THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: June 5, 2008 09:10 AM Thursday;
Millie submits record on meeting 080529 start 4th cycle at UCSF.
2...Coumadin Treatment INR 2.0 Notify Kaiser Coagulation Control Clinic
3...UCSF Security Services Reported Computer Unattended
4...Confidentiality Privacy Patient Medical Records Maintained by UCSF
5...HIPAA Causes Overreaction at UCSF Massive Patient Records Disclosure
6...Surgery Planned for Power Port in Time for CT Test Mid-July
7...Commend Primary Care Physician Kaiser Oncology Referral Coordination
8...Referral Coordination Effective Oncology Communication with Surgery
9...Cost Containment Neupogen UCSF Determines Optimal Requirment
10...Neupogen Experiment Determine Optimal Treatment for Cost Containment
11...Neupogen Prescription 2 Treatments Chemotherapy Orders 080529
12...Commend Diane Excellent Medical Care UCSF Infusion Clinic
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Meeting 080529 UCSF Start 4th Cycle 2nd Arm Clinical Study Treatment
2003 - ..
2004 - Summary/Objective
200501 - Follow up ref SDS 5 0000.
200507 - ..
2008 - Progress
200901 - Coumadin Treatment INR 2.0 Notify Kaiser Coagulation Control Clinic
200903 - Millie submitted ref DIT 1 0001 to Doctor Rugo at UCSF with copies to
200904 - the medical team, including Gloria at Kaiser, and to Peter, and Sara
200905 - at UCSF, who investigated having the computer unattended in the
200906 - cafeteria.
200908 - 1. Initially, notifying Gloria at the Kaiser Coagulation Control
200909 - Clinic that INR was 2.0 for the blood test last week on 080531
200910 - (May 31) [correction - 080529 (May 29)], ref SDS 6 PU7Y, at the
200911 - low end, but still within range to maintain current Coumadin
200912 - treatments for PE. ref DIT 1 0001
Patient Interviewed UCSF Security Services Verify Patient Assistant
460401 - ..
460402 - UCSF Security Services Reported Computer Unattended
460404 - Follow up ref SDS 5 LD7L.
460406 - 2. Last week on 080531 [correction - 080529] I was visited in the
460407 - Infusion Clinic by Peter Balesteri, Director of UCSF Security
460408 - Department. He explained having received a report that Rod's
460409 - computer was unattended in the cafeteria for 10 minutes while
460410 - he brought my lunch up to the 5th floor. ref SDS 5 H756 As you
460411 - can imagine, a visit from the security forces caused excitement
460412 - in the Clinic. Peter was courteous and professional making his
460413 - report. ref SDS 5 H764, ref DIT 1 GW6F
460415 - ..
460416 - 3. I was grateful for Peter's work, and thanked him for taking
460417 - immediate action, and letting me know what happened. I
460418 - understand there was no actual harm in this case, but Peter
460419 - emphasized risks of theft and disclosure of my medical data, if
460420 - things are left unattended even for a few minutes. The main
460421 - problem was that my schedule of meetings was visible in
460422 - documents Nola printed, ref SDS 5 H66I, so that Rod can enter
460423 - the schedule to manage the work. I am always blabbing to
460424 - friends about my schedule meeting with you and what wonderful
460425 - work UCSF does, so if someone sees this on a piece of paper, it
460426 - seems like an easy call of "no harm no foul." However, this
460427 - overlooks sensitivity of others in a hospital setting.
460428 - ref SDS 5 526J I am therefore sorry to have caused any
460429 - problems. ref DIT 1 GW6O
460433 - ..
460434 - Confidentiality Privacy Patient Medical Records Maintained by UCSF
460435 - HIPAA Causes Overreaction at UCSF Massive Patient Records Disclosure
460438 - 4. Peter mentioned that HIPPA has everyone anxious about running
460439 - afoul of regulations to preserve patient privacy, ref SDS 5
460440 - LN52, so I am taking this opportunity to make clear in the
460441 - record that at no time has anyone on the medical team at UCSF
460442 - breached any duty to protect my patient privacy. ref SDS 5 H66I
460443 - You and everyone at UCSF have been excellent both protecting my
460444 - privacy and delivering medical care. ref SDS 5 537O Going
460445 - forward we will continue to respect concerns for UCSF security
460446 - services, as related by Peter last week. ref DIT 1 GW8H
460448 - ..
460449 - 5. I also want to commend Sara Schwab's work meeting with Peter on
460450 - short notice to discuss my case. She apparently had to excuse
460451 - herself from an ongoing meeting to meet with Peter. ref SDS 5
460452 - H649 By copy to Peter and Sara, I am asking for any writings
460453 - or reports that may have been prepared, so there is
460454 - transparency on this matter. ref DIT 1 GW8R
Surgery Planned Schedule Kaiser Upgrade Port Catheter to Power Port
660401 - ..
660402 - Surgery Planned for Power Port in Time for CT Test Mid-July
660405 - 6. Good news. My primary care physician, Doctor Johnson, has
660406 - facilitated a meeting scheduled for tomorrow at 1600 with the
660407 - surgeon at Kaiser [Kaiser letter received on 080523],
660408 - ref SDS 3 MG6F, to discuss upgrading my port catheter to a
660409 - Power Port, so that this can be accomplished in time to support
660410 - the next CT test which should occur about the middle of next
660411 - month in July, based on the 12-week schedule in relation to the
660412 - last test on 080425 and the prior test on 080212 [confirms
660413 - discussion at UCSF on 080529. ref SDS 5 4F5S] I will emphasize
660414 - tomorrow importance of getting the work done at Kaiser
660415 - hopefully by the end of the month, so the new port can be used
660416 - for the next CT test in July. That will be a great relief to
660417 - solve difficulties on the last test [on 080425. ref SDS 2
660418 - FP6F], ref DIT 1 GW9O
660420 - ..
660421 - On 080528 Millie reported progress to the medical team planning the
660422 - agenda for meeting the next day on 080529 to discuss Kaiser's project
660423 - to upgrade the port catheter to a Power Port. ref SDS 4 IJ6W On
660424 - 080529 Lynn did not get the letter sent on 080528 to plan the agenda,
660425 - so this issue was not discussed during the meeting on 080529.
660426 - ref SDS 5 4F47
660428 - ..
660429 - [On 080606 meeting at Kaiser to schedule surgery upgrading
660430 - port catheter to Power Port in time for next CT test OA
660431 - 080718. ref SDS 8 IT8V
660433 - ..
660434 - The letter today, therefore confirms planning at Kaiser to remove
660435 - Millie's port catheter and replace with a Power Port device.
Commend Primary Care Physician Kaiser Oncology Terrific Referral Coo
A20401 - ..
A20402 - Commend Primary Care Physician Kaiser Oncology Referral Coordination
A20403 - Referral Coordination Effective Oncology Communication with Surgery
A20406 - Millie's letter to the medical team continues...
A20408 - 7. As well, the attendant in the Surgery Department strongly
A20409 - credited Doctor Johnson for a "terrific" referral citing the
A20410 - record of patient history that explains background [reported by
A20411 - the doctor on 080523, ref SDS 3 MG6F, so that the surgeon can
A20412 - be prepared for a productive meeting. By copy I am thanking
A20413 - Doctor Johnson for timely, thorough follow up. ref DIT 1 GW4Q
A20415 - ..
A20416 - Follows up notice on 080307 that primary care physician scheduled
A20417 - emergency meeting for examination of Cellulitis and lymphedema
A20418 - recurrence, under referral coordination requested by UCSF. ref SDS 1
A20419 - GZ4H
A20421 - [On 080606 Millie met with the surgeon at Kaiser to plan
A20422 - Power Port work, doctor well prepared to conduct productive
A20423 - meeting. ref SDS 8 MG5I
A20425 - ..
A20426 - [On 080606 surgeon surprised Millie still alive 7 years
A20427 - stage IV cancer treatments; research indicates survival rate
A20428 - 10%, ref SDS 8 0T6I; Millie credits team care UCSF Kaiser
A20429 - UCSF good referral coordination. ref SDS 8 TR6N
A20431 - ..
A20432 - [On 080801 report that record on CT test performed 080718
A20433 - was distributed to support training and technology transfer
A20434 - on using Power Ports for CT tests. ref SDS 12 SK4K
A20436 - ..
A20437 - [On 080811 report that record on CT test performed 080718
A20438 - distributed to Kaiser management to support analysis on
A20439 - transformation correcting problems with CT testing that
A20440 - apply Power Port technology. ref SDS 13 LD3H
Commend UCSF Kaiser Referral Coordination Collaboration Health Care
AS0401 - ..
AS0402 - Cost Containment Neupogen UCSF Determines Optimal Requirment
AS0403 - Neupogen Experiment Determine Optimal Treatment for Cost Containment
AS0406 - 8. I also am pleased to thank you and UCSF for health care cost
AS0407 - containment managing treatments with Neupogen, which are very
AS0408 - expensive, but have become necessary for me to get Carboplatin
AS0409 - to treat my cancer. Brigid has been a big help on this score,
AS0410 - allowing time to experiment finding the minimum amount of
AS0411 - Neupogen that enables chemotherapy to be effective reducing my
AS0412 - cancer these past few months. ref DIT 1 GW5N
AS0414 - ..
AS0415 - 9. I took Neupogen on Saturday as prescribed by Lynn last
AS0416 - Thursday. ref DIT 1 AP6G
AS0418 - [...during treatment today, Millie learned the doctor
AS0419 - prescribed 2 Neupogent treatments per week, ref SDS 7 JN38,
AS0420 - below, she sent a follow up letter to UCSF after treatment
AS0421 - to clarify requirements. ref SDS 0 4K4K
AS0423 - ..
AS0424 - 10. Today, I get NEUTS, which I hope are high, and CA 15-3 from
AS0425 - last week which hopefully will be low. ref DIT 1 GW6O
AS0427 - ..
AS0428 - 11. Thanks again to all for good work, including UCSF security.
AS0429 - ref DIT 1 LP6N
Chemotherapy Orders 080529 Request Clarification Prescribes 2 Neupog
BB04 - 1057
BB0501 - ..
BB0502 - Neupogen Prescription 2 Treatments Chemotherapy Orders 080529
BB0504 - Follow up ref SDS 7 JN38.
BB0506 - Millie submitted ref DIT 2 0001 to Diane in the Infusion Clinic to
BB0507 - confirm understandings today during treatment that the Chemotherapy
BB0508 - Orders on 080529 prescribe 2 Neupogen treatments, ref SDS 7 JN38, and
BB0509 - requests clarification on the dates for treatment.
BB0511 - 1. Just forwarding my letter to [Doctor Rugo at] UCSF, ref DIT 1
BB0512 - 0001, on events last week with Peter's visit to the Infusion
BB0513 - Clinic on Rod's computer issues. ref SDS 0 625Q, ref DIT 2 0001
BB0515 - ..
BB0516 - 2. Could you please make a copy of the document [Chemo Orders
BB0517 - Diane presented this morning during treatment at UCSF,
BB0518 - ref SDS 7 JN38] showing the prescription last week for Neupogen
BB0519 - calling for 2 treatments. Somehow, I didn't get the word, and
BB0520 - only took 1 Neupogen, based on understandings with Lynn and
BB0521 - Megan at 0830 in the Breast Care Clinic before treatment.
BB0522 - ref DIT 2 QJ6H
BB0524 - [...in another record today, Millie received the Chemo
BB0525 - Order from Diane at the end of treatment. ref SDS 7 YD51
BB0527 - ..
BB0528 - 3. Does this mean I should take 2 Neupogen shots this week, one on
BB0529 - Saturday and another on Sunday? Is there a separate work
BB0530 - order, or does the prior order control? Rod spoke to Megan
BB0531 - when she was in the Infusion Clinic a few minutes ago, and
BB0532 - explained the mixup last week. ref SDS 7 UE7L Megan asked if
BB0533 - Millie's NEUTS were good today, and Rod said just barely at
BB0534 - 1.55, ref SDS 7 QY6H, so I am getting chemo treatment today.
BB0535 - Megan was glad that, if there was a problem last week, things
BB0536 - worked out okay today. ref DIT 2 QJ6O
BB0538 - [On 080607 confusion about Neupogen caused failure of
BB0539 - treatment. ref SDS 9 Q67I
BB0541 - ..
BB0542 - 4. Megan said she would check with the doctor today on whether I
BB0543 - should take 1 or 2 Neupogen treatments, ref SDS 7 6I8L;
BB0544 - however, she seemed very busy, and so this could fall through
BB0545 - the cracks. ref DIT 2 QJ7O
BB0547 - ..
BB0548 - [On 080711 things fell through the cracks again when the CT
BB0549 - Department at Kaiser did not have enough time to prepare
BB0550 - for using Millie's Power Port to inject contrast medium,
BB0551 - and proposed delaying the test. ref SDS 11 PP7O
BB0553 - ..
BB0554 - Seems like "things fell through the cracks" 5 weeks ago, when Millie
BB0555 - did not get the Chemotherapy Orders for work on 080501 until 2 weeks
BB0556 - later, and only discovered today that UCSF reduced the dose for
BB0557 - Carboplatin on 080501, when Millie received the Chemotherapy Order for
BB0558 - last week on 080529, and compared with the prior Order for 080501, as
BB0559 - reported on 080529. ref SDS 6 MM9I
BB0561 - ..
BB0562 - [On 080626 Thomas substitutes for Megan, forgets to submit
BB0563 - order for blood test, ref SDS 10 YY3N, and blood vials for
BB0564 - clinical trial tests. ref SDS 10 YY63
BB0566 - ..
BB0567 - At the end of treatment today, Diane submitted the Chemotherapy Orders
BB0568 - dated 080529, ref SDS 6 4Z8H, and marked received in the Infusion
BB0569 - Clinic on 080602, ref SDS 6 MV6O, and showing 2 Neupogen treatments
BB0570 - are prescribed for the 4th cycle. ref SDS 7 YD51
Commend Excellent Medical Care UCSF Oncology Infusion Clinic Gratefu
BT0401 - ..
BT0402 - Commend Diane Excellent Medical Care UCSF Infusion Clinic
BT0405 - Millie's letter to Diane concludes...
BT0407 - ..
BT0408 - 5. Taking this occasion to say how grateful I am for your care and
BT0409 - concern. ref DIT 2 QJ5N
BT0411 - ..
BT0412 - 6. Anyway, thanks again for being so good at your job, and so
BT0413 - caring for your patients, especially me!! (ha ha). ref DIT 2
BT0414 - QJ8K