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: March 17, 2009 11:20 AM Tuesday; Rod Welch

Called Kaiser for CA 15-3 omitted from Millie's labs on March 10th.

1...Summary/Objective


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 9 0000, ref SDS 6 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 -    1.  On 090213 1140 Millie met with primary care physician at
040902 -        Kaiser; the doctor ordered labs for Millie on 090309 to support
040903 -        meetings at UCSF on 090312 evaluating progress responding to
040904 -        treatments for cancer started on 090219. ref SDS 2 IW68
040906 -         ..
040907 -    2.  On 090309 1500 Millie went to Kaiser and blood was drawn for
040908 -        the lab. ref SDS 3 6Z4F
040910 -         ..
040911 -    3.  On 090310 0351 Millie's letter to the medical team requested a
040912 -        copy of the report for blood test on 090309 to support the
040913 -        meeting at UCSF on 090312 for evaluating response to treatment.
040914 -        ref SDS 4 O63Q
040916 -         ..
040917 -    4.  On 090311 1517 Millie went to Kaiser and received a copy of the
040918 -        report for the blood test on 090309.  The report received from
040919 -        Kaiser on 090311 did not include CA 15-3. ref SDS 5 1U7J
040921 -         ..
040922 -    5.  On 090312 0915 Millie met with the medical team at UCSF who
040923 -        disclosed that Kaiser did not submit the report for lab on
040924 -        090309, ref SDS 6 XE3K; Millie provided a backup copy received
040925 -        from Kaiser, ref SDS 6 337K, for the blood test on 090309.
040926 -        ref SDS 3 S65I  Tara entered this in the UCSF medical chart.
040927 -        She advised evalating response to treatment is difficult
040928 -        without CA 15-3, ref SDS 6 YX5F, because IBC symptoms are
040929 -        similar to side effects of radiation and hyperthermia
040930 -        treatments. ref SDS 6 YX40  Doctor Hsu also cited advantage of
040931 -        relying on cancer marker for objective metrics to assess
040932 -        response to treatment. ref SDS 6 6I9L
040934 -         ..
040935 -    6.  On 090312 1512 called Kaiser to request results of CA 15-3 for
040936 -        the labs at Kaiser on 090309; Kaiser disclosed that the
040937 -        doctor's order on 090213 was not performed. ref SDS 7 SV90
040939 -         ..
040940 -    7.  On 090313 0127 Millie's letter to medical team reported results
040941 -        still pending for CA 15-3, ref SDS 8 B26V, for labs at Kaiser
040942 -        on 090309.
040944 -         ..
040945 -    8.  On 090313 0943 called Arlette; she will ask Doctor Johnson
040946 -        about getting results on CA 15-3, ref SDS 9 3R7J, for the blood
040947 -        test at Kasier on 090309, ref SDS 3 S65I, and submitting to
040948 -        Kaiser to complete record of examination at UCSF on 090312.
040949 -        ref SDS 6 YX5F
040950 -
040951 -
040952 -
0410 -

SUBJECTS
Default Null Subject Account for Blank Record

0503 -
050401 -  ..
050402 - Earlier thos morning about 0900 called Kaiser to follow up.  Could not
050403 - get through.  Left a voice mail for someone to call about Millie's
050404 - cancer marker for the test at Kaiser on 090309, per background above.
050405 - ref SDS 0 VE4H
050407 -  ..
050408 - Arlette called back.
050410 -  ..
050411 - Arlette recalled last Friday planning to ask Doctor Johnson on 090313
050412 - about the missing report on CA 15-3, ref SDS 9 Y077, for Millie's lab
050413 - on 030909. ref SDS 3 S65I  She explained that everything got very busy
050414 - on Friday.  A hectic schedule prevented getting the blood test
050415 - results, because there was not enough time.
050417 -  ..
050418 - Thanked Arlette for calling.
050420 -  ..
050421 - Arelette checked Kaiser's computer.  She concurred with Cisi on 090312
050422 - that CA 15-3 was somehow not ordered, despite Doctor Johnson entering
050423 - the order on 090213. ref SDS 2 6P3F
050425 -  ..
050426 - She said that sometimes nurses in the Chemotherapy Infusion Clinic do
050427 - not follow the doctor's order, but rely on the patient to specify the
050428 - scope of the test.
050430 -  ..
050431 - This aligns with Doctor Johnson's letter on 090205 that diligence is
050432 - needed to prevent critical details from "falling through the cracks."
050433 - ref SDS 1 278T
050435 -  ..
050436 - Reviewed the record showing that Millie reminded Carrie to include CA
050437 - 15-3, and this was done at that time on 090309. ref SDS 3 PQTQ
050439 -         ..
050440 -        [On 090325 0830 primary care physician disappointed by
050441 -        continual delays submitting data to UCSF, and notes conflict
050442 -        with requirements to streamline delivery of care in order
050443 -        to treat Millie's 6th relapse of cancer as a chronic
050444 -        disease. ref SDS 11 RB3G
050446 -         ..
050447 -        [On 090325 0830 Doctor Johnson verified that CA 15-3 ordered
050448 -        for lab on 090413 to prevent problems that occurred with the
050449 -        lab at Kaiser on 090309 that omitted CA 15-3. ref SDS 11 FU7H
050451 -         ..
050452 -        [On 090420 1451 Doctor Mason reported that other patients
050453 -        have not reported problems having labs performed at Kaiser
050454 -        and submitted to UCSF for referral treatment. ref SDS 13
050455 -        2H8J
050457 -  ..
050458 - Arlette will call the lab and ask them to correct the report.
050459 -
050461 -  ..
0505 -
0506 -
0507 - 1128
0508 -
050801 - Arlette called back.  She explained that when CA 15-3 is evaluated by
050802 - an outside firm, blood vials are kept for 10 days, so in that case,
050803 - they could have added CA 15-3.  However, in this case, CA 15-3 was
050804 - evaluated for Millie's blood draw on 090309 by Kaiser's internal lab.
050805 - This lab keeps blood vials for only 3 days, so they cannot add CA 15-3
050806 - to the prior report.
050808 -  ..
050809 - Arlette said Millie needs to come in for another blood draw today; and
050810 - advised that Millie will not be charged.
050812 -  ..
050813 - Arlette said she has placed the order for the blood draw in Kaiser's
050814 - computer.
050816 -  ..
050817 - Arlette suggested that Millie call the Chemotherapy Infusion Clinic to
050818 - schedule the blood draw for later today.
050820 -  ..
050821 - We reviewed the record showing the re-org has created difficulties for
050822 - customers getting through on the telephone to the Chemotherapy
050823 - Infusion Clinic.  On 090312 1437 was on hold for 90 minutes.
050824 - ref SDS 7 JO8O
050826 -  ..
050827 - Arlette said to hold the line, while she calls the Clinic.
050828 -
050830 -  ..
0509 -
0510 -
0511 - 1132
0512 -
051201 - Arlette said she is having trouble getting through on the telephone.
051202 - She will call back with the schedule for Millie to get another blood
051203 - draw to correct the mistake on the CA 15-3 test.
051204 -
051205 -
051207 -  ..
0513 -
0514 -
0515 - 1143
0516 -
051601 - Arlette called back.
051602 -
051603 - She was unable to get through on the telephone to the Chemotherapy
051604 - Infusion Clinic to ask about scheduling Millie's blood draw today.
051605 - Aligns with problems calling the clinic on 090311 1517 for 60 minutes,
051606 - ref SDS 5 6Z4F, and on 090312 1437 was on hold again for 90 minutes.
051607 - ref SDS 7 JO8O
051608 -
051609 -        [On 090415 0911 Millie had problems getting the report for the
051610 -        blood test on 090413; the first report was incorrect omitting
051611 -        90% of the data, ref SDS 12 RY4Y; after finally getting the
051612 -        full report, it was still missing ANC required for evaluating
051613 -        ability to get treatment. ref SDS 12 QP68
051615 -         ..
051616 -        [On 090420 1451 Doctor Mason reported that other patients do
051617 -        not have problems getting lab reports from Kaiser for referral
051618 -        work at UCSF. ref SDS 13 2H8J
051620 -  ..
051621 - Arlette explained that she walked down the hall from Oncology to the
051622 - Infusion Chemotherapy Clinic and made arrangements with Bella for
051623 - Millie to get a blood draw in the Chemotherapy Infusion Clinic today
051624 - at 1330 for CA 15-3.
051626 -  ..
051627 - Thanked Arlette for taking immediate action.
051628 -
051629 -
051631 -  ..
0517 -
0518 -
0519 - 1146
0520 -
052001 - Called Millie at UCSF.  She has completed her treatment, and will be
052002 - leaving shortly.  Mil will go to Kaiser on the way home and get the
052003 - blood draw at 1330.
052004 -
052005 -
052007 -  ..
0521 -
0522 -
0523 - 1330
0524 -
052401 - Millie arrived at Kaiser in Walnut Creek from UCSF in San Francisco,
052402 - via BART and then driving from the Concord station.
052404 -  ..
052405 - Anne was the nurse today in the Chemotherapy Infusion Clinic who drew
052406 - blood for the make-up lab that recovers from failure to perform CA
052407 - 15-3 for the blood draw on 090309. ref SDS 3 PQTQ
052409 -  ..
052410 - Anne appologized for the glitch last Monday on 030909.  She explained
052411 - the re-org has made things hectic with training new people.
052412 -
052413 -        [On 090323 results of blood draw today shows CA 15-3 251.
052414 -        ref SDS 10 Y077
052415 -
052416 -        [On 090325 0830 primary care physician disappointed by
052417 -        continual delays submittng data to UCSF, and notes conflict
052418 -        with requirements to streamline delivery of care in order
052419 -        to treat Millie's 6th relapse of cancer as a chronic
052420 -        disease. ref SDS 11 RB3G
052422 -         ..
052423 -        [On 090420 1451 Doctor Mason reported that other patients
052424 -        have not reported problems having labs performed at Kaiser
052425 -        and submitted to UCSF for referral treatment. ref SDS 13
052426 -        2H8J
052427 -
052428 -
052429 -
052430 -
052431 -
052432 -
052433 -
0525 -