CONTACTS 

SUBJECTS
Neupogen Magnesium Medications Treatment Resolve Low Blood Counts La

4103 -
4103 -    ..
4104 - Summary/Objective
4105 -
410501 - Follow up ref SDS 70 6H9N, ref SDS 69 TS5U.
410502 -
410503 -
410504 -
410505 -
410506 -
410508 -  ..
4106 -
4107 -
4108 - Progress
4109 -
410901 - On 080403 UCSF prescribed Neupogen to treat low blood counts.
410902 - ref SDS 67 6Y9K  Later in the day, UCSF prescription was coordinated
410903 - with Kaiser for health care cost containment, and efficient
410904 - performance of the work. ref SDS 69 TS8Y  Also, on 080403 Millie
410905 - discovered an error in the blood test omitting magnesium. ref SDS 67
410906 - XQ6L The next day on 080404, UCSF reported that correcting the mistake
410907 - in the blood test revealed low Magnesium.  As a result, UCSF revised
410908 - medications by adding magnesium to the prescription for treating low
410909 - blood counts. ref SDS 70 O059  This change was coordinated with
410910 - Kaiser, ref SDS 70 6H9N, who notified Millie to pickup Neupogen and
410911 - Magnesium at the Park Shadelands pharmacy. ref SDS 70 JW6J
410912 -
410913 -
410915 -  ..
410916 - Kaiser Pharmacy Prescription 2 Hours for 20 Minute Transaction
410917 -
410918 - Today, Millie had difficulty getting Neupogen and Magnesium medication
410919 - from Kaiser.  Normally filling prescription takes 20 minutes,
410920 - including standing in line; today the transaction took over 2 hours.
410921 -
410922 -        [On 080409 notify primary care physician of discrepancies in
410923 -        the work performed by Kaiser pharmacy. ref SDS 71 OP4O
410925 -  ..
410926 - This morning, Millie went to a cancer support group meeting in Walnut
410927 - Creek, actually in Pleasant Hill.  After the meeting, on the way home
410928 - to Concord Millie stopped at the Park Shadelands pharmacy for
410929 - medications, as directed by doctor at Kaiser yesterday on 080404.
410930 - ref SDS 70 JW6J
410932 -  ..
410933 - The pharmacy at Park Shadelands turned out to be closed; so, Millie
410934 - drove 10 miles back to Walnut Creek and visited Kaiser's pharmacy in
410935 - the hospital.
410937 -  ..
410938 - The Walnut Creek pharmacy did not have Millie's Neupogen prescription
410939 - on file.  The Pharmacist told Millie to wait while the staff figured
410940 - out how to get the order transferred from Park Shadelands to the
410941 - Walnut Creek Pharmacy, and then prepare the medication to fill the
410942 - prescription.
410943 -
410944 -        [On 081025 same experience ordering Barium Sulfate contrast
410945 -        medium for CT test. ref SDS 79 FT6Y
410947 -  ..
410948 - Millie was called to the counter about 30 minutes later.  The
410949 - pharmacist explained the order has 4 refills, and costs $12.00 for the
410950 - one Neupogen treatment today.
410952 -  ..
410953 - Millie asked why there is a charge if this is supposed to be given by
410954 - the nurse in the Infusion Clinic, discussed by Arlette in the call
410955 - yesterday on 080404? ref SDS 70 JW6J
410957 -  ..
410958 - The Pharmacist advised that the Infusion Clinic is not open today, so
410959 - Millie has to take Neupogen as a transaction to buy medication, rather
410960 - than get treatment in the hospital.
410962 -  ..
410963 - Millie asked how the patient can follow the doctor's orders for
410964 - Neupogen treatment by nurses in the Infusion Clinic that avoids
410965 - confusion and problems?  She related getting Neupogen previously in
410966 - the hospital on 061031. ref SDS 16 9U65
410967 -
410968 -            [On 080409 notify primary care physician of discrepancies
410969 -            in the work performed by Kaiser pharmacy. ref SDS 71 OP4O
410971 -             ..
410972 -            [On 080502 doctor reports problems using computer cause
410973 -            problems ordering Neupogen, ref SDS 74 NM3M; pharmacy
410974 -            reported more problems with doctor's order for Neupogen.
410975 -            ref SDS 74 NM5K
410977 -             ..
410978 -            [On 080607 UCSF provides Neupogen treatments to patients in
410979 -            the Infusion Clinic that avoids confusion and problems.
410980 -            ref SDS 75 4154
410982 -  ..
410983 - The Pharmacist said he is new on the job, and does not understand all
410984 - of the variations for medications prescribed by the doctors.  He asked
410985 - if Millie would like to speak with a supervisor?
410987 -  ..
410988 - Since the charge was $12, Millie did not investigate further.  On
410989 - 061101 the cost for 1 Neupogen treatment seemed higher than $12.
410990 - ref SDS 17 JS81
410992 -  ..
410993 - Millie asked how to take the Neupogen?
410995 -  ..
410996 - The Pharmacist said the patient needs a needle to draw medication from
410997 - the bottle, and then self-inject to complete treatment.
410999 -  ..
411000 - Millie advised that she has done this previously.  On 020520 Kaiser
411001 - prescribed 5-day treatment of Neupogen provided in pre-loaded and
411002 - disposable syrenges. ref SDS 10 RF4M  At that time, Kaiser
411003 - demonstrated how to make self-injections, supervised and adjusted
411004 - patient practice session. ref SDS 10 6Y5G  On 050415 Neupogen was
411005 - prescribed again this time for only 3 days.  At that time, Kaiser
411006 - provided the same disposable syrenges pre-loaded with the correct
411007 - amount of Neupogen for efficient application by the patient.  Again on
411008 - 061101, Millie was provided a syrenge pre-loaded with Neupogen for
411009 - treatment ordered by the doctor. ref SDS 17 JS81
411011 -  ..
411012 - The Pharmacist indicated that Neupogen was ordered by the Kaiser
411013 - computer on this occassion without a disposable syrenge pre-loaded,
411014 - because of planning for the patient to take the product to the
411015 - Infusion Clinic for injection of the medication.  However, since the
411016 - Infusion Clinic is closed until Monday, and the treatment is needed
411017 - within 3 days of getting chemotherapy on Thursday, then to provide
411018 - treatment on the prescribed schedule, Millie needs a needle for
411019 - self-injection.
411021 -  ..
411022 - Millie asked where patients get needles for self-injection, and what
411023 - procedures are required?
411024 -
411025 -            [On 080409 notify primary care physician of discrepancies
411026 -            in the work performed by Kaiser pharmacy. ref SDS 71 W19T
411028 -  ..
411029 - The Pharmacist advised that Kaiser sells the needles.  He asked Millie
411030 - to wait while he adds needles to the order.
411032 -  ..
411033 - The Phmarcist came back with a needle.  He explained these are
411034 - disposable, and so used for only 1 treatment.  The patient should draw
411035 - all of the Neupogen from each bottle into a syrenge, and then make the
411036 - injection.  Use the next needle for the next bottle, so there is no
411037 - mistake about quantity.
411039 -  ..
411040 - Millie asked the pharmacist to demonstrate the procedure.
411042 -  ..
411043 - The Pharmacist said he is about to go off duty, and Millie can wait
411044 - for someone to help with this.  He feels there should not be a
411045 - problem.  Millie got impatient and gave up.
411046 -
411047 -            [On 080607 Millie had problems with self-injection of
411048 -            Neupogen and treatment failed. ref SDS 75 Q67I
411050 -             ..
411051 -            [On 080625 Kaiser reported the protocol for Neupogen
411052 -            prescribed by UCSF required 2 injections for each
411053 -            treatment, rather than just 1. ref SDS 77 Q74G
411055 -  ..
411056 - Millie noticed the documentation called out two refills.  Millie asked
411057 - why there are 4 refills for Neupogen, and only 2 refills for needles?
411058 - Don't the number of needles need to match the number of treatments, if
411059 - needles can be used for only 1 treatment?
411060 -
411061 -            [On 080409 notify primary care physician of discrepancies
411062 -            in the work performed by Kaiser pharmacy. ref SDS 71 OP4O
411064 -  ..
411065 - The Pharmacist said he is going off duty.  He suggested that Millie
411066 - wait another few minutes, and then explain the problem to the next
411067 - Pharmacist who can straighten everything out.
411069 -  ..
411070 - By this time Millie had spent several hours trying to get Neupogen,
411071 - and so agreed to a transaction that was different from efficient, cost
411072 - effective care. ref SDS 0 FZ56
411073 -
411075 -  ..
411076 - Calcium Magnesium Dietary Supplemental Kaiser Sells to Customers
411077 - Magnesium Replacement Not Sold by Kaiser Customer Buys Calcium & Magsm
411078 -
411079 - When the next Pharmacist took over, Millie asked only about buying
411080 - over-the-counter medication, which Arlette said yesterday the doctor
411081 - proposed, ref SDS 70 JW76, to carry out the prescription at UCSF for
411082 - "Magnesium Replacement" ref SDS 70 OP6U, to help Millie recover from
411083 - low blood counts in the Lab test the day before on 080403. ref SDS 68
411084 - CP6J
411086 -  ..
411087 - The pharmacist said Kaieser does not carry any products that say
411088 - "Magnesium Replacement," described by UCSF on 080404. ref SDS 70 OP6U
411089 - Kaiser recommended that Millie buy a composite medication for Calcium
411090 - and Magnesium.  These are oral pills the patient takes several times a
411091 - day with meals and for 5 days.  This design seems more costly than the
411092 - solution at UCSF on 071213 when UCSF provided injection treatment
411093 - while Millie was in a rest period following treatment with cetuximab.
411094 - ref SDS 38 HH5I
411095 -
411096 -            [On 080409 notify primary care physician of discrepancies
411097 -            in the work performed by Kaiser pharmacy. ref SDS 71 OP4O
411099 -  ..
411100 - Millie bought the pills. ref SDS 0 FZ6T
411101 -
411102 -            [On 080410 blood test shows Magnesium 1.9 which is within
411103 -            the target range, and indicates effective treatment ordered
411104 -            by UCSF on 080404. ref SDS 73 RW6F
411105 -
411107 -  ..
411108 - Invoice Neupogen and Magnesium
411109 -
411110 - Millie received an invoice for this work...
411111 -
411112 -        Kaiser Permanente
411113 -        WCR Main Pharmacy
411114 -        1425 South Main Street 1st Floor
411115 -        Walnut Creek, CA  94596
411117 -         ..
411118 -        Batch Group #:  A 08096 01389
411120 -         ..
411123 -         ..
411124 -        5 April 2008
411126 -         ..
411129 -         ..
411130 -        Your Drug Benefit Saved You.................... $365.25
411131 -        YTD Pharmacy Charges Applied to Troop/TDC
411132 -
411133 -                Bal 4062.00                 Bal        99999.99
411135 -         ..
411136 -        Kaiser Permanente             Retail Price   Your Price
411138 -         ..
411139 -        CC# 511 080906 01339 A             357.60         12.00
411140 -
411141 -              Neupogen 1 treatment
411143 -         ..
411144 -        CC# 511 080906 01341 A              19.65
411145 -        CC# 511 080906 01371 A                .25           .25
411146 -
411147 -              Self-injection needle
411149 -         ..
411150 -        UPC/NDC      Item Name                  Qty
411151 -        07985450023  N/B Calcium &
411152 -                     Magnesium                    1        3.75
411153 -
411154 -
411155 -                 Total Batch Price                        12.25
411156 -                 Non-PIMS Rx Total:
411157 -                 Taxable OTC Total:                        3.75
411158 -             Non-taxable OTC Total:
411159 -                         Sales Tax:                         .31
411161 -                          ..
411162 -                         Total.......................... $16.31
411164 -               ..
411165 -              [On 080502 Millie charged $516 for same Neupogen - 500%
411166 -              increase on $12 cost today. ref SDS 74 5N9L
411168 -               ..
411169 -              [On 080609 Millie shocked Neupogen $2,000, 400% increase
411170 -              from today. ref SDS 76 028F
411172 -         ..
411173 -        All Prescription Sales are Final.  Unopened over-the-counter
411174 -        items may be returned for refund within 30-days with original
411175 -        receipt.
411177 -         ..
411178 -        Consult your pharmacist or physician with a list of medications
411179 -        you are currently taking if you have any questions about
411180 -        adverse drug reactions.
411182 -         ..
411183 -        Thank you for choosing Kaiser Permanente
411184 -        ID = U842070   WCRL09   B
411185 -
411187 -  ..
4112 -
4113 -
4114 - 1612
4115 -
411501 - Millie arrived home.  She took the Neupogen treatment received from
411502 - Kaiser earlier today, per above. ref SDS 0 L86O
411503 -
411504 -        [On 080409 Millie reports bone pain. ref SDS 72 V45J
411506 -         ..
411507 -        [On 080629 bone pain, headache are side effects of Neupogen
411508 -        treatments, ref SDS 78 TR5L, which the doctor prescribed on
411509 -        080403. ref SDS 67 6Y9K
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4116 -