CONTACTS 

SUBJECTS
Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 89 0000. ref SDS 71 0000.
130502 -
130503 -
130504 -
130505 -
130506 -
130507 -
130508 -
130510 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - Agenda Integrated Work Plan Kaiser UCSF
130902 -
130903 - Follow up ref SDS 89 QY5I.
130904 -
130905 - Millie's vitals are normal today:  BP 127 86 Pulse 78
130906 -
130907 - Pulse normal about 60; so 63 indicates calm, minimal anxiety.
130909 -  ..
130910 - Agenda for the meeting today...
130911 -
130912 -    1.  Cellulitis resolved............................ ref SDS 0 RM6J
130914 -         ..
130915 -    2.  IBC rash examination........................... ref SDS 0 NH4N
130917 -         ..
130918 -    3.  Emotional stress Prozac medication............. ref SDS 0 H26H
130920 -         ..
130921 -    4.  Nupeogen prescription.......................... ref SDS 0 NM3M
130923 -         ..
130924 -    5.  Neupogen correct mistake $2,000................ ref SDS 0 BT5J
130926 -         ..
130927 -    6.  Power Port surgery certificate................. ref SDS 0 7Y6I
130929 -         ..
130930 -    7.  CT test scheduled on 080718...
130931 -
130932 -        a.  UCSF proposal advance date of test......... ref SDS 0 WX6I
130933 -        b.  Infusion Clinic Huber needle............... ref SDS 0 GO3G
130934 -
130935 -
130936 -
130937 -
130938 -
130939 -
1310 -

SUBJECTS
Meeting Examination Kaiser Backup Doctor Review Strategy Work Plan 3

2303 -
230401 -  ..
230402 - Arm Left Cellulitis Lymphedema Subsiding Continue Treatment
230403 - Cellulitis Inflammation Subsiding Lymphedema Swelling Reduced by Icing
230404 -
230405 - Follow up ref SDS 89 RM6J, ref SDS 71 RM6J.
230406 -
230407 - Case study on Millie's patient history of Cellulitis and lymphedema
230408 - treatment with Keflex is shown in the record on 061203. ref SDS 16
230409 - YT4M  Background on causation is in another case study on 070130.
230410 - ref SDS 22 VX6F
230412 -  ..
230413 - Background on recent treatment for Cellulitis and lymphedema the past
230414 - few months is reported in the record on 080502. ref SDS 89 RM6J
230415 - Millie was treated in the ER on 080409, ref SDS 82 FY4L, and with
230416 - Keflex at home for 14 days. ref SDS 82 F142  Millie notified the
230417 - medical team in a letter on 080423 that treatment for Cellulitis and
230418 - lymphedema ended. ref SDS 84 TY9R  On 080520 there was another
230419 - recurrence of Cellulitis without lymphedema. ref SDS 93 OU5J  The
230420 - doctor prescribed 10 day treatment with Keflex. ref SDS 93 1K7H   On
230421 - 080528 Millie reported to the medical team progress recovering from
230422 - Cellulitis. ref SDS 95 IJ5V  This was completed on 080529, and
230423 - examination by the medical team at UCSF showed full recovery at that
230424 - time. ref SDS 96 KH6F
230426 -  ..
230427 - Today, the doctor examined Millie's left arm and again observed no
230428 - evidence of Cellulitis nor lymphedema.
230430 -  ..
230431 - Millie still has a 10-day prescription of Keflex on 080305 to treat
230432 - future recurrence, ref SDS 71 5M3F, after the 10-day treatment on
230433 - 080520. ref SDS 93 1K7H
230435 -  ..
230436 - Millie related understandings from the surgeon during the meeting at
230437 - Kaiser on 080606, along the lines that remaining lymph nodes on
230438 - Millie's left chest, and under arm (axilla), which have not been
230439 - removed by surgery, may become more robust over time, and so better
230440 - able to handle exercise without causing Cellulitis and lymphedema.
230441 - ref SDS 97 4P7L  This may account for Millie not suffering another
230442 - recurrence since 080520 while significantly increasing exercise.
230444 -  ..
230445 - Helps reduce doubt, worry, and anxiety about maintaining vigorous
230446 - exercse that maintains blood counts, essential to get cheotherapy
230447 - treatment for cancer, and without getting Cellulitis and lymphedema
230448 - that require emergency treatment, cited below. ref SDS 0 H26H
230449 -
230450 -
230451 -
230452 -
2305 -

SUBJECTS
Medications Coordinate Kaiser Coagulation Department Notify Changes

4203 -
420401 -  ..
420402 - Coordinate Medication Changes Between Kaiser and UCSF
420403 - Medication Current List Coordinate Kaiser UCSF Referral Care
420404 - Current Medications Comprehensive Care Coordinate Kaiser Referral UCSF
420405 -
420406 - Follow up ref SDS 89 IE6M, ref SDS 71 IE6M.
420407 -
420408 - Millie related discussion at UCSF yesterday on 080626 concerning
420409 - patient history of current medications, ref SDS A4 8A9G, and citing
420410 - Kaiser's listing received during the meeting on 080502, ref SDS 89
420411 - E43I, including review on frequency of use. ref SDS 89 N84O  This
420412 - complemented the list in Kaiser's medical chart on 080502. ref SDS 89
420413 - 7Y6F
420415 -  ..
420416 - Reliance on patient memory rather than the actual list of current
420417 - medications indicates slow progress on the referral coordination plan
420418 - discussed at UCSF on 070222. ref SDS 24 VK5N
420420 -  ..
420421 - The list in the medical chart at Kaiser today, ref SDS 0 7Y6F, shows
420422 - closer alignment with the longer list of drugs received from the
420423 - doctor on 080502. ref SDS 89 NA6F
420424 -
420425 -
420426 -
420427 -
420428 -
4205 -

SUBJECTS
IBC Examination Expanding Cancer Disease Diagnose 4th Relapse Recomm

5603 -
560401 -  ..
560402 - IBC Subsiding Demonstrates Response to Treatment 4th Relapse
560403 - Responding Treatment Despite Only 50% Prescribed Medication Dose
560404 -
560405 - Follow up ref SDS 89 N15G, ref SDS 71 N15G.
560406 -
560407 - During the prior meeting on 080305 the doctor observed expanding IBC
560408 - rash. ref SDS 71 N15G  The next day on 080306 Doctor Rugo at UCSF
560409 - concurred and determined Millie suffered progression of IBC disease.
560410 - After 13 months treatment with cetuximab alone. the 4th relapse of IBC
560411 - seems evident, ref SDS 72 NW3N, confirming prior findings in the
560412 - meeting on 080219. ref SDS 68 3J4I
560414 -  ..
560415 - On 080312 Millie's letter to UCSF with copy to Kaiser reports IBC rash
560416 - seems to subside before starting new treatment with Carboplatin added
560417 - to existing treatment with cetuximab. ref SDS 75 RU4U
560419 -  ..
560420 - During the meeting today, the doctor asked when Carboplatin was added
560421 - to weekly treatments at UCSF?
560423 -  ..
560424 - Millie explained that her letter to the medical team at UCSF and
560425 - Kaiser on 080312 reported she would have the first treatment with
560426 - Carboplatin on 080313 to begin the 2nd arm of the clinical study.
560427 - ref SDS 75 BH5O  The doctor recalled receiving Millie's letter and
560428 - asked if she actually had the treatment, since there have been
560429 - reports of continuing low blood counts?
560431 -  ..
560432 - Millie advised that she had treatment on 080313, adding Carboplatin
560433 - chemotherapy to cetuximab, which Millie has been getting since 070201.
560434 - as reported in the record of patient history. ref SDS 76 TZ8I
560435 - Millie's letter the next day to the medical team on 080314 confirmed
560436 - have received this treatment, and being pleased to feel energetic the
560437 - following day. ref SDS 78 KO6Y   Millie further commended Kaiser and
560438 - UCSF for improving communications coordinating her care. ref SDS 78
560439 - EX5H
560441 -  ..
560442 - The doctor reported in the Medical Chart today that Carboplatin was
560443 - added on 080313, per below. ref SDS 89 NN8I
560445 -  ..
560446 - On 080331 photographs support explanation of expanding disease.
560447 - ref SDS 80 9Q4I
560449 -  ..
560450 - The doctor examined IBC on the left arm, chest, and lower stomach
560451 - areas.  He was pleased again today to see reduced IBC inflammation and
560452 - rash, continuing findings from examination on 080502, ref SDS 89 NH4N,
560453 - that Millie has begun to improve from examination on 080305, prior to
560454 - starting expanded treatment with Carboplatin. ref SDS 71 N15G  This
560455 - finding aligns with examination at UCSF yesterday on 080626 that
560456 - reported response to treatment.
560457 -
560458 -        [...below, Medical Chart reports negative palpation, and stable
560459 -        IBC erythema. ref SDS 0 1Z6O
560460 -
560461 -
560462 -
5605 -

SUBJECTS
Default Null Subject Account for Blank Record

5703 -
570401 -  ..
570402 - Kaiser Treat Millie with Cetuximab Carboplatin
570403 - Carboplatin 50% Prescribed Treatment Due to Low Blood Counts
570404 - Low Blood Counts Reduce Carboplatin to 50% of Prescribed Treatment
570405 - Neupogen Prescribed Increase Blood Counts Enable Complete Treatment
570406 -
570407 - Follow up ref SDS 89 NL9I.
570408 -
570409 - The doctor had received Millie's letter on 080625 reporting concerns
570410 - about blood counts, Neupogen, ref SDS A3 IT5W, reduction of
570411 - Carboplatin treatment, ref SDS A3 IU9Y, and progression of IBC
570412 - disease. ref SDS A3 IU9S
570414 -  ..
570415 - The doctor advised that Kaiser can now treat Millie with Cetuximab and
570416 - Carboplatin.  This is a major change from the report on 070921 that
570417 - Kaiser cannot treat Millie with cetuximab. ref SDS 33 QY68
570419 -  ..
570420 - Millie explained during the meeting today that treatment with Neupogen
570421 - at Kaiser Infusion Clinic ordered by the doctor on 080609, ref SDS 98
570422 - IL6I, yielded improving blood counts this week, reported at UCSF
570423 - yesterday on 080626. ref SDS A4 YY7U  This enabled Millie to get
570424 - Carboplatin treatment for IBC yesterday as well. ref SDS A4 YY86
570425 -
570426 -
570427 -
570428 -
5705 -

SUBJECTS
Default Null Subject Account for Blank Record

5803 -
580401 -  ..
580402 - Black Box Knowledge Management Processing Kaiser Pharmacy
580403 - Neupogen Payment Inventory Problem Doctor Writing Letter to Resolve
580404 -
580405 - Follow up ref SDS 89 NM3M.
580406 -
580407 - The doctor was very pleased that problems have now been resolved using
580408 - the computer to schedule Millie's Neupogen treatments so that she can
580409 - maintain blood counts to get the chemotherapy treatments for IBC in
580410 - the clinical study on referral to UCSF.
580412 -  ..
580413 - The doctor received Millie's letter on 080625 notifying Kaiser that
580414 - the schedule for Neupogen treatments omitted treatment prescribed for
580415 - 080707. ref SDS A3 IT6W  Confusion from July 4th being a holiday
580416 - caused a computer schedule problem because the computer could not
580417 - schedule consecutive treatments on July 4th and 5th.  Therefore, the
580418 - computer could only schedule treatment on July 5th.  Since the next
580419 - day is Sunday, and the Clinic is closed, the computer is not
580420 - programmed to schedule the 2nd treatment for the next available day on
580421 - Monday, 080707.  To correct the mistake, during the meeting, the
580422 - doctor sent a follow up letter using the Kaiser computer system to ask
580423 - Zan in the Oncology Pharmacy about adding Millie's 2nd treatment to
580424 - the schedule for the Infusion Clinic on 080707.
580426 -  ..
580427 - The doctor will also write a letter to resolve another Kaiser computer
580428 - problem reported to the medical team in Millie's letter on 080619,
580429 - ref SDS A1 YU9T  The computer caused a conflict between drug inventory
580430 - control and patient quality care requirements in the Outpatient
580431 - Pharmacy on 080609.  Millie was mischarged $2,000 for drugs she was
580432 - required to return, ref SDS 98 K270, due to a prescription mistake.
580433 - ref SDS 98 837J  The doctor recalled this was also mentioned again in
580434 - Millie's letter on 080625. ref SDS A3 MV9K
580436 -  ..
580437 - There was discussion that Kaiser is making progress using computers
580438 - for case management.  Rolling out new technology requires continual
580439 - refinement from experience.  The doctor feels feedback from patients
580440 - complements Kaiser's staff and medical professionals, but can be very
580441 - frustrating while people figure out how to configure automated systems
580442 - to properly handle the wide range of circumstances that arise treating
580443 - patients.
580444 -
580445 -        [On 080628 Kaiser protocol requires Millie get 2 injections of
580446 -        240 mcg for Neupogen prescribed by UCSF indicates confusion and
580447 -        error by Outpatient Pharmacy providing treatment with a single
580448 -        injection of 480 mcg. ref SDS A6 Q74G
580450 -         ..
580451 -        [On 080702 letter to medical team confirms planning for primary
580452 -        care physician to write a letter correcting the mistake of
580453 -        $2,000 mischarge for drugs which Millie was required to return.
580454 -        ref SDS A7 EP4T
580456 -         ..
580457 -        [On 080707 Kaiser computer in Surgery Department did not
580458 -        notify Coagulation Control Clinic to pause Coumadin
580459 -        treatments required for surgery. ref SDS A8 JP7W
580460 -
580461 -
580462 -
580463 -
5805 -

SUBJECTS
CT Test 080212 Findings Support Diagnosis IBC Progression Disease 4t

7703 -
770401 -  ..
770402 - CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
770403 -
770404 - Follow up ref SDS 89 N15O, ref SDS 71 N15O.
770406 -  ..
770407 - The doctor did not have time today for considering Millie's report on
770408 - 080507 of a spike in heart beat (pulse) while laying down in bed; case
770409 - study shows occassional spike in pulse reported by heart monitor
770410 - during exercise, evaluated previously as defective equipment.
770411 - ref SDS 90 CK4K
770412 -
770413 -
770414 -
770415 -
7705 -

SUBJECTS
CT Test 080425 Evaluate Diagnosis IBC Progression Disease 4th Relaps

9603 -
960401 -  ..
960402 - Contrast Media Injection Trauma Power Port Surgery Controls CT Test
960403 - CT Test 080718 Doctor Support Access Power Port Inject Contrast Media
960404 -
960405 - Follow up ref SDS 89 WX6I, ref SDS 88 766K.
960407 -  ..
960408 - Millie presented referral coordination with UCSF yesterday on
960409 - scheduling the next CT test. ref SDS A4 4F5S
960411 -  ..
960412 - The doctor noted during the meeting that UCSF has important concerns
960413 - to perform tests according to clinical study protocol.  Hospitals
960414 - doing clinical studies are audited by a state agency.  Audit reports
960415 - that find failure to perform requirements can lead to loss of
960416 - certification as a clinical trial facility.
960418 -  ..
960419 - The doctor indicated today that surgery at Kaiser to implant a Power
960420 - Port scheduled on 080708 controls the next CT test to assess Millie's
960421 - progress in the clinical trial at UCSF.  On 080617 Kaiser scheduled
960422 - the CT test on 080718 in order to use the Power Port to inject
960423 - contrast medium for the CT test, ref SDS A0 DF55, which is required to
960424 - prevent injury to Millie, reported on 080425. ref SDS 85 FP6F  He can
960425 - write a letter for UCSF to reconcile protocol adjustment in this case
960426 - based on patient health requirements determined by Kaiser.
960428 -  ..
960429 - Millie explained Catherine's request for referral coordination
960430 - yesterday that Kaiser submit to UCSF for the Infusion Clinic a
960431 - certificate from the surgeon stating the Power Port has been correctly
960432 - implanted and tested for use. ref SDS A5 MZ9L
960434 -  ..
960435 - The doctor said he is unfamiliar this form of documentation for a
960436 - surgical procedure.  He asked why Millie's doctor at UCSF has not made
960437 - this request directly, which would provide opportunity to get
960438 - clarification?  Millie related Doctor Rugo's concerns on 080403 that
960439 - referral coordination takes time and creates communication
960440 - frustrations that annoy busy health care professionals. ref SDS 81
960441 - SG7I
960443 -  ..
960444 - The doctor sent a letter using Kaiser's computer email system
960445 - notifying the surgeon that UCSF requests a certificate on the Power
960446 - Port for suitability of use.
960447 -
960448 -        [On 080708 surgeon annoyed by coordination requirements between
960449 -        Kaiser and UCSF on documentation to establish Power Port was
960450 -        correctly implanted and certified for use. ref SDS A9 O65F
960452 -         ..
960453 -        [On 080708 Kaiser submitted a letter stating the Power Port was
960454 -        tested successfully, and signed by the surgeon. ref SDS A9 O14F
960456 -         ..
960457 -        [On 080710 Millie submitted the doctor's letter to UCSF,
960458 -        ref SDS A0 EE4O, the nurse advised that UCSF actually needs the
960459 -        report on the xray performed showing placement of the Power
960460 -        Port, ref SDS A9 UY3I; UCSF management called Kaiser; the
960461 -        Surgery department coordinated submission of the xray report to
960462 -        the Infusion Clinic at UCSF. ref SDS A0 TM5J
960464 -  ..
960465 - Millie asked about Bella's concern on 080617 saying Kaiser needs to
960466 - assign someone in the Infusion Clinic to support the test on 080718
960467 - because using Power Port technology for injecting contrast medium is a
960468 - new procedure for the CT Department. ref SDS A0 OQ8L
960470 -  ..
960471 - The doctor seemed annoyed by complications coordinating work between
960472 - the Infusion Clinic in the Oncology Department, and with the CT
960473 - Department for the test on 080718.  The doctor left the examination
960474 - room to consult with Bella and staff in the Infusion Clinic.
960476 -  ..
960477 - About 10 minutes later, the doctor returned.
960479 -  ..
960480 - Following the meeting in the Infusion Clinic, the doctor seemed to
960481 - recognize coordination concerns about using Millie's Power Port for
960482 - the CT test on 080718, as related by Bella on 080617. ref SDS A0 OQ57
960484 -  ..
960485 - The doctor asked Millie to call Kaiser the day before the CT test on
960486 - 080718, and let him know if nobody else has been assigned to support
960487 - the CT test for Millie on 080718, then he will personally go to the CT
960488 - Department and press the button on the CT test equipment to perform
960489 - the test.  This planning is noted in the medical chart for today, per
960490 - below. ref SDS 0 CO3H
960491 -
960492 -        [On 080711 Ike in the CT Department indicated that the primary
960493 -        care physician cannot support Millie's CT test by pushing the
960494 -        button on the CT scan equipment. ref SDS B1 JQ87
960496 -         ..
960497 -        [On 080811 Paula at Kaiser Infusion Clinic investigating
960498 -        solutions to support CT Department for Millie's next test
960499 -        OA 080912; issue has been elevated, but no progress from
960500 -        management reported at this time, ref SDS B3 LD3H; there
960501 -        seems to be at least three (3) solutions. ref SDS B3 CW3O
960502 -        Paula coordinating with primary care physician about
960503 -        contacting Kaiser Oakland to perform Millie's next CT test.
960504 -        ref SDS B3 DE79
960505 -
960506 -
960507 -
960508 -
960509 -
960510 -
960511 -
9606 -

SUBJECTS
Prozac Not Taken Current Medication Prescribed 080305 Patient Improv

AM03 -
AM0401 -  ..
AM0402 - Prozac Not Needed Emotional Stress Relieved Favorable Results
AM0403 - Emotional Stress Subsides Health Care Referral Coordination Improve
AM0404 -
AM0405 - Follow up ref SDS 89 KT4J, ref SDS 71 KT4J.
AM0406 -
AM0407 - Background on emotional trauma from medical and case management issues
AM0408 - was reported on 080502, ref SDS 89 KT4J, explaining the doctor
AM0409 - prescribed Prozac on 080305 to relieve stress and anxiety. ref SDS 71
AM0410 - 5L5M
AM0412 -  ..
AM0413 - On 080502 stress and anxiety increased emotional trauma from "black
AM0414 - box" experience ordering medication on Kaiser's computer. ref SDS 89
AM0415 - NM4J  At that time, Kaiser charged for Neupogen treatment 500% higher,
AM0416 - without notice, and without recourse when something went "wrong" with
AM0417 - Kaiser's computer, causing medical mistakes getting prescribed drugs.
AM0418 - ref SDS 89 NM6J  On 080609 confusion using Kaiser's computer ordering
AM0419 - additional medication again increased emotional trauma, ref SDS 98
AM0420 - 837J, and discussed further above. ref SDS 0 NM3M
AM0422 -  ..
AM0423 - Continual recurrence of Cellulitis and lymphedema in the left arm with
AM0424 - only minimal exercise, causing treatment in the Emergency Department,
AM0425 - and shown by case study on 061203, ref SDS 16 YT4M, presents
AM0426 - significant emotional stress.  Recent comments by the surgeon on
AM0427 - 080606 that Cellulitis and lymphedema may not occur as often due to
AM0428 - expanding capacity of existing lymphatics, helps reduce stress and
AM0429 - anxiety, per above. ref SDS 0 TU6L
AM0431 -  ..
AM0432 - Case management and referral coordination problems, discussed with the
AM0433 - doctor today on scheduling surgery, ref SDS 0 WX6I, and the next CT
AM0434 - test, ref SDS 0 GO3G, and arranging for Neupogen treatments,
AM0435 - ref SDS 0 NM3M, present an unending cascade of communication problems
AM0436 - that increase emotional trauma, stress, and anxiety.
AM0438 -  ..
AM0439 - Millie's exercise continues to increase, reported on 080616,
AM0440 - ref SDS 99 IZ5I, and a few days ago on 080622. ref SDS A2 IZ5I  The
AM0441 - recent letter on 080625 shows a surprising and helpful increase in
AM0442 - energy, exercise, and fitness.  This helps cope with emotional trauma
AM0443 - without Prozac medication.
AM0444 -
AM0445 -        [On 080702 Millie's letter to the medical team confirms
AM0446 -        reports during examinations at UCSF and at Kaiser of
AM0447 -        increased exercise and fitness. ref SDS A7 HO5O
AM0448 -
AM0449 -
AM0450 -
AM0451 -
AM0452 -
AM05 -

SUBJECTS
CT Test 080212 Findings Support Diagnosis IBC Progression Disease 4t

B503 -
B50401 -  ..
B50402 - Medical Chart Reports Examination Diagnosis Prescription Prognosis
B50403 -
B50404 - Follow up ref SDS 89 YT5N, ref SDS 71 YT5N.
B50405 -
B50406 - Received the doctor's report in the medical chart for the meeting
B50407 - today...
B50409 -         ..
B50410 -    1.  Received:  6/27/08 1:06 PM
B50412 -         ..
B50413 -    2.  .... [patient] is a 72 Y female with a history of inflammatory
B50414 -        cancer of left breast who was initially diagnosed 03/04/02.
B50415 -        She had recurrent disease noted initially in the cervical LN's
B50416 -        03/03/04.  On E2100 Study with Avastin, but she had a PE noted
B50417 -        on CT 11/03/2004.  Then, because of progression of disease, the
B50418 -        patient was started on Taxotere and Xeloda 4/15/05.  She had a
B50419 -        total of 8 cycles ending 9/16/05.  She had a palliative left
B50420 -        mastectomy performed 10/21/05.  Then her left chest lesions
B50421 -        began expanding again.  The patient started Taxotere and Xeloda
B50422 -        again 07/21/06 for 7 cycles.  She was started on a Clinical
B50423 -        Trial 02/01/07 at UCSF and was randomized to the Erbitux only
B50424 -        (no Carbo) Arm.
B50426 -         ..
B50427 -        She had weekly Carboplatin added 03/13/08 because of
B50428 -        progression of disease.  She has had to skip 3 treatments
B50429 -        because off low counts.  She has required Neupogen support and
B50430 -        sometimes has to skip a week.  She has no recent bouts of
B50431 -        cellulitis.
B50433 -  ..
B50434 - Doctor's comment might add explanation on response to treatment,
B50435 - reported during the meeting on 080502. ref SDS 89 SU49
B50437 -  ..
B50438 - Medical Chart continues...
B50439 -
B50440 -    3.  Current Medications
B50441 -
B50442 -        PROCHLORPERAZINE 10MG....... Compazine. 080313, ref SDS 72 FA4H
B50443 -        ONDANSETRON 8 MG TABLETS.... Zofran.... 080313, ref SDS 72 FA4H
B50444 -        CEPHALEXIN 500 MG CAPSULES.. Keflex.... 080409, ref SDS 82 F142
B50445 -        FLUOXETINE 20 MG CAPSULES... Prozac.... 080305, ref SDS 71 5L5M
B50446 -        NEUPOGEN 480MCG/1.6ML.................. 080502, ref SDS 89 NL4M  ,
B50447 -        WARFARIN 4 MG TABLETS....... Coumadin.. 061002, ref SDS 13 MI5I
B50448 -        TIMOLOL MALEATE 0.5% EYE.... Eye drops
B50449 -        ACYCLOVIR 800MG............. Zoviraxe.. 070614 (no record prescribed by Doctor Rugo to treat cold sore on lip)
B50450 -        LORAZEPAM 1 MG.............. Ativan.... 070921, ref SDS 33 3N8J
B50451 -        Cetuximab................... Erbitux... 070201, ref SDS 23 4N5M
B50452 -        Carboplatin............................ 080313, ref SDS 76 2N4N
B50454 -  ..
B50455 - The medical chart still does not include contrast medium treatment for
B50456 - CT tests reported in Kaiser's list of medications received during the
B50457 - meeting on 080502. ref SDS 89 SY4M
B50458 -
B50459 -        GASTROGRAFIN 66/10 SOLUTION............ 080617, ref SDS A0 DF64
B50460 -
B50461 -            [On 080829 1200 medical chart omits contrast medium again,
B50462 -            which Kaiser changed to Barrium Sulfate Suspension.
B50463 -            ref SDS B6 554I
B50465 -  ..
B50466 - The doctor added to the bottom of the list Cetuximab and Carboplatin
B50467 - prescribed by UCSF in Chemotherapy Orders, as noted for the meeting
B50468 - with the doctor on 080502, ref SDS 89 NA6F, and citing earlier
B50469 - listings of medications on 080307.  UCSF. ref SDS 74 RW3T
B50470 -
B50471 -               [On 080708 Kaiser surgery processing asks for Millie's
B50472 -               current medications, per above, ref SDS 0 7Y6F, and
B50473 -               cannot access patient medical chart; asks patient to
B50474 -               verbally cite 14 medications.
B50476 -  ..
B50477 - Kaiser should further add to the medical chart additional medications
B50478 - prescribed by UCSF for weekly treatments...
B50479 -
B50480 -        Dexamethasone............... Decadron.. 080313, ref SDS 76 2N43
B50481 -        Diphenhydramine............. Benedryl.. 080313, ref SDS 76 NX4N
B50483 -  ..
B50484 - Medical Chart continues...
B50485 -
B50486 -    4.  Physical Examination
B50487 -
B50488 -        Performance Status: 0
B50489 -        Lymph nodes: negative palpation
B50490 -        Chest wall: erythema stable on lower left chest wall
B50491 -        Ext: LUE edema decreased, erythema upper arm stable
B50493 -  ..
B50494 - On 080502 the doctor explained that "Performance Status "0" means
B50495 - Millie has evident full mobility and demonstrates no loss of normal
B50496 - functioning. ref SDS 89 NP5M
B50498 -  ..
B50499 - Stable erythema reported in the Medical Chart reflects examination
B50500 - today, per above, ref SDS 0 NH4N, and shows continuing improvement
B50501 - from examination on 080305 that found increasing IBC. ref SDS 71 1Z6O
B50503 -  ..
B50504 - Medical Chart continues...
B50505 -
B50506 -        Lab:
B50507 -        Pending
B50509 -  ..
B50510 - The doctor resolved the referral coordination problem reported for the
B50511 - examination on 080502, ref SDS 89 NP87,
B50513 -  ..
B50514 - Millie's most recent labs are reported in the record on 080626 getting
B50515 - treatment at UCSF yesterday. ref SDS A5 439L
B50517 -  ..
B50518 - Medical Chart continues...
B50519 -
B50520 -    5.  Imaging
B50521 -
B50522 -        04/25/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - no change
B50523 -        04/09/08 CHEST, TWO VIEWS
B50524 -        03/05/08 HUMERUS 2+ VIEWS - normal
B50525 -        02/12/08 CT THORAX, ABDOMEN, PELVIS W CONTRAST - increased
B50526 -                 right axillary LN; infiltrate RML fissure
B50527 -        12/27/06 BASE SKULL TO MIDTHIGH PET/CT
B50528 -        07/08/06 MRI BRAIN WO/W CONTRAST(STD)- negative
B50530 -         ..
B50531 -    6.  Imp:
B50532 -
B50533 -        1. Metastatic breast cancer (IBC)lung, lymph node and chest wall
B50534 -        2. Recurrent leukopenia
B50535 -        3. Depression; stable, exercising more
B50536 -        4. Lymphedema; stable
B50538 -  ..
B50539 - Good to see Kaiser noting correlation between managing depression and
B50540 - exercise.
B50542 -  ..
B50543 - Stable nodules in the lungs were cited by the primary care physician
B50544 - at Kaiser in a letter on 070117 to explain the medical chart reporting
B50545 - lung cancer. ref SDS 20 TS8G
B50546 -
B50548 -  ..
B50549 - Medical Chart continues...
B50550 -
B50551 -    7.  Plan
B50552 -
B50553 -        1.  Continue Clinical Trial on Erbitux with weekly Carbo
B50555 -             ..
B50556 -        2.  Repeat CT July 18th
B50558 -  ..
B50559 - During the meeting today, the doctor determined that surgery for the
B50560 - Power Port controls doing the CT test to use the Power Port, per
B50561 - above. ref SDS 0 NF6H
B50562 -
B50563 -        3.  Call my coordinator the day before CT is performed to
B50564 -            identify licensed personal in Radiology who can push
B50565 -            the dye into a central line
B50567 -  ..
B50568 - Aligns with planning during the meeting when the doctor consulted with
B50569 - staff in the Infusion Clinic, per above. ref SDS 0 GO3G
B50571 -  ..
B50572 - Medical chart continues...
B50573 -
B50574 -        4.  Place Power Port
B50576 -  ..
B50577 - During the meeting today, the doctor determined that surgery for the
B50578 - Power Port controls doing the CT test to use the Power Port, per
B50579 - above. ref SDS 0 NF6H
B50581 -  ..
B50582 - Medical chart continues...
B50583 -
B50584 -        5.  Continue Neupogen support, next July 7th
B50585 -
B50586 -        6.  RTC 8 weeks
B50588 -  ..
B50589 - The doctor submitted a paper to Millie showing the next meeting in 8
B50590 - weeks will be on August 22, 2008.
B50592 -  ..
B50593 - After the meeting, Millie visited with the schedule clerk at the front
B50594 - desk.
B50596 -  ..
B50597 - The schedule clerk said the doctor made a mistake about meeting in 8
B50598 - weeks, because the doctor will be on vacation at that time.
B50600 -  ..
B50601 - Millie explained referral coordination in her case that has been
B50602 - effective with the doctor meeting to review progress the day after
B50603 - Millie meets with the doctor at UCSF to plan the another cycle.  The
B50604 - clerk suggested scheduling the work at Kaiser at the next opportunity
B50605 - after the doctor returns from vacation, and explained this procedure
B50606 - will maintain continuity with past practice providing timely backup
B50607 - for Millie's referral care at UCSF.
B50609 -  ..
B50610 - Millie agreed.
B50612 -  ..
B50613 - The clerk said the next time the doctor can meet with Millie after his
B50614 - vacation will be 080829, 1 week later than ordered by the doctor
B50615 - during the meeting today.
B50617 -  ..
B50618 - Millie suggested checking with the doctor about acceptability of this
B50619 - delay to the work plan set up by the doctor just 5 minutes ago, as
B50620 - shown in the medical chart, per above. ref SDS 0 PX5V
B50622 -  ..
B50623 - The clerk said that doctor's don't like to be asked for clarification
B50624 - to resolve mistakes in patient care.
B50626 -  ..
B50627 - The clerk proposed scheduling the work a week late on 080829, and
B50628 - then, if the doctor decides to come into the office a week earlier to
B50629 - comply with the initial work plan, Kaiser will notify Millie of the
B50630 - change.
B50631 -
B50632 -            [On 080823 Hazel in the Infusion Clinic scheduled Millie
B50633 -            for Neupogen treatment on 080905 because Millie explained
B50634 -            there is a double schedule to meet with the doctor, and
B50635 -            second one must be the mistake, because on 080627 the
B50636 -            doctor ordered the next meeting on 080822, and the schedule
B50637 -            clerk changed this to 080829. ref SDS B5 5T75
B50639 -  ..
B50640 - Millie agreed.
B50642 -  ..
B50643 - The clerk tried entering the schedule in the computer for Millie to
B50644 - meet with the doctor on 080829, but said there is a problem, and that
B50645 - something is wrong with the computer.  After a few minutes, the clerk
B50646 - advised that while discussing the schedule with Millie, Kaiser's
B50647 - computer system now seems to be down, and so will not accept the
B50648 - schedule, similar to the problem Melanie had in the Pharmacy on
B50649 - 080609, when the computer would not correct another mistake ordering
B50650 - Neupogen. ref SDS 98 IS47
B50651 -
B50652 -            [On 080809 Donna reported Kaiser's schedule omits Millie's
B50653 -            treatment on 080823. ref SDS B2 C24J
B50655 -             ..
B50656 -            [On 080809 Donna reported Kaiser's schedule omits Millie's
B50657 -            treatment on 080823. ref SDS B2 C24J
B50659 -             ..
B50660 -            [On 080822 Kaiser's schedule still omits Millie's treatment
B50661 -            on 080823. ref SDS B4 GW73
B50663 -             ..
B50664 -            [On 080823 the next day, Hazel discovered the computer
B50665 -            mysteriously changed the schedule received 080822, causing
B50666 -            2 new problems scheduling Millie's treatments. ref SDS B5
B50667 -            5T6N
B50669 -  ..
B50670 - The clerk advised the meeting on 080829 can be placed in a
B50671 - holding directory that is part of the Kaiser case management system.
B50672 - When the computer comes back online, this directory will be
B50673 - automatically checked, and will schedule a meeting on 080829 between
B50674 - Millie and the doctor.
B50676 -  ..
B50677 - Millie agreed.
B50679 -         ..
B50681 -
B50682 -
B50683 -
B50684 -
B50685 -
B50686 -
B50687 -
B50688 -
B50689 -
B50690 -
B50691 -
B50692 -
B50693 -
B50694 -
B507 -