CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 27 0000. ref SDS 26 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Millie sent a letter on 081031 to the medical team asking about doing
040902 - the FNA biopsy test for status change ordered by UCSF on 081016 at
040903 - UCSF instead of Kaiser, because Kaiser indicates they cannot perform
040904 - the work. ref SDS 26 AJ6U
040906 -  ..
040907 - Background on difficulties performing FNA biopsy test for status
040908 - change is listed on 081031, ref SDS 26 5G5H, citing UCSF order for
040909 - medical services on 081016. ref SDS 7 J36R
040911 -  ..
040912 - UCSF responded on 081101 offering to perform the FNA biopsy to test
040913 - for status change at UCSF, and disclosed this is not part of the
040914 - sunitinib clinical trial, and therefore requires separate
040915 - authorization for payment. ref SDS 27 5G5H
040917 -  ..
040918 - Millie sent a letter to the medical team on 081102 reviewing
040919 - background on Kaiser failure to perform the FNA biopsy test for status
040920 - change, proposing to substitute core biopsy procedure, but deferring
040921 - the work 3 times due to high risks, and asking if the procedure is
040922 - necessary. ref SDS 28 AD5U  Millie reviewed patient history showing
040923 - medical necessity for FNA biopsy to test for status change,
040924 - ref SDS 28 AD5Y, and asking for the cost of UCSF performing the FNA
040925 - biopsy test for status change. ref SDS 28 AD6W
040927 -  ..
040928 - This morning Millie received a copy of a letter from the primary care
040929 - physician at Kaiser dated 081103 0859 responding to the UCSF letter on
040930 - 081101, ref SDS 27 5G5H, and making no reference to Millie's letter
040931 - yesterday to UCSF on 081102 asking about the cost of doing the FNA
040932 - biopsy test for status change at UCSF, ref SDS 28 AD6W, and discussed
040933 - in this record per above. ref SDS 0 2M46
040935 -  ..
040936 - The letter from Kaiser this morning says in total...
040937 -
040938 -    1.  Subject:  Sunitinib Start Nov 13th Meeting Doctor Rugo
040939 -        Date: Mon, 3 Nov 2008 08:59:08 -0800
040944 -         ..
040945 -    2.  We will have the procedure performed at Kaiser.
040946 -
040947 -            [On 081103 UCSF responds saying in total "Great, thanks."
040948 -            ref SDS 29 BY3H
040949 -
040950 -            [On 081103 Millie received another letter allegedly from
040951 -            the primary care physician, ref SDS 30 KO8J, but
040952 -            transmitted through Voltage IBE and which could not be
040953 -            opened. ref SDS 30 E59N
040955 -             ..
040956 -            [On 081106 Doctor Daamen calls from Kaiser Head and Neck,
040957 -            ref SDS 31 5F5H, and advances the schedule from 081117 to
040958 -            081107 and will perform a core biopsy to test Millie for
040959 -            status change. ref SDS 31 5F68
040961 -             ..
040962 -            [On 081107 Doctor Kahn draws core biopys tissue at Kaiser
040963 -            and places in a formalin specimen container for transport
040964 -            to the lab. ref SDS 32 494I
040966 -             ..
040967 -            [On 081119 Kaiser submits summary of final pathology
040968 -            report, ref SDS 33 5O8G, for the biopsy on 081107,
040969 -            ref SDS 32 496L, and it shows status unchanged, ER, PR,
040970 -            Her2neu still triple negative. ref SDS 33 UQ5P
040972 -  ..
040973 - The brevity of this letter in relation to issues at risk seems
040974 - striking.  During the meeting at Kaiser on 081024, the doctor
040975 - mentioned difficulties keeping up with the flow of information,
040976 - getting over 100 email a day, seeing patients, and conducting daily
040977 - business in calls and meetings.  The doctor explained this work load
040978 - prevented specifying the biopsy referral correctly, reported in a
040979 - letter to the doctor late in the afternoon on 081021, ref SDS 11 3U4P,
040980 - and citing the record earlier that day correcting the mistakes.
040981 - ref SDS 10 YR6O
040983 -  ..
040984 - Doctor Rugo reported in a letter on 081017 getting 500 email a day and
040985 - requested brevity, ref SDS 8 215I, illustrated by the letter today,
040986 - ref SDS 0 2M64, and previously on 081021. ref SDS 10 YR6O
040988 -  ..
040989 - Questions arising from Kaiser's response today include...
040990 -
040991 -            a.  What procedure will be performed:  core biopsy or FNA
040992 -                biopsy prescribed in the order for medical services on
040993 -                on 081016.
040994 -
040995 -                   [On 081106 Doctor Daamen calls from Kaiser Head and
040996 -                   Neck and advances the schedule from 081117 to 081107
040997 -                   and will perform a core biopsy to test Millie for
040998 -                   status change. ref SDS 31 3Z6H
041000 -                 ..
041001 -            b.  If Kaiser proposes to perform an FNA biopsy specified
041002 -                in the order for medical services on 081016 does this
041003 -                mean Kaiser has resolved representations that Kaiser
041004 -                cannnot perform an FNA biopsy to test for status
041005 -                change, reported on....
041006 -
041007 -                      •  081023..................... ref SDS 14 4Q5V
041008 -                      •  081024..................... ref SDS 15 008H
041009 -                      •  081024..................... ref SDS 16 KE6J
041011 -                 ..
041012 -            c.  If Kaiser now proposes to perform a core biopsy does
041013 -                this mean Kaiser has resolved representations that core
041014 -                biopsy presents significant risks for Millie's patient
041015 -                profile cited by Doctor Wong on 081024 in the Kaiser
041016 -                Head and Neck Department. ref SDS 16 W183
041018 -                 ..
041019 -            d.  If FNA biopsy will not be performed will this be done
041020 -                on 081117 1130 scheduled by Karen on 081027?
041021 -                ref SDS 17 G15K
041022 -
041023 -                   [On 081106 Doctor Daamen calls from Kaiser Head and
041024 -                   Neck and advances the schedule from 081117 to 081107
041025 -                   and will perform a core biopsy to test Millie for
041026 -                   status change. ref SDS 31 3Z6H
041027 -
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0411 -