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SUBJECTS
CT Test Neck Chest Abdomen Pelvis Diagnostics Evaluate Progression C

0703 -
0703 -    ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 19 0000. ref SDS 16 0000.
070502 -
070503 -
070504 -
070505 -
070506 -
070507 -
070508 -
070509 -
070511 -  ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Anne in the Infusion Clinic accessed the Power Port at 1000 for the CT
070902 - test at 1020, reported in another record today on 081230. ref SDS 41
070903 - UQ6L
070905 -  ..
070906 - Millie finished the second bottle of Barium Sulfate suspension that
070907 - provides contrast medium for the CT test, and ordered by the doctor
070908 - during the call on 081210. ref SDS 35 VZ9K
070910 -  ..
070911 - Walking from Infusion Clinic to the CT Department, stopped and visited
070912 - with Brenda in Interventional Services.
070914 -  ..
070915 - Brenda recalled meeting yesterday with Cassandra to coordinate
070916 - Millie's CT test today. ref SDS 40 5F3J
070918 -  ..
070919 - Brenda advised that an emergency just occurred in Interventional
070920 - Services that requires an "all-hands" effort.  Brenda will send a
070921 - nurse to the CT Department for Millie's test, as planned with
070922 - Cassandra yesterday. as soon as someone has time.
070924 -  ..
070925 - Millie walked to the CT Department, and checked in at the
070926 - Administration counter.  She paid $50 for the test today.  Millie
070927 - filled out the patient profile documentation and then waited to be
070928 - called for the test.
070930 -  ..
070931 - Earlier today, Millie drank the two bottles of Barium Sulfate contrast
070932 - medium, which the primary care physician ordered on 081210,
070933 - ref SDS 35 VZ9K, and was received from the Kaiser Pharmacy a week or
070934 - so ago.
070936 -  ..
070937 - There was a nurse in the lobby talking to a patient.  Upon request,
070938 - the nurse went into the CT Department testing area and asked Cassandra
070939 - to visit with the patient assistant.
070941 -  ..
070942 - About 5 minutes later, Cassandra came into the waiting room.
070944 -  ..
070945 - Cassandra reported good news.  She was successful implementing plans
070946 - yesterday on 081229 to contact Al Hutchins, the manager of Radiology,
070947 - and he ordered support today from Interventional Services for Millie's
070948 - CT test. ref SDS 40 5F8I  Cassandra confirmed Brenda's report that an
070949 - emergency has delayed Interventional Services sending a nurse for
070950 - Millie's CT test at the scheduled time of 1020. ref SDS 0 DT4H
070952 -  ..
070953 - Cassandra explained that Millie's test will be performed in the
070954 - outside trailer due to a hectic schedule today performing biopsy
070955 - procedures in the CT Department, as discussed yesterday. ref SDS 40
070956 - MR3M  When the nurse from IS arrives, Cassandra will assign someone to
070957 - walk Millie and the IS nurse to the outside trailer for the CT test.
070959 -  ..
070960 - Cassandra advised that there is a lot of patient information in the CT
070961 - trailer.  She feels that HIPAA prevents Kaiser from using the patient
070962 - assistant to support the CT test in the trailer, because this might
070963 - disclose medical information to the assistant.  She suggested the
070964 - patient assistance stand by in a waiting lobby outside the trailer,
070965 - while the CT technician and the IS nurse perform the test.
070967 -  ..
070968 - Cassandra recalled problems during Millie's CT test on 081107.  At
070969 - that time, Kaiser could not use patient assistance to expedite the
070970 - work, ref SDS 19 AN6H, because people believed there wasn't enough
070971 - time. ref SDS 19 2D50 and ref SDS 19 NY4O  Lack of patient assistance
070972 - doubled the time and cost required to perform the test. ref SDS 19
070973 - GR9K
070975 -  ..
070976 - Cassnadra feels health care providers have to strike a balance between
070977 - privacy and effective care for the patient.
070979 -  ..
070980 - Cassandra recalled Kaiser's protocol presented for the previous test
070981 - on 081107 for infirm patients to have assistance.  At that time,
070982 - Cassandra observed that Millie did not look nor sound infirm,
070983 - ref SDS 19 AN6H; Cassandra knew that Pat would be assisting with the
070984 - test on 081107, ref SDS 19 EO9K, and had worked on Millie's prior test
070985 - on 080718.  Cassandra believed Pat was not infirm.  Cassandra further
070986 - knew that Dennis set up the test on 081107, and had not presented
070987 - special instructions, and she believed Dennis was not infirm.  Absent
070988 - evidence of infirmities, Cassnadra reasonalby denied patient
070989 - assistance as unnecessary overkill - a waste of time that threatened
070990 - patient confidentiality/privacy.  After the test on 081107, Cassandra
070991 - knew that she, Pat, Dennis, and Millie all suffered significant
070992 - infirmaties unable to remember patient history critical to the mission
070993 - of CT testing, ref SDS 19 2D60, exemplified by Pat's comments that the
070994 - CT Department will do better next time. ref SDS 19 2F98
070996 -  ..
070997 - Today is the "next time."
070999 -  ..
071000 - Cassandra feels lessons learned from experience on Millie's last CT
071001 - test can be applied to strike a better balance between privacy and
071002 - patient care.
071004 -  ..
071005 - Cassandra recognized that mission critical assistance for 20 minutes
071006 - doing the test today does not leave time for the assistant to rifle
071007 - through confidential papers of other patients that might be lying
071008 - around in the test room.  Since at all times there are several Kaiser
071009 - staff doing the CT test, this provides continual realtime monitoring
071010 - to protect privacy of documents for other patients.  Kaiser can cover
071011 - or put away documents for other patients to prevent inadverant
071012 - observation.  Kaiser can assign security guards to protect documents
071013 - for other patients during the 20 minutes while the patient assistant
071014 - supports the CT test.  There are many cost effective remedies for
071015 - protecting privacy of other patients without placing the primary
071016 - patient at risk from infirmities suffered by patients and health care
071017 - providers.
071019 -  ..
071020 - Cassandra feels patient health deserves top priorty.
071022 -  ..
071023 - Cassandra went through the door from the patient lobby to the test
071024 - area.  She returned after about 2 minutes, and said there is a delay
071025 - in Interventional Services (IS) due to an emergency.  An IS nurse will
071026 - be sent to the CT Department for Millie's test when the emergency is
071027 - resolved.  This aligns with Brenda's report earlier, per above.
071028 - ref SDS 0 FD4L
071030 -  ..
071031 - Millie asked Cassandra to take as long as needed to make effective
071032 - arrangements for the CT test so that everything works correctly.
071034 -  ..
071035 - About 20 minutes later, Cassandra came into the lobby and said that IS
071036 - still cannot send anyone for Millie's CT test.  Therefore, the test
071037 - will be performed here in the CT Department, rather than in the
071038 - outside, auxillary trailer, as initially planned, per above.
071039 - ref SDS 0 DU3O
071041 -  ..
071042 - Cassandra explained that Helen is an Interventional Services (IS)
071043 - nurse already onsite assigned to perform biopsies, as discussed
071044 - yesterday on 081229 during planning meeting with Brenda. ref SDS 40
071045 - MR3M  Since IS support for Millie's test only takes a few seconds to
071046 - connect CT pressure injection equipment to the Huber needle, already
071047 - accessed to the Power Port earlier today by the Infusion Clinic,
071048 - ref SDS 41 58A5, then Helen can make the connection without delaying
071049 - biopsies for other patients.
071051 -  ..
071052 - Turned out that Helen is the nurse who was talking to a patient in the
071053 - CT Department lobby when Millie arrived from the Infusion Clinic.
071054 - ref SDS 0 AN6H
071056 -  ..
071057 - Evette came into the lobby and asked for Millie.
071059 -  ..
071060 - Millie was in the restroom dealing with side effects that suddenly
071061 - occurred from sunitinib treatment, listed in the record on 081017,
071062 - ref SDS 8 C78M, and in combination with Barium Sulfate suspension
071063 - contrast medium, which Millie completed over half-an-hour earlier, per
071064 - above. ref SDS 0 FD9N
071066 -  ..
071067 - Millie recalled that Barium Sulfate suspension caused restroom
071068 - problems for the test on 080911. ref SDS 7 S59G  This did not occur
071069 - for the test on 081107, because Millie did not start taking sunitinib
071070 - until 081114, and at that time there were side effects similar to
071071 - today. ref SDS 32 LF8M  Millie feels the combination of sunitinib and
071072 - barium sulfate suspension for the CT test has a compounding impact of
071073 - adverse side effects.  Millie wants to experiement reducing side
071074 - effects by using the previous oral contrast medium Gastrografin used
071075 - for the test on 080718,
071076 -
071077 -        [On 090409 2347 letter to Doctor Davidson, Chief Radiology
071078 -        Imaging Services Diablo Service Area asks for alternate
071079 -        contrast medium using Gastrogafin, or equivalent, rather than
071080 -        Barium Sulfate Suspension that causes medical problems.
071081 -        ref SDS 46 OW5Q
071083 -         ..
071084 -        [On 090413 1500 Kaiser did not provide a solution; Millie
071085 -        suffered recurrent multiple health problems using Barium
071086 -        Sulfate Suspension contrast medium. ref SDS 47 QO9M
071088 -  ..
071089 - About 15 minutes later, Evette came back into the lobby to get Millie
071090 - for the CT test.  By this time, Millie was back in the restroom
071091 - suffering another attack of side effects.  This was physically and
071092 - emotionally problematic.
071094 -  ..
071095 - Evette asked that Millie go directly into the CT test area after she
071096 - gets cleaned up.
071098 -  ..
071099 - About 10 minutes later, Millie came out of the restroom, and then went
071100 - directly into the CT test area.  By this time, Cassandra had gone to
071101 - lunch.  Millie explained to Pat that she might have more bathroom
071102 - problems.  Pat assured that the CT team will take care of everything.
071103 -
071104 -            [On 081231 Millie notified medical team of successful CT
071105 -            test at Kaiser in Walnut Creek using the Power Port for
071106 -            injecting contrast medium. ref SDS 42 LL5H
071108 -             ..
071109 -            [On 090107 Kaiser issued multiple reports again for
071110 -            Millie's CT test on 081230. ref SDS 44 J85F
071112 -  ..
071113 - Helen connected the pressure injection equipment to the Huber needle.
071114 - This took about 10 seconds.  Pat observed that Helen's work today
071115 - seems identical to connecting CT pressure injection equipment for
071116 - contrast medium to an IV, which CT technologists accomplish routinely
071117 - many times a day, 7 days a week for other patients.  This aligns with
071118 - Ike's understanding during the meeting at Kaiser on 080711.
071119 - ref SDS 2 JQ92
071121 -  ..
071122 - Pat pressed the button in the Control Room that executed the first
071123 - test pass for the area below the neck.
071125 -  ..
071126 - Pat then assisted Millie lowering her arms, and a second pass was done
071127 - for the neck, as was done for the test on 081107. ref SDS 19 FW6L
071129 -  ..
071130 - After the second CT scan pass for the neck, Pat disconnected the power
071131 - injection equipment from the Huber needle, doing the steps in reverse
071132 - from observing Helen make the connection to start the test process,
071133 - per above. ref SDS 0 FF74  Pat found this was safe and effective,
071134 - because the procedure is identical to disconnecting pressure injection
071135 - equipment from IV needles, which is routinely performed many times a
071136 - day, 7 days a week for other patients in the CT Department.
071138 -  ..
071139 - Jennifer Hernandez, RT, added comments to the work order for a
071140 - consolidated report on both passes of the CT scanning equipment today.
071142 -  ..
071143 - On 081113 case study patient history shows Millie has had 11 previousl
071144 - CT and PET scan tests covering the same scope for the neck, chest,
071145 - abdomen, and pelvis, and all results were consolidated into a single
071146 - report. ref SDS 30 HV4H
071147 -
071148 -            [On 090106 Chris in Radiology Department reported that the
071149 -            referral by the primary care physician ordered consolidated
071150 -            report for Millie's CT test on 081230. ref SDS 43 OO82
071152 -             ..
071153 -            [On 090107 Kaiser issued multiple reports again for
071154 -            Millie's CT test on 081230. ref SDS 44 J85F
071155 -
071157 -  ..
071158 - Kaiser issued separate reports on the neck and below the neck for the
071159 - test on 081107.  The report for the CT scans below the neck was
071160 - submitted to Millie on 081112. ref SDS 27 YO79  This report seemed to
071161 - have errors finding lymphadenopathy in the right supraclavicular,
071162 - which conflicted with patient history. ref SDS 27 5O6N  Millie's
071163 - letter to Kaiser on 081112 requested correction to the report for the
071164 - CT test on 081107. ref SDS 26 WJ4Q  Kaiser requested feedback from
071165 - Doctor Rugo at UCSF. ref SDS 29 ML8N  The next day on 081113, Doctor
071166 - Rugo at UCSF reviewed the same report received separately from Kaiser,
071167 - and requested corrections. ref SDS 28 DP8J  A second report on only
071168 - the neck for the CT test on 081107 was received later on 081113.
071169 - ref SDS 30 YO7M  Findings in the second report clarified issues
071170 - presented by the first report. ref SDS 30 OO6M  For some reason,
071171 - Kaiser never submitted the second report to UCSF.  This caused
071172 - confusion providing patient care.
071173 -
071174 -            [On 090107 Kaiser issued multiple reports again for
071175 -            Millie's CT test on 081230. ref SDS 44 J85F
071177 -  ..
071178 - Millie's letter to Kaiser on 081113 conveyed Doctor Rugo's request for
071179 - corrections to resolve confusion created by the report for the CT test
071180 - on 081107. ref SDS 31 D13H  Since Kaiser did not have time to make
071181 - corrections, confusion occurred again at UCSF on 081218. ref SDS 37
071182 - LM4I  Later on 081218, Millie's letter to Kaiser requested a
071183 - consolidated report to avoid confusion for the CT test today.
071184 - ref SDS 38 UY3T  The next day on 081219, the primary care physician at
071185 - Kaiser checked the computer and clarified the order for the CT test,
071186 - ref SDS 39 WP30, to include consolidating findings into a single
071187 - report. ref SDS 39 587G
071189 -  ..
071190 - Jennifer seemed to explain today that CT test equipment and/or
071191 - software automatically assigns account numbers for each pass of CT
071192 - scans.  Therfore an account number is assigned for the neck scans that
071193 - is separate from the account for the main part of the test scans below
071194 - the neck for the chest, abdomen, and pelvis.  As a result, sometimes
071195 - the analyst prepares multiple reports that correlate with each account
071196 - number assigned by the CT test equipment.
071198 -  ..
071199 - Millie has been getting CT scans at Kaiser for seven (7) years.  Case
071200 - study of patient history on 081113 shows that in all that time 11 CT
071201 - tests have evaluated the neck, and below the neck, including chest,
071202 - abdomen, pelvis. ref SDS 30 HV4H  There is no patient history of ever
071203 - having received multiple reports for a single test, until the report
071204 - for the test last month on 081107. ref SDS 30 RU6R
071206 -  ..
071207 - Since multiple reports caused confusion understanding the test on
071208 - 081107, per above, ref SDS 0 F59N, Jennifer will ask the analyst to
071209 - consolidate findings into a single report for the test today, and
071210 - simply associate the 2 account tracking numbers assigned automatically
071211 - to the narrative for the neck, and below the neck.
071213 -  ..
071214 - Jennifer further added comments to the work order for the CT test
071215 - requesting comparison with the previous test on 081107, and, also, to
071216 - correct the report for the test on 081107 by comparing with the most
071217 - recent previous test on 080911, rather than comnpare with the test on
071218 - 080718, as reported on 081112. ref SDS 27 RV49  This correction will
071219 - resolve the request by Doctor Rugo at UCSF on 081113 to correct the
071220 - report for the test on 081107 by comparing with the test on 080911.
071221 - ref SDS 31 8Q8V
071222 -
071223 -        [On 090107 1058 CT test report for the test today on 081230
071224 -        failed to implement Jennifer's request for correct comparison.
071225 -        ref SDS 44 8P6O
071227 -         ..
071228 -        [On 090409 2018 Doctor Davidson letter advises Kaiser made
071229 -        a mistake publishing multiple reports for each CT test that
071230 -        causes confusion and error presenting patient medical
071231 -        condition, ref SDS 45 L14I; advises future tests will
071232 -        consolidate findings into single report for each test that
071233 -        maintains a well ordered record for efficient case
071234 -        management essential to save lives, time, and money.
071235 -        ref SDS 45 XZ6U
071237 -  ..
071238 - Millie thanked everyone for excellent work today, completing the CT
071239 - test in about 20 minutes.
071241 -  ..
071242 - Millie left the CT Department and walked to the Infusion Clinic for
071243 - removing the Huber needle, ref SDS 41 W8DG, according to the work plan
071244 - discussed with Cassandra yesterday on 081229. ref SDS 40 5F9K
071245 -
071246 -
071247 -
071248 -
071249 -
071250 -
071251 -
071252 -
071253 -
0713 -