CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 6 0000, ref SDS 5 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie sent a letter this morning reminding the primary care physician
040902 - at Kaiser to schedule a biopsy of the left supraclavicular requested
040903 - by Doctor Rugo on 081016 to biopsy the swelled lymph node discovered
040904 - in the left supraclavicular.  This followed up the letter to the
040905 - medical team on 081019 confirming the doctor was aware of UCSF request
040906 - for the biopsy, ref SDS 6 DZ5T, citing discussion with Arlette the day
040907 - before on 081017, ref SDS 5 UP6I, and implementing the work plan set
040908 - by Doctor Rugo a day earlier on 081016. ref SDS 4 J36R
040910 -  ..
040911 - This afternoon, Millie received a letter sent this morning from the
040912 - primary care physician at Kaiser saying...
040913 -
040914 -    1.  Subject:  Sunitinib Clinical Study Work Plan Underway
040915 -        Date: Tue, 21 Oct 2008 11:39:37 -0700
040919 -         ..
040920 -        Here is your appointment for evaluation. The biopsy will be
040921 -        scheduled after this first appointment.
040923 -  ..
040924 - On 040303 Doctor Lau in Kaiser Head and Neck Department performed FNA
040925 - biopsy on node in left supraclavicular. ref SDS 1 VF77  At that time,
040926 - the doctor performed the biopsy the same day, ref SDS 1 Y171; the
040927 - procedure did not require multiple days, proposed in Kaiser's schedule
040928 - today.
040929 -
040930 -            [...below, Advice Nurse reports the referral for biopsy
040931 -            does not specify FNA, nor left supraclavicular. ref SDS 0
040932 -            IW54
040934 -             ..
040935 -            [On 081021 letter to primary care physician requests follow
040936 -            up tomorrow with Head and Neck to clarify referral, and
040937 -            expedite the work. ref SDS 7 3U6S
040939 -             ..
040940 -            [On 081022 Millie visits Kaiser Head and Neck Department;
040941 -            Advise Nurse advises that Kaiser can perform the FNA biopsy
040942 -            on the neck in the afternoon at 1400; Millie submitted the
040943 -            UCSF order for the FNA biopsy and request to check for
040944 -            status change. ref SDS 9 HD85
040946 -         ..
040947 -    2.  Patient Name:
040948 -
040954 -         ..
040955 -    3.  Appointment Type:   LUMP
040957 -         ..
040958 -    4.  Appointment Date:   Oct 23, 2008
040960 -         ..
040961 -    5.  Appointment Day:    Thursday, 10:50 AM
040963 -         ..
040964 -    6.  Provider:           T M MACPHERSON M.D.
040966 -         ..
040967 -    7.  Home Page:
040968 -
040969 -                  kp.org/mydoctor/macpherson
040971 -         ..
040972 -    8.  Facility:           WALNUT CREEK MEDICAL CENTER
040974 -         ..
040975 -    9.  Department:         SURGERY CLINIC - WALNUT CREEK
040977 -  ..
040978 - Doing the biopsy in the surgery department conflicts with patient
040979 - history.  On 040303 this same scope of work was done in the Head and
040980 - Neck Department. ref SDS 1 Y171
040981 -
040982 -            [...below, called Kaiser to investigate. ref SDS 0 IW66
040983 -
040984 -            [...below, Kaiser changed the work to the Head and Neck
040985 -            Department. ref SDS 0 03GE
040987 -             ..
040988 -            [On 081022 Millie visits Kaiser Head and Neck Department;
040989 -            Advise Nurse advises that Kaiser can perform the FNA biopsy
040990 -            on the neck in the afternoon at 1400; Millie submitted the
040991 -            UCSF order for the FNA biopsy and request to check for
040992 -            status change. ref SDS 9 HD85
040994 -  ..
040995 - Letter from Kaiser continues...
040996 -
040997 -   10.  Location:           3RD FLOOR, MED OFC BLD 2 WCR
040999 -         ..
041000 -   11.  Cancellation Number:
041001 -
041002 -                  (925) 295-4110  (MON-SUN, 12 AM-12 PM)
041004 -         ..
041005 -   12.  Rebook Number:
041006 -
041007 -                  (925) 295-4110  (MON-FRI, 8 AM-5 PM)
041009 -         ..
041010 -   13.  Look forward to seeing you on Friday.
041012 -         ..
041013 -   14.  Robert A Johnson, MD
041015 -         ..
041016 -   15.  NOTICE TO RECIPIENT:  If you are not the intended recipient of
041017 -        this e-mail, you are prohibited from sharing, copying, or
041018 -        otherwise using or disclosing its contents.  If you have
041019 -        received this e-mail in error, please notify the sender
041020 -        immediately by reply e-mail and permanently delete this e-mail
041021 -        and any attachments without reading, forwarding or saving them.
041022 -        Thank you.
041023 -
041025 -  ..
0411 -
0412 -
0413 - 1357
0414 -
041401 - Millie called the Surgery Department and changed the schedule from
041402 - Thursday at 1050 to 1445, in order to have time for driving back from
041403 - UCSF in San Francisco after Millie's treatment.
041404 -
041406 -  ..
0415 -
0416 -
0417 - 1457
0418 -
041801 - Called Kaiser back.
041802 -
041803 - Talked to Gloria in the schedule group.
041805 -  ..
041806 - Gloria was difficult to understand.
041808 -  ..
041809 - Talked to Advice Nurse: Anne.
041811 -  ..
041812 - Anne checked the computer to see why FNA biopsy procedure ordered by
041813 - UCSF on 081016, ref SDS 4 J36R, was scheduled in the Surgery
041814 - Department on 081023 1050, shown in the doctor's referral above.
041815 - ref SDS 0 0X9F   Anne feels this conflicts with Millie's medical
041816 - schedule showing chemotherapy treatment at UCSF in San Francisco on
041817 - 081023 from 0800 until 1130, reported on 080918, ref SDS 3 AM3N, and
041818 - then has to drive home to Concord.  Kaiser's schedule for the FNA
041819 - biopsy on 081023 1050, per above, ref SDS 0 0X9F, has to be changed to
041820 - align with the patient's medical schedule.
041822 -  ..
041823 - Anne feels this is a computer problem because coordinating schedules
041824 - between Kaiser and referral providers, like UCSF, is hard work.
041825 -
041826 -        [On 081105 computer problem ordering Muga test on 081106
041827 -        conflicts with UCSF work plan showing Millie on vacation and
041828 -        not available to begin medical tasks until 081107, and then has
041829 -        not dates available until 081111. ref SDS 10 WO72
041831 -  ..
041832 - Asked why the procedure is being done in Surgery and not in Head and
041833 - Neck Department?
041835 -  ..
041836 - Anne said it depends on where the biopsy is being taken.
041838 -  ..
041839 - We reviewed objectives to get results of the biopsy in time for
041840 - Millie's meeting with the primary care physician on Friday, 081024
041841 - 1140.
041843 -  ..
041844 - Anne explained that the doctor wants a meeting to locate the node, and
041845 - then another meeting to perform the biopsy.
041847 -  ..
041848 - Reviewed backbround on 040303 when Doctor Lau performed the biopsy in
041849 - the Kaiser Head and Neck Department. ref SDS 1 VF77  At that time, the
041850 - doctor performed the biopsy the same day. ref SDS 1 Y171
041852 -  ..
041853 - Anne put the call on hold to check the referral.
041854 -
041856 -  ..
0419 -
0420 -
0421 - 1512
0422 -
042201 - Anne came back online.
042202 -
042203 - She said the referral does not specify the location of the lump to
042204 - biopsy.
042206 -  ..
042207 - We reviewed the notice to Kaiser on 081016 that presents the UCSF work
042208 - plan, and says in part...
042209 -
042210 -      FNA L SC node, ER PR HER2 neu status, ref SDS 4 J36R
042212 -  ..
042213 - Anne advised that UCSF referral for "FNA" calls for a Fine Needle
042214 - Aspiration procedure in the left supraclavicular, and is checking for
042215 - status change.
042217 -  ..
042218 - Anne said the referral to the Surgery Department does not specify FNA
042219 - left supraclavicular and status change.
042220 -
042221 -            [On 081021 letter to primary care physician requests follow
042222 -            up tomorrow with Head and Neck to clarify referral, and
042223 -            expedite the work. ref SDS 7 3U6S
042225 -             ..
042226 -            [On 081022 Millie visits Kaiser Head and Neck Department;
042227 -            Advise Nurse advises that Kaiser can perform the FNA biopsy
042228 -            on the neck in the afternoon at 1400; Millie submitted the
042229 -            UCSF order for the FNA biopsy and request to check for
042230 -            status change. ref SDS 9 HD85
042232 -  ..
042233 - Anne noted that FNA procedures can often be done with one visit, but
042234 - this is not a procedure typically done in the surgery department; it
042235 - is usually performed in the Head and Neck Department.  This aligns
042236 - with Millie's patient history on 040303, when FNA biopsy was done the
042237 - same day in the Head and Neck Department. ref SDS 1 Y171
042239 -  ..
042240 - Anne said there is nothing in the order that calls for checking status
042241 - change.
042243 -  ..
042244 - Anne decided to check with Doctor MacPherson, scheduled to meet with
042245 - Millie on Thursday. ref SDS 0 4Q4C
042247 -  ..
042248 - We reviewed patient history showing Doctor Riley-Paull has a lot of
042249 - experience treating Millie, most recently on 080708 upgrading the
042250 - Power Port, ref SDS 2 0001, from the port catheter which Doctor
042251 - Riley-Paull originally installed on 040419.
042253 -  ..
042254 - Anne said that Doctor Riley-Paull's long history treating Millie
042255 - beginning 2002, makes her a good source to consult on this matter.
042257 -  ..
042258 - Anne said that Doctor Riley-Paull is in the office today.  She will
042259 - check to see if the doctor is available to discuss Millie's case.
042260 -
042261 -
042263 -  ..
0423 -
0424 -
0425 - 1516
0426 -
042601 - On hold.
042602 -
042604 -  ..
0427 -
0428 -
0429 - 1527
0430 -
043001 - Anne came back online.
043002 -
043003 - She has talked to Doctor Riley-Paull.
043005 -  ..
043006 - The doctor said that FNA procedure in the left supraclavicular should
043007 - be performed in Head and Neck Department, as was done previously on
043008 - 040303. ref SDS 1 Y171
043010 -  ..
043011 - Previously, on 080708 the doctor cited complex patient history can be
043012 - annoying aligning communications with work plans. ref SDS 2 O65F  The
043013 - doctor mentioned case management can be stressful and annoying,
043014 - requires skills and tools to make sense of complexity. ref SDS 2 OK8M
043015 -
043016 -        [On 081022 after successful visit at Head and Neck performing
043017 -        the biopsy, Millie stopped at Surgery Department and asked Anne
043018 -        to thank Doctor Riley-Paull for assistance today adjusting the
043019 -        referral to align with patient history. ref SDS 9 HA33
043021 -  ..
043022 - Discussed checking with the primary care physician to determine if
043023 - there is a reason for doing the work in the Surgery Department, that
043024 - may not be evident.  Perhaps a strategy of somekind, or that Head and
043025 - Neck is booked for this week.
043027 -  ..
043028 - Anne will check with Doctor Johnson on why the referral was made to
043029 - Surgery and not to Head and Neck.
043031 -  ..
043032 - If the doctor approves, Anne will cancel the procedure on Thursday in
043033 - the Surgery Department, as recommended by Doctor Riley-Paull.  She
043034 - will prepare a referral for Millie to Head and Neck, citing the order
043035 - prepared by UCSF submitted to Kaiser on 081016, ref SDS 4 J36R, and
043036 - per above. ref SDS 0 IW44
043037 -
043038 -        [On 081022 Millie visits Kaiser Head and Neck Department;
043039 -        Advise Nurse advises that Kaiser can perform the FNA biopsy
043040 -        on the neck in the afternoon at 1400; Millie submitted the
043041 -        UCSF order for the FNA biopsy and request to check for
043042 -        status change. ref SDS 9 HD85
043044 -  ..
043045 - Anne will personally hand carry the referral to the Head and Neck
043046 - Department right away to expedite scheduling the work.
043048 -  ..
043049 - Anne will coordinate with the Head and Neck Department to expedite
043050 - this referral with the objective to get results of the FNA biopsy and
043051 - check for status change in time for Millie's meeting with the primary
043052 - care physician on Friday, 081024 1145.
043054 -  ..
043055 - Anne said Kaiser will call back later today about finalizing these
043056 - arrangements.
043057 -
043058 -
043060 -  ..
0431 -
0432 -
0433 - 1643
0434 -
043401 - Called Anne back.  Talked to Sandy.
043402 -
043403 - She transferred the call to Anne.
043405 -  ..
043406 - Anne reported that she took the referral to Head and Neck, and gave
043407 - it to the Advice Nurse, Jane.
043408 -
043409 -      925 295 4100
043411 -  ..
043412 - Anne advised that Jane explained a doctor in the Head and Neck
043413 - Department will initially perform a "triage," of the referral from the
043414 - Oncology Department, and then approve scheduling the work.
043416 -  ..
043417 - Anne said she did not notify Jane that FNA biopsy should check for
043418 - status change, because the referral from Millie's doctor does not
043419 - specify checking status change. per above. ref SDS 0 3Z6M
043420 -
043421 -        [On 081021 letter to primary care physician requests follow up
043422 -        tomorrow with Head and Neck to clarify referral, and expedite
043423 -        the work. ref SDS 7 3U6S
043425 -         ..
043426 -        [On 081022 Millie visits Kaiser Head and Neck Department;
043427 -        Advise Nurse advises that Kaiser can perform the FNA biopsy
043428 -        on the neck in the afternoon at 1400; Millie submitted the
043429 -        UCSF order for the FNA biopsy and request to check for
043430 -        status change. ref SDS 9 HD85
043432 -         ..
043433 -        [On 081022 meeting with doctor for FNA procedure, checking for
043434 -        status change was not specified in referral from Surgery;
043435 -        corrected problem with UCSF order for FNA and checking status
043436 -        change. ref SDS 9 RS8M
043438 -         ..
043439 -        [On 081022 after successful visit at Head and Neck performing
043440 -        the biopsy, Millie stopped at Surgery Department and thanked
043441 -        Anne for extra effort today coordinating to adjust the referral
043442 -        to align with patient history. ref SDS 9 HA33
043444 -  ..
043445 - Asked why she requested FNA biopsy, since she indicated the referral
043446 - from Oncology does not specify FNA?
043448 -  ..
043449 - Anne recalled telling Jane that the patient needs FNA of left
043450 - supraclavicular, because of the discussion earlier, per above.
043451 - ref SDS 0 IW44
043453 -  ..
043454 - Anne suggested telling the doctor who does the biopsy to order status
043455 - check.
043457 -  ..
043458 - She feels it would be a good idea to contact Head and Neck to expedite
043459 - scheduling the work, and to make sure everything is ordered as
043460 - required by UCSF.
043461 -
043462 -        [,..in another record Millie notified the primary care
043463 -        physician of changes in the Oncology referral, ref SDS 7 XK79,
043464 -        and requested support scheduling the work tomorrow, or as soon
043465 -        as possible. ref SDS 7 3U5W
043467 -         ..
043468 -        [On 081022 Millie visits Kaiser Head and Neck Department;
043469 -        Advise Nurse reported that Kaiser can perform the FNA biopsy on
043470 -        the neck in the afternoon at 1400;, ref SDS 8 0D6F; Millie
043471 -        submitted the UCSF order for the FNA biopsy and request to
043472 -        check for status change. ref SDS 8 IE34
043474 -         ..
043475 -        [On 081022 meeting with doctor for FNA procedure, checking for
043476 -        status change was not specified in referral from Surgery;
043477 -        corrected problem with UCSF order for FNA and checking status
043478 -        change. ref SDS 9 RS8M
043480 -  ..
043481 - Anne tried to transfer the call to Jane in Head and Neck.
043482 -
043484 -  ..
0435 -
0436 -
0437 - 1646
0438 -
043801 - Got a message saying that Head and Neck is closed after 1645.
043802 -
043803 -        [On 081022 Millie visits Kaiser Head and Neck Department;
043804 -        Advise Nurse reported that Kaiser can perform the FNA biopsy on
043805 -        the neck in the afternoon at 1400; Millie submitted the UCSF
043806 -        order for the FNA biopsy and request to check for status
043807 -        change. ref SDS 9 HD85
043808 -
043809 -
043810 -
043811 -
043812 -
043813 -
043814 -
043815 -
043816 -
0439 -