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SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 8 J44X, ref SDS 7 K34V.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Paula was in the Infusion Clinic today, when Millie was getting
040902 - Neupgen treatment from Florida, reported in another record.
040903 - ref SDS 9 UZ7K
040905 -  ..
040906 - Paula reported having read the copy of Millie's letter to the medical
040907 - team on Wednesday, 081015, ref SDS 7 K354, which was sent to Paula for
040908 - support with arranging to get Millie's next CT test on 081107 at
040909 - Kaiser in Walnut Creek, rather than in Oakland. ref SDS 7 K354  Paula
040910 - had also read the follow up letter on scheduling the CT test sent to
040911 - the medical team confirming UCSF proposal to change Millie's
040912 - treatment, but which still requires a CT test on 081113. ref SDS 8
040913 - J44X
040915 -  ..
040916 - Today, Paula related having discussed earlier today with the head of
040917 - Radiology planning for Millie's CT next test.  This sounded like an
040918 - informal chat during a general staff meeting; Paula made a point of
040919 - sitting next to the Radiology chief, and followed up prior informal
040920 - discussion, which Paula reported on 080905. ref SDS 4 6S7H  Paula
040921 - gathered in the discussion today that Radiology is trying to arrange
040922 - for performing the referral from the primary care physician for
040923 - Millie's CT test on 081113, which was reported to Paula along with the
040924 - rest of the medical team in a letter on 080917. ref SDS 6 SG4X
040926 -         ..
040927 -        [On 081019 Millie letter confirms Kaiser is working on
040928 -        scheduling the next CT test on 081113 using Millie's power port
040929 -        at Walnut Creek, as requested by the primary care physician.
040930 -        ref SDS 10 DZ6R
040932 -  ..
040933 - Paula explained that the head of Kaiser Radiology in Walunt Creek is
040934 - communicating with the Oakland Kaiser Radiology Department to learn
040935 - how the Oakland performed Millie's CT test with Power Port technology,
040936 - and without an employee from Interventional Radiology to connect the
040937 - CT equipment to the Huber needle, as reported for Millie's test on
040938 - 080911. ref SDS 5 LK3R  At that time, only Angela, the technologist in
040939 - the Oakland CT Department, performed the CT test, including connecting
040940 - the test equipment to the Huber needle and the Powr Port, as related
040941 - in the record on 080911. ref SDS 5 3650
040943 -  ..
040944 - On 080829 Paula indicated understanding that the law requires a doctor
040945 - or specially trained professional to connect the CT test equipment to
040946 - the Power Port that accesses the central venous artery. ref SDS 3 OA9M
040947 - On 080905 Paula mentioned discussions with Kaiser management on this
040948 - requirement. ref SDS 4 AX8N
040950 -  ..
040951 - Today, Paula commented that Al Michaels, head of Radiology in Walnut
040952 - Creek, is asking the Oakland Radiology Department if they interpret
040953 - legal requirements differently, if they filed a memorandum of
040954 - procedure, protocol, etc., and have received a waiver, or are simply
040955 - unaware of requirements in light of the record on 080911, per above.
040956 - ref SDS 0 8Y8O
040957 -
040958 -     [On 081024 Dennis in the CT Department asks about assigning a
040959 -     nurse to support Millie's CT test on 081107 using the Bard Power
040960 -     Port to inject contrast medium; Dennis indicated the manager of
040961 -     the Radiology Department is coordinating to find out how Kaiser in
040962 -     Oakland did Millie's CT test using the Power Port and attended
040963 -     only by a CT Technician. ref SDS 11 2061
040965 -      ..
040966 -     [On 081107 Cassandra in the CT Department applied policy for
040967 -     Kaiser in Walnut Creek that Technicians cannot connect pressure
040968 -     infusion equipment for contrast medium to Power Ports accessed
040969 -     with a Huber needle. ref SDS 12 2F56
040971 -  ..
040972 - Paula further seemed to indicate that if the legal issue can be
040973 - resolved then the procedure at Oakland getting support from the
040974 - manufacturer, Bard, sending a representative to the CT Department for
040975 - guidance on using Power Port technology, ref SDS 5 JG43, would not be
040976 - needed to help the CT Department a Kaiser in Walnut Creek to avoid 5
040977 - possible problems starting use of a new technology, ref SDS 5 SF5J,
040978 - and which caused failure of a CT test at Kaiser in Walnut Creek on
040979 - 080718. ref SDS 2 LK3R
040981 -  ..
040982 - Paula further said that Kaiser does not need to use Bard Huber
040983 - needles, called out in manufacturer's requirements for the Bard Power
040984 - Port, reported on 080708 0630. ref SDS 1 JE7N, because Kaiser
040985 - procurement has purchased Lifeguard Huber needles that use high
040986 - strength steel required to support pressure injection of contrast
040987 - medium to perform CT tests.  She feels that since Millie had a
040988 - successful CT test at Kaiser in Oakland using a Lifeguard Huber needle
040989 - to access Millie's Power Port at UCSF for the CT test on 080911 1330.
040990 - ref SDS 5 N43F then Kaiser can use the same protocol for Millie's next
040991 - test in the Walnut Creek CT Department.  She said that consideration
040992 - using Bard Huber needles has ended, because Kaiser has purhcased
040993 - Lifeguard needles.
040995 -  ..
040996 - Paula seems to feel that as long as the Power Port is accessed by
040997 - qualified nurses in the Infusion Clinic, then no further assistance is
040998 - needed to roll out a new protocol at Walnut Creek.  This overlooks
040999 - risks of small mistakes occuring due to inexperience, which the
041000 - manufacturer can help avoid, as reported at Oakland on 080911.
041001 - ref SDS 5 JG43
041002 -
041003 -        [On 081019 Millie letter confirms Kaiser is working on
041004 -        scheduling the next CT test on 081113 using Millie's power port
041005 -        at Walnut Creek, as requested by the primary care physician.
041006 -        ref SDS 10 DZ6R
041008 -         ..
041009 -        [On 081107 Dennis, CT Department supervisor at Kaiser in Walnut
041010 -        Creek, was not available to manage use of new technology for
041011 -        the 2nd time to correct problems the first time, ref SDS 12
041012 -        VR4L; Pat who had worked on Millie's CT test using the Power
041013 -        Port for the 1st time, and had scheduled the 2nd test, did not
041014 -        remember Millie nor that the test would use Bard Power Port
041015 -        technology, ref SDS 12 MX4L; Steve, District Manager for Bard,
041016 -        who had talked to Dennis and said Kaiser was "good to go" using
041017 -        the Bard Power Port for the CT test, and Julie, who had offered
041018 -        to be on-site for the test, did not have time to support the
041019 -        2nd attempt using Bard equipment, which had failed on the 1st
041020 -        attempt, ref SDS 12 2F6S; nobody seemed to be prepared for
041021 -        applying manufacturer's instructions; communication to
041022 -        collaborate on coordinating the work failed by relying on
041023 -        memory of very talented, dedicated people under stress with
041024 -        limited time. ref SDS 12 2F32
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0411 -