CONTACTS 

SUBJECTS
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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 10 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - During the meeting today in Oncology, the primary care physician used
040902 - Kaiser's Knowledge Management system to schedule Millie for a CT test
040903 - on 081107 1330, noted in the letter to the medical team after the
040904 - meeting with the doctor. ref SDS 16 XZ9P  The doctor entered in the
040905 - referral notice that the test will use Millie's Power Port to inject
040906 - contrast medium.
040908 -  ..
040909 - The test was orignially planned to evaluate progress responding to
040910 - treatment in the clinical study for cetuximab and Carboplatin, which
040911 - the doctor ordered on 070105, and which requires CT tests every 8
040912 - weeks.  Millie's last test was on 080911, and so 8 weeks later is
040913 - 081107, noted in Millie's letter to the medical team on 080917,
040914 - ref SDS 6 SH5Q, and discussed the next day to start cycle 8 for
040915 - treatment at UCSF. ref SDS 7 MF5L
040917 -  ..
040918 - On 081015 the team was reminded to order CT test. ref SDS 8 K34V  The
040919 - next day at UCSF Doctor Ruog expected progression of cancer that would
040920 - require changing treatment to sunitinib clinical study.  At that time
040921 - on 081016, the doctor presented a work plan for screening patients to
040922 - participate in the study.  The first task was to biopsy a swelled
040923 - lymph node ("lump") to test for cancer in the left supraclavicular.
040924 - This is required for screening to participate in the sunitinib
040925 - clinical study at UCSF. ref SDS 9 J36R
040927 -  ..
040928 - Another step in the screening process is a CT test.
040930 -  ..
040931 - Planning for a CT test on 081107 was presented in Millie's letter to
040932 - the medical team on 080917 required to evaluate progress under the
040933 - prior treatment for the 3rd and 4th relapse of IBC with cetuximab and
040934 - Carboplatin. ref SDS 6 SG4X  A month later on 081015 planning was
040935 - cited again in Millie's letter submitting an agenda for a meeting at
040936 - UCSF the next day on 081016. ref SDS 6 SG4X  During that meeting at
040937 - UCSF on 081016, Doctor Rugo suspected progression of cancer.  The
040938 - doctor presented a work plan ordering an FNA biopsy to test a swelled
040939 - lymph node in the left supraclavicular. ref SDS 9 J34U  Positive test
040940 - establishes progression of disease.  In that case, the doctor proposed
040941 - treatment in the sunitinib clinical trial. ref SDS 9 J34R
040943 -  ..
040944 - The biopsy was performed at Kaiser on 081022. ref SDS 11 NZ5N  The
040945 - next day on 081023 Kaiser reported the pathology was positive for
040946 - cancer. ref SDS 14 4Q9Q  Later in the evening, Doctor Rugo notified
040947 - Millie that positive results stop treatment in the cetuximab
040948 - Carboplatin clinical trial, begun on 070201. ref SDS 15 D65G  As
040949 - noted, this test finding launches the work plan to begin treatment in
040950 - the sunitinib clnical trial. ref SDS 9 J34R
040952 -  ..
040953 - The new work plan on 081016 calls for getting the CT test on 081107
040954 - for screening to participate in the sunitinib clinical study.
040955 - ref SDS 9 J44X  Millie's letter to the doctor yesterday on 081023
040956 - submits an agenda for the meeting today, which explains requirements
040957 - for scheduling a CT test at Kaiser in Walnut Creek. ref SDS 12 TH9K
040959 -  ..
040960 - Today, during the meeting at Kaiser in the Oncology Department the
040961 - primary care physician ordered the CT test for 081107 1300 at the
040962 - Kaiser CT Department in Walnut Creek, as planned on
040963 -
040964 -                080917............................ ref SDS 6 SG4X
040965 -                081015............................ ref SDS 8 K354
040966 -                081016............................ ref SDS 9 J44X
040967 -                081023............................ ref SDS 12 TH9K
040969 -  ..
040970 - Today, the primary care physician asked Millie to coordinate with the
040971 - CT Department in Walnut Creek about using Millie's Power Port for
040972 - pressure injection of contrast medium.  Previously, Millie coordinated
040973 - on 080711 with Paula in the Infusion Clinic, ref SDS 2 OC9G, and then
040974 - with Ike in the CT Department to schedule the CT test on 080718 to use
040975 - the Power Port. ref SDS 2 PP6O  Difficulties with technology transfer
040976 - caused problems using the Power Port for the CT test on 080718.
040977 - ref SDS 3 LK3R  The next CT test was done at Kaiser in Oakland.  On
040978 - 080905, the primary care physician approved coordination to arrange
040979 - for Millie's CT test. ref SDS 4 S28G
040981 -  ..
040982 - After meeting with the doctor in Oncology, Millie went to the CT
040983 - Department in the basement floor of the hospital.  No one was
040984 - available for coordination.  The attendant said that Dennis, the
040985 - manager of the CT Department would call to follow up.
040986 -
040988 -  ..
0410 -
0411 -
0412 - Telecon
0413 -
041301 - When we got back from Kaiser, there was a message on the answering
041302 - machine to call Pat at 925 295 6874 about scheduling Millie's CT test.
041304 -  ..
041305 - Pat was the Technician who assisted Dennis doing Millie's CT test at
041306 - Kaiser on 080718.
041308 -  ..
041309 - Called the number Pat had left on the answering machine, and got a fax
041310 - sound.
041312 -  ..
041313 - Hung up and called the Kaiser general number.  Was told to call the
041314 - CT department schedule nuumber...
041315 -
041316 -                     925 295 4798
041318 -  ..
041319 - Asked for Pat, returning her call.
041321 -  ..
041322 - The schedule attendant said there is nobody in the CT department named
041323 - Pat.  There is Ike and Dennis.  These are familiar names in the record
041324 - on Millie's patient history.
041326 -  ..
041327 - Ike visited with Millie on 080711 to plan Kaiser's first attempt using
041328 - Millie's Power Port for the CT test. ref SDS 2 2P3N  Dennis supported
041329 - the CT test a week later on 080718, and complimented Millie for
041330 - holding up well when difficulties occurred using the Power Port for
041331 - the first time at Walnut Creek. ref SDS 3 FM74
041333 -  ..
041334 - The schedule attendant transferred the call to the CT Department
041335 - control room.  She said anyone who answers can figure out who can take
041336 - the call.
041338 -  ..
041339 - Pat answered the phone.
041341 -  ..
041342 - Pat confirmed that Millie's doctor has ordered a CT test using
041343 - Millie's Power Port, and the test is scheduled for 081107 1300.
041345 -  ..
041346 - Pat said that Millie needs a blood test for Creatinine within the past
041347 - 3 weeks.  Since Kaiser's computer shows the last Creatinine test was
041348 - on 080708 for Millie's surgery, ref SDS 1 8U4N, Pat scheduled Millie
041349 - for a blood test at Kaiser later today, because Millie will be on
041350 - vacation until the day before the CT test scheduled for 081107.
041352 -  ..
041353 - Millie had a blood draw at UCSF for treatment yesterday.  Creatinine
041354 - was 0.54. ref SDS 13 8U4N
041356 -  ..
041357 - Pat said this is within the target range for the CT test.  Pat
041358 - cancelled the order for Millie's lab today.  She asked that Millie
041359 - bring the report from UCSF for the blood test on 081023 to the CT
041360 - Department on the day of the test.
041361 -
041362 -        [On 081106 Virginia in the CT Department called and ordered
041363 -        another blood draw for Millie to get the CT test on 081107,
041364 -        because the Kaiser computer did not have the record on Pat's
041365 -        work today that determined the test at UCSF on 081023 is
041366 -        sufficient for Millie to get the CT test at Kaiser on 081107.
041367 -        ref SDS 21 ED6H
041369 -  ..
041370 - Pat said that coordination is needed to implement the doctor's
041371 - referral for using Millie's Power Port, per above. ref SDS 0 285H  Pat
041372 - recalled difficulties from assisting Dennis, and also Nora and later
041373 - Kathi, from Intervential Radiology, that occurred during Millie's
041374 - prior test, which was on 080718. ref SDS 3 A25R
041375 -
041376 -            [On 081107 Dennis, the supervisor of CT tests at Kaiser in
041377 -            Walnut Creek, was not available to support the CT test usig
041378 -            new technology for the 2nd time, ref SDS 24 VR4L; Pat who
041379 -            had worked on Millie's prior test using the Power Port for
041380 -            the 1st time, and had scheduled the current test, did not
041381 -            remember Millie nor that the test would use Bard Power Port
041382 -            technology, ref SDS 24 MX4L, Steve, District Manager for
041383 -            Bard, who had talked to Dennis and said Kaiser was ready to
041384 -            do the CT test with the Power Port, and Julie, who had
041385 -            offered to support the test on-site, did not have time to
041386 -            visit Kaiser to support the 2nd attempt to prform a CT test
041387 -            using Bard equipment which had previously failed on the 1st
041388 -            attempt, at Kaiser in Walnut Creek;, ref SDS 24 2F6S;
041389 -            communications to collaborate on coordinating the work,
041390 -            failed by relying on memory of people under stress with
041391 -            limited time. ref SDS 24 2F32
041393 -  ..
041394 - Discussed including the CT department in distribution of work plans
041395 - for Millie's medical team.  This enables people to remember critical
041396 - details that avoid past problems.  Pat feels this is a good idea.  She
041397 - said the CT Techs see so many patients it is hard to remember
041398 - everything.  After awhile specifics of each test become confusing,
041399 - essentially just a blur.  Pat suggested talking to Dennis, the
041400 - supervisor for the CT Department, about getting communication on
041401 - Millie's CT test.
041403 -  ..
041404 - Pat transferred the call.
041405 -
041407 -  ..
0415 -
0416 -
0417 - 1635
0418 -
041801 - Talked to Dennis.
041802 -
041803 - Dennis recalled working with Millie for the CT test on 080718.
041804 - ref SDS 3 FM74
041806 -  ..
041807 - We reviewed practice at Oakland using Millie's Power Port for the CT
041808 - test on 080911. ref SDS 5 2U8V
041810 -  ..
041811 - Dennis was pleased to hear that the CT test using the Power Port was
041812 - successful in Oakland, reported on 080911. ref SDS 5 LK3R
041814 -  ..
041815 - Dennis asked for background on what was done at Kaiser in Oakland that
041816 - enabled a successful CT test with Millie's Power Port.
041817 -
041818 -        [On 081028 Millie's letter to Dennis at Kaiser in Walnut Creek
041819 -        submitted background on the CT test in Oakland on 080911.
041820 -        ref SDS 17 PE8X
041822 -  ..
041823 - Discussed Angela's point on 080911 that getting a visit from Bard the
041824 - day before Millie's test was a big help for orienation on using the
041825 - Power Port similar to using a conventional IV.  There are evidently no
041826 - changes in CT equipment settings required.  The connection is the
041827 - same.  The CT tech simply flushes the port, verifies blood flow, and
041828 - then executes the test. ref SDS 5 LK3R
041830 -  ..
041831 - Recommended that Bard visit the CT Department in Walnut Creek, for
041832 - similar orientation, explained by Angela on 080911. ref SDS 5 3662
041834 -  ..
041835 - We considered today that a major factor was accessing the Power Port
041836 - by nurses in the Infusion Clinic, who are experienced doing this work.
041837 - On 080911, Millie was getting weekly treatment at UCSF for 2 years
041838 - accessing Millie's port.  On 080911, the Huber needle was left in
041839 - place rather than removed after treatment.  On the way driving home,
041840 - Millie stopped at Kaiser in Oakland.  Angela, the CT Technician,
041841 - removed the dressing, flushed the needle, and verified blood flow,
041842 - ref SDS 5 LK3R, which is the same thing CT Technicians do using an IV
041843 - in the arm.  She then connected the CT equipment and did the test.
041844 - After the test, Millie went next door to the Infusion Clinic, and a
041845 - nurse maintained the Power Port with Heparin, and then removed the
041846 - Huber needle. ref SDS 5 SH5O
041848 -  ..
041849 - Dennis feels this should work in Walnut Creek.
041850 -
041851 -            [On 081030 telecon Steve at Bard he has coordinated with
041852 -            Agenal who did CT test using Millie's Power Port
041853 -            successfully on 080911 at Kaiser in Oakland, ref SDS 20
041854 -            XN9C; and has further talked to Dennis at the CT Department
041855 -            at Kaiser in Walnut Creek; feels Dennis's team at Walnut
041856 -            Creek is good to go for doing Millie's CT test with the
041857 -            Bard Power Port on 081107. ref SDS 20 UF5H
041859 -             ..
041860 -            [On 081107 Dennis, the supervisor of CT tests at Kaiser in
041861 -            Walnut Creek, was not available to support the CT test usig
041862 -            new technology for the 2nd time, ref SDS 24 VR4L; Pat who
041863 -            had worked on Millie's prior test using the Power Port for
041864 -            the 1st time, and had scheduled the current test, did not
041865 -            remember Millie nor that the test would use Bard Power Port
041866 -            technology, ref SDS 24 MX4L, Steve, District Manager for
041867 -            Bard, who had talked to Dennis and said Kaiser was ready to
041868 -            do the CT test with the Power Port, and Julie, who had
041869 -            offered to support the test on-site, did not have time to
041870 -            visit Kaiser to support the 2nd attempt to prform a CT test
041871 -            using Bard equipment which had previously failed on the 1st
041872 -            attempt, at Kaiser in Walnut Creek;, ref SDS 24 2F6S;
041873 -            communications to collaborate on coordinating the work,
041874 -            failed by relying on memory of people under stress with
041875 -            limited time. ref SDS 24 2F32
041877 -  ..
041878 - Dennis approved working through the Infusion Clinic this time for
041879 - accessing Millie's Power Port with a Huber needle, and after the test,
041880 - Millie will return to the Infusion Clinic to remove the Huber Needle,
041881 - and maintain the port.
041883 -  ..
041884 - Dennis asked that Millie contact the Infusion Clinic to schedule the
041885 - work accessing the Power Port in advance of coming to the CT
041886 - Department for the test on 081107, since that procedure worked well
041887 - for the previous test in Oakland on 080911.
041888 -
041889 -            [On 081029 Florida confirms Kaiser CT department in Walnut
041890 -            Creek approves doing test using Millie's Power Port, access
041891 -            scheduled in Infusion Clinic 081107 1230. ref SDS 19 4E3G
041893 -  ..
041894 - Dennis indicated the CT department is investigating whether a nurse
041895 - must be assigned for the CT test using Millie's Power Port, because CT
041896 - technologists cannot access a venous artery, involved with Millie's
041897 - Power Port.  Dennis seemed to say that a Doctor (Al Michales??), who
041898 - heads the Radiology Department at Kaiser in Walnut Creek is
041899 - coordinating with Oakland on how Millie's test was performed in the CT
041900 - Department at Kaiser in Oakland using only a CT Technologist, as
041901 - reported in the record on 080911. ref SDS 5 3650
041903 -  ..
041904 - This aligns with Paula's understanding, e.g., recently on 081017.
041905 - ref SDS 10 8Y8O
041906 -
041907 -        [On 081107 Cassandra in the CT Department applied policy for
041908 -        Kaiser in Walnut Creek that Technicians cannot connect pressure
041909 -        infusion equipment for contrast medium to Power Ports accessed
041910 -        with a Huber needle. ref SDS 24 MY92
041912 -  ..
041913 - There was discussion today that different Kaiser hospitals may
041914 - interperet regulations differently.  This issue might be addressed by
041915 - issuing a memorandum of procedure, protocol, ect., and/or by arranging
041916 - for support during the test from a nurse in Interventional Radiology.
041917 - We considered solving this problem by assigning Nora or Kathi to visit
041918 - the CT Department for Millie's test on 081107 at 1300.  They were
041919 - effective at that time assisting the process. ref SDS 3 A39Q
041921 -         ..
041922 -        [On 081106 Millie subitted a letter to Dennis reminding of
041923 -        requirements for doing the CT test on 081107 with Power Port
041924 -        technology. ref SDS 22 4J3Q
041926 -  ..
041927 - Since the test on 081107 will be only the second time the CT
041928 - Department at Kaiser in Walnut Creek has attempted to do a test with
041929 - Power Port technology, and since the first time on 080718 had problems
041930 - and failed, it is prudent risk management have extra help, just to
041931 - observe and be available in case of unexpected problems.
041932 -
041933 -        [On 081028 letter to Dennis and the medical team associated
041934 -        with Millie's CT test discusses assigning a nurse from the
041935 -        Radiology Department to assist the CT Technician for Millie's
041936 -        test on 081107. ref SDS 17 PF3W
041938 -         ..
041939 -        [On 081029 called Dennis to coordinate arrangements for
041940 -        Millie's CT test on 081107; Dennis plans to read Millie's
041941 -        letter and call if he has any questions. ref SDS 18 QK7M
041943 -         ..
041944 -        [On 081030 telecon Steve at Bard he has coordinated with Agenal
041945 -        who did CT test using Millie's Power Port successfully on
041946 -        080911 at Kaiser in Oakland, ref SDS 20 XN9C; and has further
041947 -        talked to Dennis at the CT Department at Kaiser in Walnut
041948 -        Creek; feels Dennis's team at Walnut Creek is good to go for
041949 -        doing Millie's CT test with the Bard Power Port on 081107.
041950 -        ref SDS 20 UF5H
041952 -         ..
041953 -        [On 081106 Millie subitted a letter to Steve, District Manager
041954 -        for Bard, reminding of the CT test at Kaiser in Walnut Creek on
041955 -        081107 which would implement Bard Power Port technology, and
041956 -        asking for support during the test. ref SDS 23 7U3S
041958 -         ..
041959 -        [On 081107 Dennis, CT Department supervisor at Kaiser in Walnut
041960 -        Creek, was not available to manage use of new technology for
041961 -        the 2nd time to correct problems the first time, ref SDS 24
041962 -        VR4L; Pat who had worked on Millie's CT test using the Power
041963 -        Port for the 1st time, and had scheduled the 2nd test, did not
041964 -        remember Millie nor that the test would use Bard Power Port
041965 -        technology, ref SDS 24 MX4L; Steve, District Manager for Bard,
041966 -        who had talked to Dennis and said Kaiser was "good to go" using
041967 -        the Bard Power Port for the CT test, and Julie, who had offered
041968 -        to be on-site for the test, did not have time to support the
041969 -        2nd attempt using Bard equipment, which had failed on the 1st
041970 -        attempt, ref SDS 24 2F6S; nobody seemed to be prepared for
041971 -        applying manufacturer's instructions; communication to
041972 -        collaborate on coordinating the work failed by relying on
041973 -        memory of very talented, dedicated people under stress with
041974 -        limited time. ref SDS 24 2F32
041975 -
041976 -
041977 -
041978 -
041979 -
041980 -
041981 -
041982 -
041983 -
041984 -
0420 -