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SUBJECTS
Neupogen Side Effects Bone Pain Fatigue No Headache Suffered Today A

1503 -
1503 -    ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 68 0000. ref SDS 66 0000.
150502 -
150503 -
150504 -
150505 -
150506 -
150508 -  ..
1506 -
1507 -
1508 - Progress
1509 -
150901 - Neupogen Treatment at Kaiser Prescribed at UCSF for Clinical Trial
150902 -
150903 - Follow up ref SDS 68 9W9I, ref SDS 66 9W9I.
150904 -
150905 - Background on missing treatment at UCSF due to low blood counts, and
150906 - requirements for Neupogen are reported in the record on 080821.
150907 - ref SDS 60 ON5M   Case study on neutropenia reported in the record for
150908 - 080828 shows continuing need for Neupogen. ref SDS 65 8O7I
150910 -  ..
150911 - On 080829 Cisi scheduled Millie's treatment today for 1100.
150912 - ref SDS 66 453L
150914 -  ..
150915 - Florida was Millie's nurse today.  She gave Millie 2 injections
150916 - required for Neupogen treatment for UCSF prescription, and
150917 - implementing Kaiser protocols discussed on 080801 ref SDS 53 9W9I, and
150918 - originally presented by Laura on 080628. ref SDS 38 Q74G
150919 -
150920 -
150921 -
150922 -
1510 -

SUBJECTS
Default Null Subject Account for Blank Record

1603 -
160401 -  ..
160402 - Schedule Neupogen Treatments Extended through October
160403 -
160404 - Follow up ref SDS 68 WJ4O, ref SDS 66 WJ4O.
160405 -
160406 - Millie needs updated schedule from 080823, ref SDS 63 D28I, to include
160407 - October. which Laura planned to enter after Millie's treatment last
160408 - Saturday on 080830. ref SDS 68 WJ4O
160410 -  ..
160411 - The schedule Millie received from Kaiser today shows...
160412 -
160413 -                                                        UCSF Chemo
160414 -        Date    Time   Provider         Services      Cycle Treatmnt
160415 -        080905  1100   Infusion Nurse   Neupogen        7     3
160416 -        080906  0900   Infusion Nurse   Neupogen        7     3
160417 -         ..
160418 -   *1   080912  0930   Infusion Nurse   Neupogen        7     4
160419 -        080913  0900   Infusion Nurse   Neupogen        7     4
160420 -        080919  0830   Infusion Nurse   Neupogen        8     1
160421 -        080920  0900   Infusion Nurse   Neupogen        8     1
160422 -        080926  0830   Infusion Nurse   Neupogen        8     2
160423 -        080927  0900   Infusion Nurse   Neupogen        8     2
160424 -        081003  1400   Infusion Nurse   Neupogen        8     3
160425 -        081004  0900   Infusion Nurse   Neupogen        8     3
160426 -        081010  0830   Infusion Nurse   Neupogen        8     4
160427 -        081011  0900   Infusion Nurse   Neupogen        8     4
160428 -        081017  0830   Infusion Nurse   Neupogen        9     1
160429 -        081018  0900   Infusion Nurse   Neupogen        9     1
160430 -         ..
160431 -   *2   081024  1230   Infusion Nurse   Neupogen        9     2
160432 -        081025  0900   Infusion Nurse   Neupogen        9     2
160434 -  ..
160435 - * Comments
160436 -
160437 -        1.  Treatments for Neupogen on Friday are scheduled at 0830 and
160438 -            0900. ref SDS 0 6E8N  This may not align with UCSF protocol
160439 -            for Neupogen treatment 24 hours after Carboplatin
160440 -            chemotherapy, presented by the doctor on 080821.
160441 -            ref SDS 60 4B4L, which Millie gets on Thursday about 1100,
160442 -            and completes about 1130, as shown in the schedule at UCSF
160443 -            yesterday. ref SDS 70 HG57
160444 -
160445 -               [On 080913 Kaiser changed the schedule for Neupogen
160446 -               treatments to the afternoons on Fridays. ref SDS 72 WJ4O
160448 -             ..
160449 -        2.  Treatment on 081024 1230, ref SDS 0 6E4G reflects Millie's
160450 -            meeting with the doctor at 1140.
160451 -
160452 -
160453 -
160454 -
1605 -

SUBJECTS
Default Null Subject Account for Blank Record

1703 -
170401 -  ..
170402 - Exercise Hiking Maintain Fitness Strengthen Immune System
170403 -
170404 - Follow up ref SDS 68 3E4K, ref SDS 66 3E4K.
170405 -
170406 - Millie hiked only 1 lap at the Reservoir today because she had a made
170407 - plans to go shopping with Janna.
170408 -
170409 -
170410 -
1705 -

SUBJECTS
Default Null Subject Account for Blank Record

1803 -
180401 -  ..
180402 - Memeber Services Notify about Radiology Assigning Nurse to CT Dep
180403 -
180404 - Paula was in the Infusion Clinic today, while Millie was getting
180405 - Neupogen treatment.  Paula visited for few minutes to discuss Millie's
180406 - next CT test.
180408 -  ..
180409 - Paula received a copy of Millie's letter to Kaiser submitted on
180410 - 080903, reporting Millie is now scheduled to get a test on 080911 at
180411 - the Kaiser CT Department in Oakland. ref SDS 69 BK5N  Paula was
180412 - pleased that planning on 080811 has been implemented, ref SDS 59 L465,
180413 - and her warning was heeded last week on 080829 that 8 weeks after
180414 - failure on 080718, ref SDS 48 LK3R, the CT Department at Kaiser in
180415 - Walnut Creek is still not ready to perform tests using Power Port and
180416 - Huber needle technology for injecting contrast medium.  Millie's
180417 - doctor approved transferring the test to Oakland, and Arlette placed
180418 - the order again on 080822, ref SDS 62 N66E, but on 080826 Millie was
180419 - notified that Oakland sent it back to Walnut Creek. ref SDS 64 VU64
180420 - After hearing Paula's comments on 080829, Millie's doctor transferred
180421 - the test back to the Oakland CT Department, noted in Millie's letter
180422 - to medical team on 080829. ref SDS 67 RP7S
180424 -  ..
180425 - Paula indicated that Millie's case is well known by Kaiser management;
180426 - she feels the record showing difficulties making arrangements and
180427 - performing Millie's CT test on 080718 provides guidance for upgrading
180428 - the CT Department in Walnut Creek to use Power Ports for injecting
180429 - contrast medium.  This aligns with Lisa's call on 080826 reporting
180430 - that the case was elevated to management above the department level.
180431 - ref SDS 64 HT6X
180433 -  ..
180434 - Paula seemed to relate having discussed Millie's case with the head of
180435 - Radiology during a staff meeting today.  She got the impression that
180436 - Radiology is working on solving problems using the Power Port for
180437 - injecting contrast medium for tests in the CT Department at Walnut
180438 - Creek.  Paula feels the law requires a doctor or other qualified
180439 - medical professional to connect the CT test equipment to the Power
180440 - Port that injects contrast medium into a central artery, which she
180441 - noted previously on 080829. ref SDS 67 OA9M  Paula noted that this
180442 - requirement can be accomplished by assigning a qualified nurse from
180443 - Interventional Radiology to the CT Department.
180445 -  ..
180446 - Paula asked that Millie file a complaint with Member Services asking
180447 - that Interventional Radiology assign a nurse to the CT Department who
180448 - can support using Huber needle with Power Port technology for power
180449 - injection of contrast medium.  She feels this would add energy to
180450 - efforts in the Radiology Department to upgrade services.
180451 -
180452 -            [On 080917 Millie did not file complaint; instead the
180453 -            primary care physician submitted the record of Millie's
180454 -            successful CT test using the Power Port at Oakland, and
180455 -            made a referral to the Walnut Creek Radiology Department
180456 -            for Millie's next CT test on 081113 in Walnut Creek using
180457 -            procedures that were successful in Oakland. ref SDS 73 SG4X
180459 -             ..
180460 -            [On 081017 Paula reports further discussion with Kaiser
180461 -            management making progress on arrangements for Millie's
180462 -            next CT test on 081113 at Kaiser in Walunt Creek using
180463 -            procedures for injecting contrast medium with Power Port
180464 -            technology that was done successfully at Oakland.
180465 -            ref SDS 74 707L
180467 -             ..
180468 -            [On 081017 Kaiser in Walnut Creek investigating how Kaiser
180469 -            in Oakland handled laws about accessing a central venous
180470 -            artery with CT test equipment using a Power Port,
180471 -            ref SDS 74 8Y4N, and seemed to indicate that if legal
180472 -            issues are resolved, and the Power Port is accessed by
180473 -            qualified nurses in the Infusion Clinic, then support from
180474 -            the Power Port manufacturer is not needed. ref SDS 74 035K
180476 -  ..
180477 - Seems like there should be at least 3 or 4 such personnel, since
180478 - people go on vacation, get sick, have emergencies, quit, etc.  On
180479 - 080711 Ike said the CT Department has 3 doctors who are certified to
180480 - support Power Port and Huber needle devices for injecting contrast
180481 - medium required to perform CT tests; but, at that time Ike indicated
180482 - that not even one could be scheduled for Millie's CT test a week later
180483 - on 080718. ref SDS 43 RG9M
180485 -  ..
180486 - Paula noted today that the CT Department at Kaiser in Walnut Creek
180487 - arranged for nursing support of Millie's test on 080718 from
180488 - Interventionary Radiology. ref SDS 48 2U8V  This assignement was made
180489 - again in a call Millie received from the CT Department on 080826 to
180490 - schedule Millie's next CT test. ref SDS 64 HT6X
180492 -  ..
180493 - Paula said that Interventional Radiology was assigned to assist the CT
180494 - Department with Millie's tests because the patient was proactive
180495 - coordinating the work to use Power Port and Huber needle devices for
180496 - injecting contrast medium.  She feels other patients do not coordinate
180497 - work plans, and so suffer continuing problems like Millie experienced
180498 - on 080425. ref SDS 22 FP6F
180500 -  ..
180501 - We reviewed problems using Interventional Radiology for Millie's CT
180502 - test on 080718. ref SDS 48 LK3R  Even though the work was performed by
180503 - a highly qualified nurse with a master's degree, ref SDS 48 2U8V, the
180504 - lack of regular, daily experience accessing the Power Port with a
180505 - Huber needle, and converting units of measure to set the flow rate for
180506 - injection, resulted in failure. ref SDS 48 7M6F
180507 -
180508 -            [On 080911 Millie had the CT test at Kaiser in Oakland;
180509 -            using the Power Port was successful for injecting contrast
180510 -            medium, ref SDS 71 LK3R, because the manufacturer, Bard,
180511 -            sent a representative to the CT Department for guidance on
180512 -            using Power Port technology correctly, ref SDS 71 JG43;
180513 -            this helped the CT technologist avoid 5 possible problems,
180514 -            ref SDS 71 SF5J, which caused failure of the previous test
180515 -            at Kaiser in Walnut Creek on 080718. ref SDS 48 LK3R  Nora
180517 -  ..
180518 - Paula feels these problems can be solved at Kaiser in Walnut Creek
180519 - using the procedure at Kaiser in Oakland, where Millie was initially
180520 - directed to visit the Infusion Clinic for accessing the Power Port
180521 - with a Huber needle, then go to the CT Department for the test, as
180522 - related in Millie's letter to Kaiser on 080903. ref SDS 69 IO4X  She
180523 - seemed to indicate that the nurse from Interventionary Radiology
180524 - provides qualified supervision and backup for accessing a central
180525 - artery, noted by Ike in discussions with the CT Department in Walnut
180526 - Creek on 080711. ref SDS 43 RG9O
180528 -             ..
180529 -            [On 080917 Millie's primary care physician submitted a
180530 -            referral to the Walnut Creek Radiology Department for
180531 -            Millie's next CT test on 081113 in Walnut Creek, rather
180532 -            than Oakland. ref SDS 73 SG4X
180534 -             ..
180535 -            [On 081017 Kaiser in Walnut Creek investigating how Kaiser
180536 -            in Oakland handled laws about accessing a central venous
180537 -            artery with CT test equipment using a Power Port,
180538 -            ref SDS 74 8Y4N, and seemed to indicate that if legal
180539 -            issues are resolved, and the Power Port is accessed by
180540 -            qualified nurses in the Infusion Clinic, then support from
180541 -            the Power Port manufacturer is not needed. ref SDS 74 035K
180542 -
180543 -
180544 -
180545 -
180546 -
180547 -
180548 -
180549 -
180550 -
1806 -