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
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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
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2105 -