043190 - As well, there may have been no discussions between Kaiser and UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043191 - on 070607.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043193 -  ..
043194 - Late in the PM after work on 070607, Millie submitted the record of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043195 - work on 070607 to both UCSF and Kaiser. ref SDS 82 EF6J  Possibly UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043196 - reviewed the record the next day, and noticed that Kaiser prescribed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043197 - follow on IV treatment, ref SDS 82 8L8H, like UCSF gave earlier in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043198 - morning. ref SDS 82 8J37                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043200 -  ..
043201 - If UCSF was too busy to review the record of work performed on 070607,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043202 - then their medical team may not been aware that Kaiser first                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043203 - prescribed Keflex oral antibiotics, ref SDS 0 LR71, but later changed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043204 - and prescribed IV treatment, nstead of oral antibiotic, which UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043205 - first proposed, when Cellulitis was diagnosed on 070607, ref SDS 82                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
043206 - ZI37, and says today was subsequently recommended to Kaiser.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043207 - ref SDS 0 JQ5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043208 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043210 -  ..
043211 - 070608 Chronology Time Line                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043212 - 
043213 - On 070608 there were further opportunities for UCSF to learn that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043214 - Kaiser was treating Millie with Ceftriaxone IV 2gms...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043216 -             ..
043217 -        1.  Millie's letter to UCSF and Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043218 -            reported she was leaving, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043219 -            following planning day before on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043220 -            070607 for 5-days IV treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043221 -            Cellulitis, ref SDS 82 8L46, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043222 -            get outpatient treatment at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043223 -            Kaiser Martinez.................... 0814, ref SDS 83 AK59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043225 -             ..
043226 -        2.  Voice mail from Brigid requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043227 -            contact information for primary care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043228 -            physcian at Kaiser; Millie submits                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043229 -            to UCSF with copy to Arlette at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043230 -            Kaiser for primary care physician,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043231 -            and confirms Kaiser 5-day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043232 -            treatment schedule with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043233 -            Ceftriaxone........................ 1027, ref SDS 83 035H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043235 -             ..
043236 -        3.  Keflex, Millie asks if she should                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043237 -            take oral antibiotic on Sunday,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043238 -            which Kaiser's schedule skips for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043239 -            IV antibiotic...................... 1027, ref SDS 83 0R8F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043241 -             ..
043242 -        4.  Millie notifies primary care physician                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043243 -            with Kaiser's special email program                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043244 -            that UCSF seeks communication with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043245 -            Kaiser to collaborate on Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043246 -            care, duplicating prior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043247 -            coordination through                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043248 -            Arlette............................ 1153, ref SDS 83 6Q3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043250 -             ..
043251 -        5.  Millie sends another letter to primary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043252 -            care physician asking if UCSF and Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043253 -            were communicating to coordinate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043254 -            her care........................... 1743, ref SDS 83 Y75F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043256 -  ..
043257 - This record suggests that since UCSF needed information for contacting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043258 - the primary care physician at Kaiser, there had been communication for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043259 - collaboration on coordinating Millie's care between UCSF and Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043260 - until some time after 070608 1027. ref SDS 0 JS5K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043262 -  ..
043263 - 070608 1153 would have been a good time for collaboration discussions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043264 - between Kaiser and UCSF to coordinate Millie's treatment. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043265 - W39Q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043267 -  ..
043268 - There is no record of communications with the medical team on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043269 - Saturday, 070609.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
043271 -  ..
043272 - On Sunday 070610, the primary care physician responded to Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043273 - letter on 070608 reporting that the "right channels of communication                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043274 - were now open" between Kaiser to coordination Millies care on referral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043275 - to UCSF. ref SDS 85 OG7F  This suggests that by this time the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043276 - had communicated with UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043278 -  ..
043279 - The most likely scenario is that the doctors talked on 070608 sometime                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043280 - after 1153 and before 1743, and to confer on Millie's treatment, as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043281 - related in Brigid's call today. ref SDS 0 JQ6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043283 -  ..
043284 - Evidently at that time, according to Brigid's call this afternoon,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043285 - UCSF proposed ending IV treatment prescribed by Kaiser on 070607, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043286 - substituting Keflex, as Brigid's relates today, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043287 - JQ6F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043288 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043289 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043290 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043292 -  ..
0433 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0434 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0435 - 1644                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0436 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
043601 - Mental Maps Read What is Expected Not What is Written                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043602 - Kaiser Proposes Oral Antibiotics That Have Not Been Prescribed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043603 - 
043604 - Millie received a letter from the primary care physician at Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043605 - responding to Millie's letter this morning requesting clarification of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043606 - treatment for Cellulitis, per above, ref SDS 0 OG7F, and following up                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043607 - initial notice from Kaiser that the doctor was out of the office and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043608 - could not respond, per above. ref SDS 0 JP8I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043609 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043610 -        Subject:  Clarify Cellulitis Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
043612 -         ..
043613 -        Date:  June 11, 2007 1548                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043615 -         ..
043616 -        You should complete the full course of oral antibiotics even                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043617 -        though your arm has improved.  If the cold sores worsen, let me                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043618 -        know.  Usually they disappear after a few days.  If not, we may                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043619 -        need to treat you with acyclovir.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
043620 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043621 -           [On 070612 primary care physician at Kaiser clarifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043622 -           treatment plan to start Keflex oral antibiotics after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043623 -           completing IV medications. ref SDS 86 QE4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043625 -  ..
043626 - When this was first reviewed today, the word "oral" was overlooked,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043627 - and the rest of the construction appeared to endorse the current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043628 - treatment plan prescribed by Kaiser on 070607 calling for 5 days IV                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043629 - treatment, ref SDS 82 8L46, and in accordance with the schedule                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043630 - received from Kaiser the next day on 070608. ref SDS 83 AL39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
043632 -  ..
043633 - Further review entering the record brought into focus the doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043634 - submitted a construction...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
043635 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043636 -           ...complete the full course of oral antibiotics...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043637 -                                             ----                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
043639 -  ..
043640 - "Oral" antibiotics was initially overlooked, i.e., read past by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043641 - mistake without recognition, because there is no prescription for oral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043642 - antibiotics in the record.  On 070607 Millie was told Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043643 - prescribed 5-days of IV treatment at Martinez.  Millie went to Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043644 - in Martinez on on 070608 and nurse gave her treatment called out in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
043645 - Kaiser's computer, presumably entered by the doctor. ref SDS 83 AK6H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043646 - Since the only "course" currently scheduled is for IV antibiotics, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
043647 - since Millie asked if she should complete the course of IV treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
043648 - scheduled, ref SDS 85 IY3J, a construction saying to complete the full                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
043649 - course caused the mind to overlook "oral".                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
043651 -  ..
043652 - After situational awareness of "oral" occurred, Millie submitted                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
043653 - another letter for clarification of treatment for Cellulitis...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043654 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
043656 -  ..
0437 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0439 - 2118                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0440 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044001 - Clarification Prescription for Cellulitis Complete IV Treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044002 - 
044003 - Millie submitted a letter responding to the doctor's letter earlier                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044004 - today saying to complete the full course of oral antibiotics.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044005 - ref SDS 0 QE5H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044006 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044007 -        Subject:  Clarify Cellulitis Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044009 -         ..
044010 -        Date:  June 11, 2007 2120                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044012 -         ..
044013 -        Your letter today says to complete the "full course of oral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044014 -        antibiotics." ref SDS 0 QE5H  Should this start tomorrow, or on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044015 -        Thursday, after I complete the 5-day IV treatment at Martinez,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044016 -        as reported on 070608. ref SDS 83 AL39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044017 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044018 -            [On 070612 nurse at Kaiser in Martinez suggests starting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
044019 -            Keflex in the evening after getting the final IV treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044020 -            ref SDS 86 RJ9G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044022 -             ..
044023 -            [On 070612 primary care physician at Kaiser clarifies                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044024 -            treatment plan to start Keflex oral antibiotics after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044025 -            completing IV medications; does not specifiy whether this                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044026 -            should be same day, or the next day. ref SDS 86 QE4M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044028 -         ..
044029 -        By "full course" do you mean use pills in the bottle of Keflex                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044030 -        I have left over from the prescription last March?  I don't                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044031 -        have a current prescription of Keflex, but assume the prior one                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044032 -        is still good.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044033 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044034 -            [On 070612 Kaiser does not clarify prescription for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044035 -            medication to start after IV antibiotics. ref SDS 86 ZH59                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044037 -         ..
044038 -        You can't imagine how relieved I am for that rash to go away.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044039 -        It was a shock to see last Thursday, and a big dissapointment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044040 -        with everything going so well.  Now things look better.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044042 -         ..
044043 -        The Infusion Clinic did a great job using my port today, after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044044 -        problems on Saturday trying to use a needle IV.  The nurse left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044045 -        the connection in place so I won't need continual punctures,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044046 -        and it can also be used on Thursday for my treatment at UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044047 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044048 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044050 -  ..
0441 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0442 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0443 - 2138                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0444 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044401 - Confirm UCSF Medical Team Coordinating with Kaiser on Patient Care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044402 - 
044403 - Millie sent a letter to UCSF with feedback confirming understandings                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044404 - in the telephone call from Brigid earlier today, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044405 - ref SDS 0 JQ5G  Feedback is a component of intelligence support,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044406 - explained in POIMS. ref OF 1 2200                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
044407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044408 -        Subject:  Cellulitis Treatment with Ceftriaxone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044410 -         ..
044411 -        Date:  June 11, 2007 2141                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044413 -         ..
044419 -         ..
044420 -        Thanks for your call this afternoon, responding to my letter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044421 -        asking for clarification of treatment for Cellulitis, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044422 -        explaining consultations between you and Doctor Rugo at UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044423 -        and Doctor Johnson at Kaiser on this matter that occurred on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044424 -        070607. ref SDS 0 JQ5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044425 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044427 -         ..
044428 -        Conflict Treatments Antibiotics with Cetuximab Coumadin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044429 -        Complete IV Treatments Unless Conflict Other Treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044430 -        
044431 -        Since Kaiser has prescribed 5-days of IV treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044432 -        ceftriaxone, and since 3 of the 5 treatments have been                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044433 -        completed, and so there are only 2 more to go, I am inclined to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044434 -        complete the current regimen, unless there is a conflict with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044435 -        cetuximab and or my Coumadin treatments.  We have had issues in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044436 -        the past at Kaiser with conflicts between treatments, so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044437 -        naturally I am cautious.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044438 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044439 -            [On 070612 Millie gets 4th IV treatment for Cellulitis at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044440 -            Kaiser in Martinez. ref SDS 86 ZG84                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044442 -         ..
044443 -        By copy I am asking Gloria in the Coagulation Control Clinic at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044444 -        Kaiser in Martinez about conflicts between Coumadin and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044445 -        ceftriaxone.  Further remind Gloria I have a blood test at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044446 -        on Thursday, 070614, and will notify Kaiser of INR results for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044447 -        evaluating Coumadin treatment adjustments.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044449 -         ..
044450 -        Thanks for your help.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044451 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044453 -  ..
044454 - Conflicts prescribing treatments have occurred several times in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044455 - patient history....                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044456 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044457 -        1.  Cellulitis medication conflict                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
044458 -            temperature 102+, Millie treated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044459 -            Kaiser emergency.................. 041202, ref SDS 9 IX9N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044461 -             ..
044462 -        2.  Neupogen withheld by Pharmacy Department                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044463 -            resolved by reliance on patient history;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044464 -            Zan appologized and thanked Millie for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044465 -            keeping diary recommended by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
044466 -            Kaiser............................ 050415, ref SDS 11 KX49                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044468 -             ..
044469 -        3.  Capecitabine treatment for Cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044470 -            conflicts with Coumadin treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044471 -            for pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044472 -            embolism.......................... 061020, ref SDS 29 T650                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044474 -             ..
044475 -        4.  Treatment conflicts created in part                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044476 -            by reliance on computers which staff                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044477 -            not trained to use but rely on using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044478 -            only familiar parts of software                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
044479 -            which prevents discovering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044480 -            treatment conflicts............... 061024, ref SDS 31 NU5O,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
044482 -             ..
044483 -        5.  Diflucan (fluconazole) treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044484 -            experiment assess spread IBC rash from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044485 -            left to right breast conflicts with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
044486 -            Coumadin treatment for pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044487 -            embolism; INR increases, risk                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044488 -            of death.......................... 061214, ref SDS 36 XF77                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
044489 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044490 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044491 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044493 -  ..
0445 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0447 - 2332                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
0448 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
044801 - Recognized writing up the record on the letter Millie sent to Brigid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044802 - confirming telecon, and with a copy to Gloria at Kaiser, that the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
044803 - letter incorrectly represented Millie would have a blood test on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044804 - 070612, and that results would be submitted to Gloria for managing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044805 - Millie's Coumadin to treat pulmonary embolism, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044806 - VW8G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044808 -  ..
044809 - Millie submitted a correction in a 2nd letter to Gloria, with a copy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044810 - to Brigid, and saying...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044811 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044812 -        Subject:  INR Blood Test Schedule Correction                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044813 -                  Cellulitis Treatment with Ceftriaxone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044815 -         ..
044816 -        Date:  June 11, 2007 2339                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
044817 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044824 -         ..
044825 -        I made a mistake in the letter earlier this evening indicating                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
044826 -        I have a blood test on Thursday, 070614. ref SDS 0 VW8G  My                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044827 -        blood tests at UCSF occur to start each new treatment cycle.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044828 -        The next cycle (6th) starts a week later on 070621, as shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044829 -        the schedule UCSF submitted on 060510. ref SDS 80 PT9H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044831 -         ..
044832 -        I will try to get INR results to Kaiser soon after the tests.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
044833 -        Doctor Johnson said in a letter yesterday on 070610 that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044834 -        communication channels are now open between Kaiser and UCSF.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044835 -        ref SDS 85 OG7F  Brigid called this evening and seemed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044836 -        indicate coordination is still a work in progress, ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044837 -        JQ6F, so I will try to fill in the gaps.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044839 -         ..
044840 -        Notice that treatment numbers are in the right hand column, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
044841 -        dates are in the 1st column of the schedule.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044843 -         ..
044844 -        By copy to Brigid, there are a few questions on the schedule                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
044845 -        beginning on line AP0445. ref SDS 80 0A6G  These are minor,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
044846 -        just a heads up.  Brigid planned to address schedule issues                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
044847 -        when they come up.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
044848 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044849 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044850 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044851 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044852 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044853 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044854 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
044855 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0449 -