CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 25 0000. ref SDS 24 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Background shows on 081016 UCSF ordered FNA biopsy to test for status
040902 - change. ref SDS 7 J36R  On 050909 Kaiser reported status change could
040903 - have a huge affect improving Millie's care by expanding treatments for
040904 - cancer. ref SDS 1 JX9P  On 081023 Kaiser reported being unable to
040905 - perform FNA biopsy for status change.  Kaiser advised Millie's medical
040906 - team that testing for status change at Kaiser requires doing a core
040907 - biopsy, and asked if this is "necessary." ref SDS 12 4Q9Q  On 081023
040908 - UCSF reported status change can be tested at UCSF with FNA biopsy.
040909 - ref SDS 13 4Q52, as specified in the UCSF medical order on 081016.  On
040910 - 081024 Kaiser reported core biopsy to check status change presents big
040911 - risks for Millie's patient profile. which are avoided using the FNA
040912 - biopsy method. ref SDS 14 W183  On 081027 Kaiser deferred core biopsy
040913 - to test status change 3 times.  This further indicates medical
040914 - concerns about Millie's safety, and allows for time for the medical
040915 - team to assess risks to Millie. ref SDS 15 UE6N  On 081031 UCSF
040916 - disclosed that core biopsy to check for status change is in
040917 - controversy, ref SDS 22 K16K, because UCSF specified an FNA biopsy
040918 - procedure on 081016 that does not present increased risk to Millie's
040919 - patient profile. ref SDS 7 J36R
040921 -  ..
040922 - On 081031 Millie sent a letter to UCSF and Kaiser asking about doing
040923 - the FNA biopsy to test for status change ordered by the doctor on
040924 - 081016 at UCSF, since UCSF says they can do it, and Kaiser says they
040925 - cannot. ref SDS 24 AJ6U
040927 -  ..
040928 - Yesterday, on 081101 Millie received a letter from Doctor Rugo with a
040929 - copy to Doctor Johnson at Kaiser responding to Millie's letter on
040930 - 081031 asking about doing the FNA biopsy for status change at UCSF
040931 - instead of Kaiser. ref SDS 24 AJ6U
040933 -  ..
040934 - Doctor Rugo responded in a letter yesterday on 081101 with a copy to
040935 - Kaiser saying UCSF can perform the work, as specified in the doctor's
040936 - order for medical services on 081016, ref SDS 7 J36R, and that this
040937 - requires additional approval from Kaiser for payment, since the biopsy
040938 - to test for status change is not required for the sunitinib clinical
040939 - trial, noted in the doctor's letter on 081101. ref SDS 25 5G5H
040941 -  ..
040942 - Millie submitted a letter to Doctor Rugo with a copy to Doctor
040943 - Johnson saying...
040944 -
040945 -    1.  Subject: FNA Biopsy Test Status Change Cost??
040946 -        Date: Sun, 02 Nov 2008 02:52:24 -0800
040954 -         ..
040955 -    2.  In your letter on 081101 (Nov 1), you say UCSF can check for
040956 -        status change with FNA biopsy, ref SDS 25 5G5H, which is the
040957 -        scope presented in the UCSF order on 081016. ref SDS 7 J36R
040959 -         ..
040960 -    3.  Kaiser says in a letter on 081023 that Kaiser cannot do this
040961 -        work with an FNA biopsy, but must use a core procedure.
040962 -        ref SDS 12 4Q9Q  Kaiser has deferred the work 3 times, and
040963 -        asked if it is "necessary" [reported on 081027, ref SDS 15
040964 -        UE6N].  My take is that people are worried about a core biopsy
040965 -        for my patient history.
040967 -         ..
040968 -    4.  I assume the procedure is necessary, otherwise it would not be
040969 -        ordered.  Doctor Shim in a letter from Kaiser in Oakland on
040970 -        050909 said that testing for status change can have a "huge"
040971 -        affect on treatments for my care. ref SDS 1 JX9P
040973 -         ..
040974 -    5.  This sounds like something that should be done.
040976 -         ..
040977 -    6.  How much will it cost?
040979 -         ..
040980 -    7.  If this is less than a core biopsy, it would seem like a
040981 -        bargain for Kaiser to do the FNA at UCSF??
040983 -         ..
040984 -    8.  By copy to Doctor Johnson, I'm asking for his feeling.
040985 -
040986 -           [On 081103 primary care physician advises that Kaiser will
040987 -           perform the procedure. ref SDS 26 2M64
040988 -
040989 -           [On 081107 Doctor Kahn draws core biopys tissue at Kaiser
040990 -           and places in a formalin specimen container for transport to
040991 -           the lab. ref SDS 28 494I
040993 -         ..
040994 -    9.  If there is no rush on this we can just stand down, and discuss
040995 -        when we meet on 081113, or further down the road.  Can we check
040996 -        status any time, or are we on the clock?
040997 -
040998 -           [On 081106 Doctor Daamen calls from Kaiser Head and Neck,
040999 -           ref SDS 27 5F5H, and advances the schedule from 081117 to
041000 -           081107 and will perform a core biopsy to test Millie for
041001 -           status change. ref SDS 27 5F68
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