THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: February 5, 2009 02:26 PM Thursday;
Rod Welch
Kaiser authorization received Millie's treatment for 6th relapse of IBC
using hyperthermia at UCSF Radiation Oncology Department.
1...Summary/Objective
2...Authorization A023141470 Kaiser Referral to UCSF for Millie's Treatment
3...Kaiser Referral to UCSF Millie's Treatment Radiation and Hyperthermia
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 95 0000, ref SDS 94 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - 1. Case study dilemma balancing sunitinib treatments to optimize
040902 - recovery from 5th relapse IBC, and without increasing
040903 - debilitating side effects that prevent exercise required to
040904 - benefit from recovery. ref SDS 29 I87N
040906 - ..
040907 - 2. On 090108 examination at UCSF showed possible progression of
040908 - IBC in breastbone area, as set out in Millie's letter to the
040909 - medical team on 090109. ref SDS 31 UC4H Millie reported severe
040910 - side effects shown by wide range of blood counts falling.
040911 - ref SDS 31 UF3Q Medical team prescribed another cycle
040912 - sunitinib treatment, with cyclophosphamide paused until blood
040913 - counts increase to a safe level. ref SDS 31 UF3T
040915 - ..
040916 - 3. On 090109 Millie's letter reports rise of IBC with sunitinib
040917 - seen at UCSF on 090108 occurred previously, cited in Millie's
040918 - letter on 081125, ref SDS 23 XX4P; there was rise of IBC and
040919 - then substantial recovery reported again on 081217, ref SDS 24
040920 - YJ4V; on 081230 Millie's letter reported on 081224 and 081225
040921 - rise of IBC, and then improvement on 081226, ref SDS 29 JV5M;
040922 - most recently on 090106 Millie cited again advance of IBC on
040923 - 081224 and 081225, and now disease seems to be subsiding again.
040924 - ref SDS 30 YO4V]
040926 - ..
040927 - 4. On 090115 Millie letter to Catherine and Diane in the Infusion
040928 - Clinic at UCSF reported rising side effects of sunitinib
040929 - protocol, ref SDS 34 5J9Y; she tried hiking a few times, but
040930 - this hurts her feet (peripheral neuropathy) and legs are very
040931 - weak, shown in patient history on daily treatments. ref SDS 33
040932 - KL4J Have been spending more time in the gym doing aerobics,
040933 - which is a little more tolerable. ref SDS 33 3E4K
040935 - ..
040936 - 5. On 090116 Glenna called to ask about response to treatment and
040937 - side effects, ref SDS 35 JY6L, and was advised that IBC in the
040938 - breastbone area was stable to worse, and other sites are stable
040939 - to improved with sunitinib protocol, citing the record of
040940 - patient history the day before on 090115. ref SDS 33 124N
040942 - ..
040943 - 6. On 090116 during call from Glenna advised that Millie wants to
040944 - reduce the dose of sunitinib in order to reduce debilitating
040945 - side effects, and requested remedy to reduce side effects with
040946 - full dose of sunitinib in order to optimize recovery.
040947 - ref SDS 35 JY7J
040949 - ..
040950 - 7. On 090116 Millie received a letter from Glenna transmitting a
040951 - copy of a letter Glenna wrote to the doctor reporting
040952 - understandings from telecon in the morning on 090116,
040953 - ref SDS 37 YN9H; Glenna's letter to the doctor described
040954 - difficulty tolerating side effects of sunitinib, and IBC on
040955 - breastbone area looks worse, ref SDS 37 4P5M, that Millie wants
040956 - to reduce the dose to reduce side effects, but is afraid about
040957 - losing benefits of recovering from IBC. ref SDS 37 HV3M
040959 - ..
040960 - 8. On 090116 Glenna's letter to the doctor asked about changing to
040961 - another treatment. ref SDS 37 HV3O
040963 - ..
040964 - 9. On 090116 Glenna planned to meet with the doctor later in the
040965 - day on 090116 to discuss changing Millie's treatment.
040966 - ref SDS 37 HP4J
040968 - ..
040969 - 10. On 090116 Millie's letter to the medical team clarifies telecon
040970 - on condition following examination at UCSF on 090108, reporting
040971 - IBC in breastbone area looks stable to worse, and everywhere
040972 - else looks improved to stable, indicating recovery has slowed
040973 - ref SDS 38 IS6G, relative to findings on 081218, ref SDS 25
040974 - VD4F, confirmed in Millie's letter later that day reporting
040975 - significant recovery. ref SDS 26 GF8V
040977 - ..
040978 - 11. On 090118 Millie talks about wanting to end treatment with
040979 - sunitinib that seems now less effective and has severe side
040980 - effects after adding cycloposphamide. ref SDS 39 UC41
040982 - ..
040983 - 12. On 090121 Millie letter to primary care physician says very
040984 - pleased to take this occasion on my birthday to say thanks for
040985 - such great care the past 7 years. You noted in our first
040986 - meeting on 020321 that Oncology presents unique challenges.
040987 - ref SDS 2 R94H My case has been complicated by other maladies
040988 - that strain resources of time, money, and emotion. Having you
040989 - at the helm with Arlette's assistance has been a blessing.
040990 - ref SDS 42 F23Y
040992 - ..
040993 - 13. On 090121 Glenna calls and asks again about Millie's response
040994 - to treatment, ref SDS 43 AJ3J, following up her call on 090116,
040995 - ref SDS 35 JY6L, and per background above. ref SDS 43 JY5I
040997 - ..
040998 - 14. On 090121 during call from Glenna reported patient history,
040999 - ref SDS 43 ZO4F, on 090120 shows IBC rash looks improved to
041000 - stable, and nodules in the breastbone area seem worse,
041001 - ref SDS 41 124N, relative to detailed review on 090110,
041002 - ref SDS 32 124N, and after 11 days of treatment with only
041003 - sunitinib, and 25 total treatments with sunitinib, since the
041004 - pause on 081218 and resuming on 081226. ref SDS 40 6C4J
041006 - ..
041007 - 15. On 090121 during call from Glenna reported patient history
041008 - reported IBC worsening in breastbone area has progressed onto
041009 - the right breast and spread toward the left chest reflects
041010 - rising cancer marker, ref SDS 43 N95K, Labs at Kaiser on 090116
041011 - report CA 15-3 303. ref SDS 36 PQTQ This record indicates
041012 - Millie has suffered 6th relapse of IBC.
041014 - ..
041015 - 16. On 090121 Glenna asked for most severe side effects from
041016 - continuing with sunitinib treatment. ref SDS 43 TW53
041018 - ..
041019 - 17. On 090121 Glenna asked for Millie's records on Doctor Rugo's
041020 - plans for follow on treatments? During the call developed
041021 - background on UCSF planning for Millie's future treatment after
041022 - sunitinib. ref SDS 43 Y67L
041024 - ..
041025 - 18. On 090121 Glenna reported during the call that she would send
041026 - another letter to Doctor Rugo explaining Millie's slow response
041027 - to treatment with sunitinib, and supplementing Glenna's letter
041028 - to the doctor on 090116, ref SDS 54 SY5J; Glenna further advised
041029 - during the call on 090121 that she would meet again with Doctor
041030 - Rugo to discuss plans for changing Millie's treatment to
041031 - recover from Millie's 6th IBC relapse. ref SDS 43 N976
041033 - ..
041034 - 19. On 090121 patient history summarized to faciliate Glenna's
041035 - meeting with Doctor to figure out Millie's next treatment.
041036 - ref SDS 43 NU5H
041038 - ..
041039 - a. Laboratory blood tests listed for Millie to facilitate UCSF
041040 - considering Millie's next treatment. ref SDS 43 6Y9K
041042 - ..
041043 - b. Image test history of PET, CT, Xray, MRI listed for Glenna
041044 - to discuss with Doctor Rugo discussing Millie's next
041045 - treatment. ref SDS 43 216F
041047 - ..
041048 - c. Treatment history listed for Glenna to discuss with Doctor
041049 - Rugo discussing Millie's next treatment. ref SDS 43 H16M
041051 - ..
041052 - d. Strategy considerations for selecting Millie's next
041053 - treatment. ref SDS 43 558O
041055 - ..
041056 - 20. On 090122 telephone message from Glenna reported that the
041057 - doctor ended treament with sunitinib protocol; Glenna met with
041058 - Doctor Rugo to develop treatment plan for Millie, and UCSF
041059 - scheduled Millie to start new treatment on 090129. ref SDS 47
041060 - K96F
041062 - ..
041063 - 21. On 090123 primary care physician at Kaiser cited sudden relapse
041064 - of IBC with nodules spreading in the breastbone area, and
041065 - cancer marker elevated to CA 15-3 303 in the labs at Kaiser on
041066 - 090116, ref SDS 36 PQTQ, shows Millie needs immediate change of
041067 - treatment to prevent cancer from cascading out of control, and
041068 - that UCSF should prescribe treatment, ref SDS 52 RK6O, because
041069 - Millie's 6th relapse of IBC shows cancer has mutated to cells
041070 - that are now very resistant to treatments available at Kaiser,
041071 - as discussed previously during the meeting at Kaiser on 080829,
041072 - and cited in Millie's letter to the medical team. ref SDS 20
041073 - RP9R
041075 - ..
041076 - 22. On 090123 Millie's letter to medical team reports progress at
041077 - UCSF scheduling Millie to start on a new treatment. ref SDS 48
041078 - KR4P
041080 - ..
041081 - 23. On 090123 Glenna called and thanked her for expediting Millie's
041082 - new treatment to start on 090129 so that cancer does not
041083 - cascade out of control, ref SDS 49 TR80; request documentation
041084 - on new treatment in order to be prepared starting on 090129
041085 - 0830, as presented in Glenna's telephone message on 090122,
041086 - ref SDS 47 AT6N
041088 - ..
041089 - 24. On 090123 Glenna advised during her call that there was not
041090 - enough time to meet with Doctor Rugo on 090121; she received a
041091 - letter from the doctor to coordinate with Kaiser on getting
041092 - timely referral to start Millie's next treatment at UCSF on
041093 - 090129. ref SDS 49 118M
041095 - ..
041096 - 25. On 090123 Doctor Johnson, Millie's primary care physician at
041097 - Kaiser, called and confirmed prior advice that Doctor Rugo can
041098 - prescribe follow on treatment for Millie because her cancer has
041099 - become resistant to drugs available at Kaiser. ref SDS 52 8K6K
041101 - ..
041102 - 26. On 090127 Millie letter to medical team reporting Doctor
041103 - Johnson called on 090123 to advise of approval for Doctor Rugo
041104 - to prescribe Millie's follow on treatment at UCSF to start
041105 - immediately on 090129. ref SDS 54 TY5W
041107 - ..
041108 - 27. On 090127 Millie's letter to the medical team submitted patient
041109 - history to facilitate prescribing new treatment for Millie's
041110 - 6th relapse of IBC. ref SDS 54 TY6S
041112 - ..
041113 - 28. On 090127 Millie's letter reported side effects of sunitinib
041114 - have begun to subside after stopping treatment on 090122 in
041115 - order to prepare to start new treatment on 090129. ref SDS 54
041116 - TY8T
041118 - ..
041119 - 29. On 090128 Millie letter to primary care physician and the
041120 - medical team reported IBC worsening, and taking Vicodin for
041121 - pain. ref SDS 56 2S8X
041123 - ..
041124 - 30. On 090129 Doctor Rugo sent a letter to primary care physician
041125 - at Kaiser reporting rising pain from worsening IBC, ref SDS 63
041126 - TZ6H; and, requesting referral to UCSF for treatment with
041127 - hyperthermia and Doxil, reported in Millie's letter to medical
041128 - team on 090130. ref SDS 63 AY9Q
041130 - ..
041131 - 31. On 090130 Millie letter to primary care physician, ref SDS 63
041132 - GV4M, reports examination at UCSF on 090129 found rising vitals
041133 - signal Millie suffering rising pain, ref SDS 63 AY7T, because
041134 - IBC progressing rapidly, ref SDS 63 4S8O, as Doctor Johnson
041135 - noted earlier on 090123, ref SDS 52 8K6K;
041137 - ..
041138 - 32. On 090130 Millie letter to primary care physician advises UCSF
041139 - reported communication delay prevented getting referral from
041140 - Kaiser, which then delayed starting hyperthermia treatment on
041141 - 090129 in time to be effective. ref SDS 63 AY8Q
041143 - ..
041144 - 33. On 090130 Millie letter to medical team reports that on 090129
041145 - coordinating timely referral from Kaiser was delayed because
041146 - primary care physician was not in the office. ref SDS 63 AY9T
041148 - ..
041149 - 34. On 090130 Krshna called Millie to schedule hyperthermia
041150 - treatment in the Radiation Oncology Department, and said that
041151 - UCSF has not received referral authorization from Kaiser.
041152 - ref SDS 61 NM5H
041154 - ..
041155 - 35. On 090130 called Arlette, ref SDS 62 RY4G, and she contacted
041156 - Doctor Johnson off-site in a meeting, and he advised that the
041157 - doctor would file authorization in the evening on 090130.
041158 - ref SDS 62 PPYY
041160 - ..
041161 - 36. On 090131 2318 Millie received letter from Doctor Johnson,
041162 - primary care physician, that Kaiser authorization was issued on
041163 - 090130, ref SDS 64 GV4M, for Millie to get treatment for 6th
041164 - relapse of IBC with hyperthermia and Doxil, prescribed by
041165 - Doctor Rugo on 090129 (reported in Millie's letter on 090130.
041166 - ref SDS 63 AY9Q
041168 - ..
041169 - 37. On 090201 Millie letter reports to medical team 6th relapse IBC
041170 - getting worse by the hour requires immediate treatment to
041171 - prevent cancer from getting out of control. Rising pain from
041172 - IBC makes sleeping difficult. ref SDS 65 KN9T
041174 - ..
041175 - 38. On 090201 Millie plans to go to UCSF for treatment tomorrow on
041176 - 090202 when convenient for Doctor Hsu to provide hypethermia
041177 - treatment. ref SDS 65 KN9W
041179 - ..
041180 - 39. On 090201 Millie reports lymphedema recurrence caused by
041181 - sling-immobilizer to treat dislocated shoulder on 090122;
041182 - advises Cellulitis did not recur, as previously. ref SDS 65
041183 - KN4S
041185 - ..
041186 - 40. On 090201 Millie reports good news energy recovering after side
041187 - effects from stopping treatment on sunitinib clinical study
041188 - ordered by Doctor Rugo on 090122. ref SDS 65 KN4Y
041190 - ..
041191 - 41. On 090201 UCSF letter notifies Millie that Doctor Rugo is
041192 - communicating with Doctor Hsu using email to expedite Millie's
041193 - treatment; recommends that Millie not come to UCSF on Monday
041194 - 090202 in order to assist the medical team start hyperthermia
041195 - treatment in time to be effective. ref SDS 66 GV4M
041197 - ..
041198 - 42. On 090201 Millie letter assures medical team that the patient
041199 - would not "camp out" in Doctor Hsu's office, but would stand-by
041200 - in the cafeteria so that treatment can begin when convenient
041201 - for UCSF, and without waiting for patient to travel through
041202 - mid-day traffic, so that urgent treatment is not delayed beyond
041203 - a point when treatment can no longer be effective. ref SDS 67
041204 - GV4M
041206 - ..
041207 - 43. On 090201 Millie asks Doctor Rugo about coordinating to provide
041208 - medical records on file in the doctor's office the past 2 years
041209 - treating Millie at UCSF, ref SDS 67 5R4S, to use by Doctor Hsu,
041210 - requested by Krshna in a call the day before on 090130.
041211 - ref SDS 61 DL4J
041213 - ..
041214 - 44. On 090201 emotional trauma esclates from delays getting
041215 - treatment for aggressive cancer that seems to be cascading out
041216 - of control because of communication delays. ref SDS 67 5R4V
041218 - ..
041219 - 45. On 090202 Michelle at UCSF called in the morning, and said
041220 - Kaiser has not submitted authorization for Millie's treatment
041221 - by Doctor Hsu. ref SDS 69 9Y5I Michelle asked the patient to
041222 - coordinate with the primary care physician at Kaiser to file
041223 - Authorization, ref SDS 69 9Y6Y, reported in Millie's letter to
041224 - the medical team. ref SDS 71 GV4M
041226 - ..
041227 - 46. On 090202 Michelle was advised that Doctor Johnson reported in
041228 - a letter on 090131 that Doctor Rugo at UCSF was notified on
041229 - 090130 that Kaiser issued authorization for Millie's treatment,
041230 - ref SDS 64 GV4M, and further that Doctor Johnson would be out
041231 - of town for several days, so he is not available on 090202 for
041232 - coordinating requested by UCSF on 090202, ref SDS 68 Y35M, to
041233 - file duplicate authorization, reported in Millie's letter to
041234 - the medical team on 090202 1028. ref SDS 71 FR6P
041236 - ..
041237 - 47. On 090202 0940 numerous calls were made to coordinate.
041238 - ref SDS 70 9Y5I Florida in Kaiser Oncology Department, Walnut
041239 - Creek CA advised that Pam in Kaiser Outside Referrals
041240 - Department said the doctor did not enter a "code" in the
041241 - Authorization form for hyperthermia treatment, so Pam is
041242 - waiting to get the code when the doctor returns from traveling
041243 - sometime in the next few days, ref SDS 70 1A5J, reported in
041244 - Millie's letter to the medical team. ref SDS 71 FR7R
041246 - ..
041247 - 48. On 090202 1012 called Kaiser Outside Referrals and left a
041248 - message that we need submission of authorization, so that
041249 - Millie can get treatment in time to be effective. ref SDS 70
041250 - W17K Suggested Outside Referrals send written notice to
041251 - Michelle Williams Jones at UCSF that authorization is on file
041252 - at Kaiser, and will be submitted to UCSF, so that my treatment
041253 - can be initiated concurrently. ref SDS 70 254F, reported in
041254 - Millie's letter to the medical team. ref SDS 71 FR7U
041256 - ..
041257 - 49. On 090202 1047 Pam in Outside Referrals at Kaiser called and
041258 - disclosed that the department needed to know the type of
041259 - treatment Millie would get on referral to UCSF? Advised
041260 - treatment is "hyperthermia," in the Radiation Oncology
041261 - department at UCSF. Pam reported that Kaiser does not have a
041262 - code for "hypethermia" nor for "Radiation Oncology." Pam used
041263 - a code for "Radiology." Problem solved. ref SDS 72 QQ7N, and
041264 - reported in Millie's letter to the medical team on 090202 1139.
041265 - ref SDS 74 M88H
041267 - ..
041268 - 50. On 090202 1117 Pam called back and wanted to know if referral
041269 - to UCSF is for in-patient or out-patient treatment? Since
041270 - radiation is often out-patient care, and initial discussions
041271 - did not indicate Millie would require staying in the hospital,
041272 - Pam coded the form for out-patient care, reported in the record
041273 - on 090202 1047]. ref SDS 72 0256, and reported in Millie's
041274 - letter to the medical team on 090202 1139. ref SDS 74 C94Y
041276 - ..
041277 - 51. On 090202 1118 Doctor Rugo notified the medical team that
041278 - Doctor Hsu cannot see Millie on 090202; advises that Doctor Hsu
041279 - is aware of Millie's situation. ref SDS 73 V47L
041281 - ..
041282 - 52. On 090202 1353 Doctor Hsu's assistant, Krshna reported that the
041283 - doctor was not aware of urgency to treat Millie, cited in
041284 - Doctor Rugo's letter on 090202 1118. ref SDS 73 V47L Krshna
041285 - proposes scheduling the work on 090219, ref SDS 75 XO7G, and
041286 - does not feel comfortable asking Doctor Hsu to advance the date
041287 - for treatment, because his schedule is already booked.
041288 - ref SDS 75 SP8I, reported in Millie's letter to the medical
041289 - team on 090202 1437. ref SDS 76 R23P
041291 - ..
041292 - 53. On 090202 1353 Krshna offers UCSF Radiation Oncology schedule
041293 - hyperthermia treatment 3 weeks delay to 090219. ref SDS 75 XO7G
041295 - ..
041296 - 54. On 090202 1437 Millie notifies medical team that UCSF received
041297 - Kaiser authorizations for treating the 6th relapse of IBC,
041298 - ref SDS 76 JR4J, reported on 090202 1353. ref SDS 75 SP6H
041299 - Millie thanks Doctor Rugo for expediting authorization with
041300 - Doctor Johnson at Kaiser, citing Doctor Rugo's letter to Doctor
041301 - Johnson on 090129, reported on 090130, ref SDS 63 TZ6H, Doctor
041302 - Rugo's letter to medical team on 090202 1118, indicating Doctor
041303 - Hsu is aware of Millie's situation. ref SDS 73 V47L
041305 - ..
041306 - 55. On 090202 1437 IBC disease has advanced significantly since
041307 - examination at UCSF on 090129, and pain on chest is rising.
041308 - Since Doctor Rugo has much more experience with IBC, if this
041309 - just "looks bad," but delaying treatment to 090219 presents no
041310 - risk of losing control, then I am fine with waiting until the
041311 - 19th. ref SDS 76 R23S
041313 - ..
041314 - 56. On 090202 1437 Millie notifies UCSF that Krshna indicated if
041315 - Doctor Rugo feels earlier treatment is needed, she can notify
041316 - Doctor Hsu directly. ref SDS 75 F65G, cited in Millie's letter
041317 - to medical team on 090202 1437, ref SDS 76 R23V
041319 - ..
041320 - 57. On 090202 1437 Millie apologizes for adding to Doctor Rugo's
041321 - work load. Waiting to the 19th is a shock compared to what
041322 - Millie sees on her chest. Results for CA 15-3 from the lab
041323 - last week on 090129 have not been published, but expect it will
041324 - be 200+, since it was 303 at Kaiser on 090116. ref SDS 36 PQTQ
041325 - Those are scary numbers in Millie's patient history. Millie
041326 - avers being a "sissy." Doctor Rugo and others at UCSF and
041327 - Kaiser are working hard to help Millie and many other patients,
041328 - cited in Millie's letter to medical team on 090202 1437.
041329 - ref SDS 76 R23Y
041331 - ..
041332 - 58. On 090202 1550 called VCI and asked about Millie getting
041333 - hyperthermia treatment immediately, rather than wait to 090219
041334 - offered by UCSF. ref SDS 77 YU8H
041336 - ..
041337 - 59. On 090202 1732 Doctor Rugo letter notifies medical team that
041338 - Millie needs urgent treatment quickly to be effective.
041339 - ref SDS 78 Y15J
041341 - ..
041342 - 60. On 090203 0939 call VCI and schedule call to discuss alternate
041343 - source for Millie to get hyperthermia treatment in time to be
041344 - effective recovering from 6th relapse of IBC. ref SDS 79 9Y5I
041346 - ..
041347 - 61. On 090203 1009 letter to VCI submits patient history for review
041348 - to support telephone conference, ref SDS 79 IN94, on arranging
041349 - for VCI to provide hyperthermia treatment in time for Millie to
041350 - recover from 6th relapse of IBC. ref SDS 79 EP3S
041352 - ..
041353 - 62. On 090203 1024 called UCSF talked to Jennette in Radiation
041354 - Oncology; she will discuss with Doctor Hsu advancing Millie
041355 - getting hyperthermia treatment from 090219 to this week.
041356 - ref SDS 80 XX5I
041358 - ..
041359 - 63. On 090203 1206 Doctor Al-Bussam called and reported well
041360 - ordered record for Millie's patient history enabled expedited
041361 - review of complex medical problems. ref SDS 81 8488 VCI
041362 - offered to start work the next day on 090204 giving Millie
041363 - hyperthermia treatment in time to be effective recoverying from
041364 - 6th relapse IBC. ref SDS 81 OE4F
041366 - ..
041367 - 64. On 090203 1417 Millie's letter to medical team reports VCI
041368 - proposal to provide hyperthermia treatment in time to be
041369 - effective starting tomorrow on 090204. ref SDS 82 IS3P
041371 - ..
041372 - 65. On 090203 1417 Millie advises medical team that if UCSF can
041373 - juggle the schedule to start treatment in the next few days,
041374 - Millie prefers working with Doctor Hsu locally, based on
041375 - excellent results working with Doctor Rugo. There is a lot of
041376 - benefit to close practice collaboration at UCSF. ref SDS 82
041377 - IS3Y
041379 - ..
041380 - 66. On 090203 1417 alternatively, Millie requests a medical opinion
041381 - on risks of waiting to Feb 19th against advantages of doing the
041382 - work tomorrow at VCI. ref SDS 82 IS4R
041384 - ..
041385 - 67. On 090203 1417 Millie ask whether treatment at UCSF can be
041386 - advanced from 090219. If not, is the medical condition urgent
041387 - enough to require another provider, and, if so, is VCI a good
041388 - choice under the circumstances? Is there another way to get
041389 - this work done in time to be effective? ref SDS 82 IS5V
041391 - ..
041392 - 68. On 090203 1438 Jennette with UCSF Radiation Oncology Department
041393 - called back and advised that Doctor Hsu advanced Millie's
041394 - hypertermia treatment to begin on 090205 in time to be
041395 - effective recovering from 6th relapse of IBC, ref SDS 83 XX5I,
041396 - rather than risk waiting until 090219, as proposed yesterday on
041397 - 090202 1357. ref SDS 75 XO7G
041399 - ..
041400 - 69. On 090203 1444 Millie's letter notified medical team,
041401 - ref SDS 84 6Q3J, that Jennette in Doctor Hsu's office at UCSF
041402 - called on 090203 1438, ref SDS 83 XX5I, following Millie's
041403 - letter on 090203 1417 notifying medical team that VCI offered
041404 - to perform hypethermia treatment tomorrow on 090204 in time to
041405 - be effective for Millie to recover from 6th relapse IBC,
041406 - ref SDS 82 IS3P, and Jennette said UCSF changed their proposal
041407 - for Millie to start treatment on 090219, and instead Millie is
041408 - scheduled to meet Doctor Hsu in Radiation Oncology at UCSF to
041409 - start hyperthermia treatment on 090205, ref SDS 83 XX5I, shown
041410 - in Millie's letter. ref SDS 84 YQ5W
041412 - ..
041413 - 70. On 090203 1444 Millie sent copy of letter for the medical team
041414 - to VCI, ref SDS 84 YQ6P, thanking Nash and Doctor Al-Bussam for
041415 - timely, professional support investigating my case, ref SDS 81
041416 - JZ4F, and offering a backup solution [reported in record on
041417 - 090203 1206. ref SDS 81 OE4F
041419 - ..
041420 - 71. On 090203 1444 Millie's letter notifies the medical team that
041421 - communication with Doctor Hsu's office at UCSF in Radiation
041422 - Oncology has not been established, ref SDS 84 YQ6S, previously
041423 - noted in Millie's letter to the medical team on 090202,
041424 - ref SDS 74 C95U]. Millie routinely gets blood draws on
041425 - Thursdays at 0800, and so asks if this is needed to support the
041426 - meeting with Doctor Hsu on Thursday 090205, and if not need to
041427 - cancel the meeting with the Infusion Clinic on Thursday. By
041428 - copy alerted Catherine and Diane in Infusion that blood draw
041429 - may not be needed on 090205. ref SDS 84 YQ6S
041431 - ..
041432 - 72. On 090203 1444 Millie commended Doctor Johnson, the primary
041433 - care physician at Kaiser Oncology, and Doctor Rugo, Millie's
041434 - oncologist on referral to UCSF, for support moving forward with
041435 - hyperthermia treatment to recover from 6th relapse of IBC.
041436 - ref SDS 84 YQ6V Noting this might not work; citing research
041437 - [on 090129] indicates there is a good chance. ref SDS 60 OI6N
041438 - and ref SDS 60 SQ6L
041440 - ..
041441 - 73. On 090203 1632 Doctor Johnson, Millie's primary care physician
041442 - at Kaiser advised that Millie does not need blood draw at UCSF
041443 - on Thursday 090205 to support starting hyperthermia treatment
041444 - meeting Doctor Hsu in the UCSF Radiation Oncology Department,
041445 - ref SDS 85 3X6H, responding to Millie's letter to the medical
041446 - team on 090203 1444 asking about labs. ref SDS 84 YQ6S
041448 - ..
041449 - 74. On 090203 2257 Doctor Rugo letter to medical team commends Dr
041450 - Hsu on advancing the schedule by 2 weeks of Millie to getting
041451 - hyperthermia treatment, ref SDS 87 WX8M, responding to Millie's
041452 - letter earlier today on 090203 1444 notifying that Radiation
041453 - Oncology changed the schedule from 090219 to 090205 in order to
041454 - provide urgent treatment quickly enough to be effective, which
041455 - was requested in Doctor Rugo's letter to the medical team on
041456 - 090202 1732. ref SDS 78 Y15J]
041458 - ..
041459 - 75. On 090203 2257 Doctor Rugo notifies medical team that Millie
041460 - cannot get treatment at UCSF without authorization. Millie
041461 - does not have any regular blood draws, and the doctor
041462 - recommends checking for authorization before Millie does
041463 - anything at UCSF. This includes clinic visits. Infusion
041464 - Clinic was notified Millie's meetings should be cancelled.
041465 - ref SDS 87 L35Q This responds to Millie's letter on 090203
041466 - 1444 asking about getting a blood draw before visiting Doctor
041467 - Hsu in Radiation Oncology on 090205. ref SDS 84 YQ6S
041469 - ..
041470 - 76. On 090203 2257 Doctor Rugo is hopeful Millie can move on to
041471 - another trial after the hyperthermia, that will continue a high
041472 - quality of life experienced the past 2 years at UCSF.
041473 - ref SDS 87 L36S
041475 - ..
041476 - 77. On 090203 2247 Doctor Rugo letter to Millie advises against
041477 - getting hyperthermia treatment at VCI, ref SDS 88 DY4K,
041478 - responding to Millie's letter earlier on 090203 1417 asking for
041479 - medical opinion about getting hyperthermia treatment at VCI
041480 - today on 090204, compared to waiting 3 weeks until 090219
041481 - proposed for treatment by UCSF. ref SDS 82 IS4R
041483 - ..
041484 - 78. On 090204 0117 Millie's letter thanks Doctor Rugo for help
041485 - advancing the schedule in Radiation Oncology for hyperthermia
041486 - treatment 3 weeks, ref SDS 89 DY4K, with a letter to the
041487 - medical team on 090202 1932 advising that Millie needs urgent
041488 - treatment quickly enough to be effective. ref SDS 78 Y15J, and
041489 - the doctor's letter on 090129 expedited referral from Kaiser
041490 - authorizing hyperthermia treatment, reported in Millie's letter
041491 - to the medical team on 090130. ref SDS 63 TZ6H
041493 - ..
041494 - 79. On 090204 0117 Millie notes in a letter to UCSF that VCI said
041495 - they had treated patients on referral from UCSF, reported on
041496 - 090202. ref SDS 77 P67F Did UCSF have a bad experience sending
041497 - a patient to VCI? Patients can make mistakes when rushed to
041498 - find a solution, a la "clutching at straws," ref SDS 89 EL4U,
041499 - which seemed to occur on 090202 when UCSF had earlier advised
041500 - on 090122 that Millie should stop treatment to be prepared for
041501 - starting new treatment on 090129, ref SDS 47 J47F, and on
041502 - 090129 UCSF advised there was a communication mixup that
041503 - prevented getting treatment, reported on 090130, ref SDS 63
041504 - AY8Q, and then writes a letter on 090202 saying Millie needs
041505 - urgent treatment quickly in time to be effective, ref SDS 78
041506 - Y15J, and UCSF schedules the work 3 weeks later on 090219.
041507 - ref SDS 75 XO7G
041509 - ..
041510 - 80. On 090204 0219 Millie thanks Doctor Rugo for guidance on case
041511 - management, ref SDS 90 135F, and notes innovation will be
041512 - needed for continuing care after hyperthermia treatment at
041513 - UCSF. ref SDS 90 277X Millie requests Doctor Rugo at UCSF
041514 - continue teamwork from past 2 years with Doctor Johnson at
041515 - Kaiser, and maintain internal practice synergy with Doctor Hsu
041516 - at UCSF to collaborate on designing effective treatment.
041517 - ref SDS 90 278Q
041519 - ..
041520 - 81. On 090204 0219 Millie asks Doctor Rugo to submit an opinion on
041521 - likely scenarios and possible treatment options so that
041522 - proactive management will avoid scrambling at the last minute
041523 - to get things done for the next treatment, ref SDS 90 278T,
041524 - that were required for the current hyperthermia treatment
041525 - scheduled to begin tomorrow on 090205, and shown by case study
041526 - in this record listing chronology of delays, per above.
041527 - ref SDS 94 MN5I
041529 - ..
041530 - 82. On 090204 1528 Millie letter to medical team reports calling
041531 - Arlette returning her message on Millie's cell phone yesterday
041532 - on 090203 with instructions on pain medication, ref SDS 92
041533 - 135F, and responding to Millie's letter reporting rising pain
041534 - on 090203 1417, ref SDS 82 IS6U; following up request the
041535 - before for pain relief, on 090202 1437. ref SDS 76 R23S, and
041536 - further cited 2 days ago on 090201 1852, ref SDS 65 KN9T.
041537 - Millie reported a bad flare up of pain the previous night on
041538 - 090203 2217, and got through it by taking more Vicodin.
041539 - ref SDS 86 KE5I
041541 - ..
041542 - 83. On 090204 1528 Millie cited the record on 090203 2217 showing
041543 - only 30% of prescribed pain medicine was being taken in order
041544 - to avoid over-medicating, ref SDS 86 L74H, ignoring
041545 - instructions during examination at UCSF a week earlier on
041546 - 090129 to take more medication reported to medical team on
041547 - 090130 1722, ref SDS 63 AY7T], but with everything going on
041548 - lately, 53 case management tasks since 090129, per above,
041549 - ref SDS 95 LQ3O, the patient got mixed up and forgot.
041550 - ref SDS 92 D64P
041552 - ..
041553 - 84. On 090204 1528 following Arlette's instructions pain relieved
041554 - Millie taking a double dose of Vicodin, and if that doesn't
041555 - work then low-dose morphine will be prescribed. ref SDS 92 D64T
041557 - ..
041558 - 85. On 090204 1914 Doctor Rugo advised that UCSF has to wait for
041559 - results of hyperthermia to arrange for comprehensive cancer
041560 - care from teamwork practice synergy collaborating with Doctor
041561 - Hsu applying Doctor Rugo's experience treating Millie weekly
041562 - for 2 years, as requested in Millie's letter to UCSF on 090204
041563 - 0219, ref SDS 90 278Q, and further Millie's request for Doctor
041564 - Rugo to plan strategy for treatment after hyperthermia, also in
041565 - Millie's letter to UCSF on 090204 0217, ref SDS 90 278Q. Since
041566 - Millie's case is very complex, proactive planning to be
041567 - prepared for alternate scenarios, which was successful applying
041568 - 2nd opinions from Doctor Benz in 2005 and 2007, won't work in
041569 - 2009, because UCSF proposes scheduling is not a simple
041570 - prescription like when you first saw Doctor a consultation
041571 - after hyperthermia to talk about the options. ref SDS 94 278T
041573 - ..
041574 - 86. On 090204 1914 the cost to collaborate with Doctor Hsu for
041575 - practice synergy and proactive planning for treating cancer as
041576 - a chronic disease requires talking with the clinic manager or
041577 - patient services to determine the scope of services covered by
041578 - the Kaiser referral for hyperthermia treatment. ref SDS 94 T43Y
041580 - ..
041581 - 87. On 090204 1930 Millie thanks the medical team for explaining
041582 - strategy to defer planning treatment of cancer as a chronic
041583 - disease for Millie's 7th relapse in 8 years, until after
041584 - results of hyperthermia, because Millie's case is too complex
041585 - for proactive management to plan for alternate scenarios.
041586 - ref SDS 95 278T
041588 - ..
041589 - 88. On 090204 1930 Millie notifies medical team of risks failing to
041590 - apply collaboration synergy of a winning team demonstrated over
041591 - the past 26 months. ref SDS 95 W84Q Continuity of care from
041592 - doctors experienced with the case provides the best security
041593 - for effectiveness, as requested in Millie's letter to UCSF and
041594 - Kaiser on 090204 0219 for Doctor Rugo to collaborate on
041595 - continuing care based on 2 years of weekly treatments.
041596 - ref SDS 90 278Q
041598 - ..
041599 - 89. On 090204 1930 Millie's letter to medical team asks if Doxil
041600 - will be given in the Infusion Clinic, since this is a
041601 - chemotherapy drip treatment, ref SDS 95 W84T, which Doctor Rugo
041602 - prescribed in the recommendation for Millie's treatment
041603 - submitted to Kaiser on 090129, reported on 090130, ref SDS 63
041604 - HK3V, and UCSF stated in a letter on 090203 2257 that Millie
041605 - would no longer be treated in the Infusion Clinic. ref SDS 87
041606 - L35Q and ref SDS 87 L35Y
041608 - ..
041609 - 90. On 090204 1930 Millie reports side effects of sunitinib and
041610 - cyclophosphamide seem mostly gone. Still have pain from IBC
041611 - and mostly my shoulder (actually the arm). ref SDS 95 W84W
041612 - Doctor Johnson has prescribed treatment that is working tody,
041613 - reported in the record earlier on 090204 1528. ref SDS 92 D64T
041615 - ..
041616 - 91. On 090205 1318 primary care physician at Kaiser, Doctor
041617 - Johnson, asks Millie to start using Kaiser's "closed" email
041618 - system that is part of Kaiser's "Health[Connect" Knowledge
041619 - Management system rather than public domain email, because
041620 - checking multiple email systems complicates and so delays
041621 - communication. Since the doctor checks Health Connect
041622 - regularly, correspondence sent through public domain email
041623 - increases risks that Millie will "fall through the cracks," at
041624 - a time when Millie is reporting rising symptoms of pain.
041625 - ref SDS 97 278T
041627 - ..
041628 - 92. On 090205 1318 review shows most of Millie's care is now
041629 - performed at UCSF which requires coordination with Kaiser.
041630 - Since Kaiser's Health Connect system has limitations that
041631 - prevent communication with UCSF, using the public domain email
041632 - for efficient, uniform distribution of correspondence among
041633 - Millie's large medical team increases chances to prevent urgent
041634 - care from falling through the cracks. ref SDS 97 YU4L
041636 - ..
041637 - 93. On 090205 0830 Millie visits Doctor Hsu and Doctor Chang to
041638 - start treatment for 6th relapse of IBC. ref SDS 96 O47G
041639 -
041640 - a. Doctor Hsu submitted an email address for collaborating
041641 - with the medical team on Millie's progress. ref SDS 96 P35K
041643 - ..
041644 - b. Pulmonary embolism patient history reviewed in relation to
041645 - impact from radiation and hyperthermia. ref SDS 96 P33M
041647 - ..
041648 - c. Radiation treatment patient history reviewed to assess
041649 - amount of additional radiation can be tolerated.
041650 - ref SDS 96 PN8H
041652 - ..
041653 - d. IBC patient history discovering and diagnosing IBC.
041654 - ref SDS 96 O534
041656 - ..
041657 - e. Lymphadenopathy left and right axillary, and in the left
041658 - supraclavicular, including recent biopsy on 081022 was
041659 - discussed. ref SDS 96 7H64
041661 - ..
041662 - f. CT test layout IBC fields for radiation plan scheduled on
041663 - 090209, and planning treatment 4 days a week. ref SDS 96
041664 - LT6K
041666 - ..
041667 - g. IBC severity discovered during the meeting changed
041668 - treatment plan from 2 to 4 weeks. ref SDS 96 R29M
041670 - ..
041671 - h. Radiation substituted for Doxil with hyperthermia changed
041672 - during the meeting. ref SDS 96 EY5F
041674 - ..
041675 - i. Lymph Node left supraclavicular swelled again palpated
041676 - during the meeting. ref SDS 96 OH88
041678 - ..
041679 - j. Side effects from radiation will cause scaling similar to a
041680 - sunburn for several weeks after treatment. ref SDS 96 GM4N
041682 - ..
041683 - k. Prognosis favorable for radiation and hyperthermia to
041684 - reduce IBC in Mille's case. ref SDS 96 1R5M
041686 - ..
041687 - l. Work plan to visit the doctor for a CT test to layout
041688 - treatment fields. ref SDS 96 0399
041690 - ..
041691 - 94. On 090209 0018 Millie letter to medical team submits record
041692 - meeting at UCSF on 090205. ref SDS A0 278T
041693 -
041694 - a. Pulmonary embolism case management performed by Kaiser
041695 - Coagulation Control unit; notify Gloria INR 2.5 for labs at
041696 - UCSF on 090129. ref SDS A0 736Y
041698 - ..
041699 - b. On 090203 Kaiser advised blood draw will not be performed
041700 - for meeting at UCSF on 090205, ref SDS 85 3X6H; Doctor Rugo
041701 - notified that UCSF Infusion Clinic cannot flush the Power
041702 - Port required every 4 - 6 weeks when not getting treatment;
041703 - Kaiser canceled Neupogen treatments because blood counts
041704 - have recovered after ending sunitinib study on 090122.
041705 - ref SDS 47 AT6N Kaiser needs to order blood draw for INR
041706 - case management within a few weeks. ref SDS A0 743R
041708 - ..
041709 - c. Summary submitted to medical team for meeting at UCSF on
041710 - 090205, ref SDS 96 0001; request feedback on accuracy.
041711 - ref SDS A0 743X
041713 - ..
041714 - 95. 090209 1347 Millie meeting with Doctor Hsu and Chris Diedrich
041715 - for CT test and xrays to layout radiation fields for treating
041716 - IBC. ref SDS A1 0G5I
041717 -
041718 - a. Treatment scheduled to begin on 090219 1315, ref SDS A1
041719 - RF7L, which conflicts with Doctor Rugo's letter on 090202
041720 - 1932 saying urgent treatment is needed quickly. ref SDS 78
041721 - Y15J
041723 - ..
041724 - b. Treatment delayed for UCSF to create molds that guide
041725 - radiation treatments. ref SDS A1 TW7O
041726 -
041727 -
041728 -
041729 -
0418 -
SUBJECTS
Kaiser Authorization Millie's Treatment 6th Rlapse IBC Radiation Hy
1603 -
1604 - Progress
160501 - ..
160502 - Authorization A023141470 Kaiser Referral to UCSF for Millie's Treatment
160503 - Kaiser Referral to UCSF Millie's Treatment Radiation and Hyperthermia
160504 -
160505 - Follow up ref SDS 95 278T, ref SDS 94 278T.
160506 -
160507 - Millie received ref DRT 1 0001 today a letter from Pam dated 090202
160508 - submitting Kaiser's authorization for treatment to recover from 6th
160509 - relapse of IBC, implementing Doctor Rugo's work plan on 090129,
160510 - reported on 090130. ref SDS 63 4S8O
160511 -
160512 - 1. Kaiser Permanente has approved your request for medical care
160513 - from the above provider [UCSF]. An Authorization for Medical
160514 - Care form describing the specific treatment/services you
160515 - require has been completed and sent to this provider. If you
160516 - do not already have an appointment, please contact the provider
160517 - to schedule one. ref DRT 1 0001
160519 - ..
160520 - Kaiser's letter responds to Doctor Rugo's letter dated 090129 to the
160521 - primary care physician at Kaiser recommending hyperthermia for Millie
160522 - to recover from 6th relapse of IBC, reported on 090130. ref SDS 63
160523 - TZ6H
160525 - ..
160526 - Pam's letter today implements telecon on 090202 1047. ref SDS 72 9Y5I
160527 - At that time on 090202, Pam took immediate action to expedite Millie's
160528 - care. ref SDS 72 XF9F Later on 090202 1412 UCSF commended Pam's
160529 - initiative to provide care for Millie in time to be effective.
160530 - ref SDS 75 SP6H
160532 - ..
160533 - Kaiser's letter dated 090202 continues...
160534 -
160535 - 2. The Authorization expires on the date noted above [090602], but
160536 - may be terminated sooner by Kaiser Permanente. Both you and
160537 - the provider will be notified in advance if the Authorization
160538 - is terminated. If you require services from the provider
160539 - beyond the expiration date, the provide must obtain a new
160540 - Authorization. ref DRT 1 FU67
160541 -
160542 - [On 090401 1214 Pam advised that expiration of Kaiser
160543 - Referral contracts is automatically extended to 1 year in
160544 - order for UCSF to provide treatment of Millie's cancer
160545 - ordered in Doctor Rugo's letter to Kaiser on 090129,
160546 - reported on 090130, ref SDS 63 TZ6H, and required to meet
160547 - Kaiser's obligation for standard of care. ref SDS B0 KT9G
160549 - ..
160550 - 3. Kaiser Permanente will pay for all authorized medical care
160551 - rendered prior to expiration or termination of the
160552 - Authorization, in accord with the terms of the Authorization.
160553 - If your Kaiser Permanente benefits require you to pay
160554 - co-payments deductables and non-convered services, you will be
160555 - billed or notified by Kaiser Permanente. ref DRT 1 FU73
160557 - ..
160558 - 4. If you receive any bills from this provider, please do not pay
160559 - them. Under the terms of the Authorization and California law,
160560 - the provider must bill only Kaiser Permanente. Send any bills
160561 - you do receive to the Kaiser Permanente address above, marked
160562 - "Attention: Referrals Staff". We will notify the provider not
160563 - to bill you any further. If it is later determined that you
160564 - were not elegible for Kaiser Permanente benefits, you will be
160565 - required to pay all charges for services performed under this
160566 - Authorization. ref DRT 1 FU7N
160568 - ..
160569 - 5. For any questions concerning this Authorization, please contact
160570 - The Referral Staff. It is a pleasure to provide you medical
160571 - care. ref DRT 1 009O
160572 -
160573 -
160574 -
160575 -
160576 -
160577 -
160578 -
160579 -
160580 -
160581 -
160582 -
160583 -
160584 -
1606 -