THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: May 2, 2008 03:44 PM Friday;
Rod Welch
Millie notified the medical team results of meeting at Kaiser today.
1...Summary/Objective
2...Meeting Kaiser Backup Examination Notify UCSF Findings Planning
3...Current Medications List Received from Kaiser for Submission to UCSF
4...Neupogen Prescription Changed from 2 to 1 Treatment Per Week
5...Black Box Prescribe Medication Pharmacy Unpredictable Results
6...Pharmacy Black Box Procedures Prescribing Medication Results Uncertain
7...Pharmacy Prescription Problems Neupogen 6 Treatments 90 Minutes $500
8...90 Minutes Pharmacy Neupogen Prescription Problems $500 6 Treatments
9...6 Treatments $500 Neupogen Pharmacy Prescription Problems 90 Minutes
10...Neupogen $500 6 Treatments Pharmacy Prescription Problems 90 Minutes
11...$500 Neupogen 10 Times Increase from Prior Purchase
12...Health Care Cost Containment Checking the Record Saves $500
13...Cost Containment UCSF Saves $500 by Checking the Record
14...Coordination UCSF Kaiser Save Customer $500
15...Pharmacy Discloses Cost Containment Procedures Hospital Treatment
16...Cost Containment Request Support at Kaiser and UCSF
17...Power Port Surgery Referral Prescribed by Primary Care Physician
..............
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CONTACTS
SUBJECTS
Meeting Examination Kaiser Letter Medical Team Report Progress Backu
1803 -
1803 - ..
1804 - Summary/Objective
1805 -
180501 - Follow up ref SDS 9 0000, ref SDS 7 0000.
180502 -
180503 -
180504 -
180505 -
180507 - ..
1806 -
1807 -
1808 - Progress
1809 -
180901 - Meeting Kaiser Backup Examination Notify UCSF Findings Planning
180902 - Current Medications List Received from Kaiser for Submission to UCSF
180903 -
180904 - Follow up ref SDS 9 QY5I, ref SDS 7 0001.
180905 -
180906 - Millie submitted ref DIT 1 0001 after the meeting today with the
180907 - primary care physician at Kaiser. It was sent to the doctor, and the
180908 - medical team at UCSF for coordination, discussed with UCSF on 080403.
180909 - ref SDS 1 4U9O
180910 -
180911 - 1. Thanks for a good meeting today, ref SDS 9 0001, and for timely
180912 - submission of the record [medical chart], ref SDS 9 YT5N, which
180913 - includes an updated "current medications." ref SDS 9 IE6M I
180914 - will submit this to UCSF in the next few days to support their
180915 - new practice of integrating patient history from multiple
180916 - providers for comprehensive care [reported on 080501].
180917 - ref SDS 7 QK4G ref DIT 1 0001
180918 -
180919 -
180920 -
1810 -
SUBJECTS
Default Null Subject Account for Blank Record
1903 -
190401 - ..
190402 - Neupogen Prescription Changed from 2 to 1 Treatment Per Week
190403 -
190404 - Follow up ref SDS 9 NL9I.
190405 -
190406 - 2. I am letting Brigid know that I was finally able to see what
190407 - was written in her UCSF electronic message saying to disregard
190408 - initial instructions from Megan (she talked to me in the
190409 - Infusion Clinic during treatment) after the meeting yesterday,
190410 - to take 2 Neupogen treatments per week for the current cycle,
190411 - ref SDS 8 4E9N, [further related in the record meeting with the
190412 - medical team on 080501, ref SDS 7 M64J], and instead to take
190413 - just one, ref SDS 7 M658, as prescribed previously on 080403.
190414 - ref SDS 1 6Y9K Your letter related having reviewed patient
190415 - history and noticed that NEUTS increased from 1.34 to 6.85
190416 - after just one Neupogen, shown in the record on 080410.
190417 - ref SDS 5 QY6H, ref DIT 1 8I6F
190419 - ..
190420 - 3. Today, I met with [primary care physician] at Kaiser.
190421 - ref SDS 9 0001 He explained that persistant low blood counts
190422 - are common for patients who have received a lot of
190423 - chemotherapy, ref SDS 9 NL4W, as I have (going on 7 years and
190424 - counting...). ref DIT 1 8I7H
190425 -
190426 -
190428 - ..
190429 - Black Box Prescribe Medication Pharmacy Unpredictable Results
190430 - Pharmacy Black Box Procedures Prescribing Medication Results Uncertain
190431 -
190432 -
190433 - 4. The doctor further noted that ordering medication from the
190434 - Pharmacy can sometimes seem like a "black box," where you are
190435 - not sure what will actually happen. ref SDS 9 NM4J, ref DIT 1
190436 - 8I7N
190438 - ..
190439 - 5. We tried to order on the computer 6 Neupogen treatments, which
190440 - at 1 treatment per week would be enough for 2 cycles of 3
190441 - treatments each, i.e. enough for the next 2 months. ref SDS 9
190442 - NM3M I figured 6 x $12 per treatment would be $60, at the rate
190443 - charged for the treatment prescribed last month on 080403.
190444 - ref SDS 1 XV4G, ref DIT 1 8I8J
190446 - ..
190447 - On 080403 Millie submitted a letter to Kaiser notifying the primary
190448 - care physician that UCSF prescribed Neupogen, ref SDS 2 TS6P, and
190449 - requested that the doctor order the prescription. ref SDS 2 TS7T
190451 - ..
190452 - On 080405 Millie paid $12 for 1 treatment with Neupogen. ref SDS 4
190453 - FZ56
190454 -
190456 - ..
190457 - Pharmacy Prescription Problems Neupogen 6 Treatments 90 Minutes $500
190458 - 90 Minutes Pharmacy Neupogen Prescription Problems $500 6 Treatments
190459 - 6 Treatments $500 Neupogen Pharmacy Prescription Problems 90 Minutes
190460 - Neupogen $500 6 Treatments Pharmacy Prescription Problems 90 Minutes
190461 -
190462 -
190463 - Letter to Kaiser continues...
190465 - ..
190466 - 6. After the meeting I spent about 90 minutes in the Pharmacy
190467 - trying to get the Neupogen. The Pharmacist said he had to call
190468 - the doctor because something was wrong. I explained the doctor
190469 - had left the hospital for a meeting off-site. The Pharmacist
190470 - told me to go sit down and wait while he investigates. He
190471 - never came back. ref SDS 9 NM5K, ref DIT 1 8I8Q
190472 -
190473 -
190475 - ..
190476 - $500 Neupogen 10 Times Increase from Prior Purchase
190477 - Health Care Cost Containment Checking the Record Saves $500
190478 - Cost Containment UCSF Saves $500 by Checking the Record
190479 -
190480 -
190481 - 7. Eventually, I went to the counter and talked to another person
190482 - and then got the 6 bottles of Neupogen, but the cost was $517
190483 - nearly 10 times [higher than the last time. ref SDS 9 5N9L You
190484 - can see that by checking the record [on 080501] you discovered
190485 - a way save $500 from relying on patient history to change the
190486 - prescription from 2 per week back to 1. ref SDS 7 M658
190487 - ref DIT 1 8I9O
190488 -
190489 -
190490 -
190491 -
1905 -
SUBJECTS
Default Null Subject Account for Blank Record
2003 -
200401 - ..
200402 - Coordination UCSF Kaiser Save Customer $500
200403 - Pharmacy Discloses Cost Containment Procedures Hospital Treatment
200404 -
200405 -
200406 - 8. The pharmacist, Patricia Chin (925 295 4461), further advised
200407 - that I could save an additional $500 or so by [the doctor]
200408 - prescribing injection in the Infusion Clinic, rather than doing
200409 - home care injection. ref SDS 9 HF82 Since [the doctor] planned
200410 - to leave the office [immediately after] our meeting today, I
200411 - don't know how much leeway we have to coordinate to implement
200412 - Patricia's work plan. I would like to save another $500, but
200413 - realize that Doctor Rugo indicated on 080403 that I should take
200414 - the Neupogen at the latest by Monday following treatment [so
200415 - there may not be enough time for UCSF and Kaiser to coordinate
200416 - on helping the customer realize $500 savings]. ref DIT 1 8I4M
200417 -
200418 -
200420 - ..
200421 - Cost Containment Request Support at Kaiser and UCSF
200422 -
200423 -
200424 - 9. I can come back to Kaiser later today for the shot, tomorrow,
200425 - Sunday, or Monday. Is it also possible to do this at UCSF? I
200426 - hate making 2 trips to the City just for a shot, but saving
200427 - $600 makes it seem worthwhile. I have come into to Kaiser many
200428 - times for injections, usually takes only a few minutes.
200429 - ref DIT 1 8I5M
200431 - ..
200432 - 10. Can you please let me know if Monday is okay for the injection,
200433 - so that [the priarcy care physician] has time to set this up in
200434 - the Kaiser Infusion Clinic here in Walnut Creek. Since he is
200435 - now out of the office and may not see this letter until this
200436 - evening, or even next Monday, it may turn out that
200437 - administratively, using the computer things are too complicated
200438 - to solve the cost problem this cycle in time to meet medical
200439 - requirements for making a timely injection. Please let me
200440 - know. ref DIT 1 8I5T
200441 -
200442 -
200443 -
2005 -
SUBJECTS
Default Null Subject Account for Blank Record
2103 -
210401 - ..
210402 - Power Port Surgery Referral Prescribed by Primary Care Physician
210403 -
210404 -
210405 - 11. Additionally, during the meeting today, the Doctor sent a
210406 - letter to the surgeon, Doctor Riley-Paul, to ask about
210407 - upgrading my port catheter, installed by the surgeon on 040419,
210408 - with a "Power Port" to handle CT test injections, as you
210409 - described in the meeting at UCSF yesterday. ref SDS 7 TQ7H We
210410 - have 2 - 3 months until the next test to work the problem.
210411 - ref SDS 9 AA8L Hopefully a solution can be developed in that
210412 - time. ref DIT 1 8I6T
210413 -
210414 - [On 080508 Millie asks primary care physician about progress
210415 - scheduling surgery to upgrade the port catheter to a Power
210416 - Port for injecting contrast medium in time for the next CT
210417 - test. ref SDS 10 GO8G
210419 - ..
210420 - [On 080520 Kaiser did not respond; Millie sent followed up
210421 - letter asking Kaiser to coordinate with the Surgery
210422 - department on expediting Power Port surgery, ref SDS 11
210423 - GS8K, in time for next CT test expected in 4 weeks.
210424 - ref SDS 11 TV4S
210426 - ..
210427 - [On 080523 Millie received a letter from Kaiser advising
210428 - that the surgeon reports Kaiser can upgrade Millie's port
210429 - catheter to a Power Port, and he made a referral for this
210430 - work to be performed, ref SDS 12 MG6F; this will solve the
210431 - problems reported on 080425 injecting contrast medium for CT
210432 - tests. ref SDS 6 FP6F
210434 - ..
210435 - [On 080528 Millie reported progress to the medical team on
210436 - Kaiser's project to upgrade the port catheter to a Power
210437 - Port. ref SDS 13 IJ6W
210439 - ..
210440 - [On 080606 planning to upgrade port catheter to Power Port
210441 - implements direction from UCSF to do the work on the right
210442 - side opposite from the primary location of Millie's cancer
210443 - on the left side. ref SDS 15 IT77
210445 - ..
210446 - [On 080608 Millie sent a letter to the surgeon using
210447 - Kaiser's internal email system, because the doctor is
210448 - not included in distribution for referral coordination
210449 - with the medical team at Kaiser and UCSF; and notifying
210450 - the surgeon of requirements to coordinate surgery to
210451 - implant the Power Port and to access the new port with a
210452 - Huber needle to enable CT testing within the next few
210453 - days after surgery. ref SDS 16 XS4S
210455 - ..
210456 - [On 080609 Kaiser Surgery Department notified the patient
210457 - that requirements for coordination of Power Port surgery in
210458 - time for the next CT test were presented to the Schedule
210459 - Department. ref SDS 11 MG5I
210461 - ..
210462 - [On 080617 Power Port surgery scheduled on 080708.
210463 - ref SDS 17 3C7N; CT test using Power Port scheduled 10 days
210464 - later on 080718 1100. ref SDS 17 DF55
210466 - ..
210467 - [On 080619 Millie notified medical team at Kaiser and UCSF
210468 - that CT test is scheduled to use the Power Port on 080718,
210469 - ref SDS 18 YU6X; cites requirements to resolve protocol and
210470 - certification issues over next 4 weeks. ref SDS 18 YV4R
210472 - ..
210473 - [On 080625 Millie's letter to medical team at Kaiser and
210474 - UCSF confirms planning for CT test at Kaiser to use the
210475 - Power Port for saving time and money that meets requirements
210476 - cost containment. ref SDS 19 IU7R
210478 - ..
210479 - [On 080702 Millie's letter to medical team confirms that on
210480 - 080627 the primary care physician coordinated support by the
210481 - Infusion Clinic to access the Power Port on 080718 in time
210482 - for CT test at 1100; and further initiated planning that, if
210483 - no one else is assigned, the primary care physician will
210484 - personally press the button for the CT test using the Power
210485 - Port on 080718. ref SDS 20 EQ3T
210486 -
210487 -
210488 -
210489 -
210490 -
210491 -
210492 -
210493 -
210494 -
210495 -
210496 -
2105 -