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: April 1, 2009 12:14 PM Wednesday; Rod Welch

Called Pam clarify Kaiser authorization Millie's treatment at UCSF.

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 11 0000, ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday, Millie received a telephone call from UCSF notifying Millie
040902 - about meeting with Doctor Rugo on 090402 (tomorrow). ref SDS 7 EC6J
040904 -  ..
040905 - Called Pam this afternoon at Kaiser about clarifying the referral for
040906 - Kaiser to pay for Millie meeting in the Breast Care Clinic with Doctor
040907 - Rugo, planned for 090423 0800, presented in the letter to Doctor Rugo
040908 - last night on 090401 0108.
040910 -  ..
040911 - Pam said nobody understands Medicare requirements for clinical trials
040912 - and who pays 20% coinsurance when the doctor prescribes treatment in a
040913 - clinical trial, and when Kaiser is responsible for patient care.
040915 -  ..
040916 - Pam mentioned that her mother is experiencing this same issue, and the
040917 - family is having problems making arrangements through Medicare for
040918 - care.
040920 -  ..
040921 - Explained meeting at UCSF on 090312; Doctor Hsu advised that Millie's
040922 - patient history strongly indicates continuing care will be needed at
040923 - UCSF to resolve IBC. ref SDS 4 576L  This was discussed again a few
040924 - days ago on 090330 1200. ref SDS 6 E76I  There was also discussion
040925 - that Millie may need 6 months treatment for side effects of radiation.
040926 - ref SDS 6 T487  On 090204 Doctor Rugo explained Millie's treatment
040927 - plan to implement Kaiser's prescription for UCSF to treat Millie's
040928 - cancer as a chronic disease, ref SDS 1 278T, shown in case study
040929 - reviewed at Kaiser on 090325. ref SDS 5 L15M
040931 -             ..
040932 -            [On 090402 1520 Millie's letter notifies medical team about
040933 -            contacting Kaiser Outside Referrals Department to clarify
040934 -            scope of authorization for Millie's care at UCSF.
040935 -            ref SDS 12 LG4G
040937 -             ..
040938 -            [On 090402 0119 Doctor Rugo responded in a letter saying to
040939 -            send information on Kaiser's referral authorization to the
040940 -            UCSF "authorization person." ref SDS 13 WB8F
040942 -             ..
040943 -            [On 090402 0849 Millie letter to UCSF asks Glenna for
040944 -            assistance on scheduling and finding the "authorization
040945 -            person" for sending information, as requested by Doctor
040946 -            Rugo. ref SDS 14 WM8M
040948 -             ..
040949 -            [On 090402 1013 Glenna called and gave several names of
040950 -            people to contact; she did not have time to submit contact
040951 -            information. ref SDS 15 E54L
040953 -  ..
040954 - Pam asked how Millie is doing?
040956 -  ..
040957 - Explained that radiation and hyperthermia treatments at UCSF which
040958 - ended on 090317 were effective stopping the rapid advance of cancer
040959 - from Millie's 6th relapse on 090122.  On 090213 Millie's primary care
040960 - physician, Doctor Johnson, was very worried in a meeting at Kaiser
040961 - before starting treatment that Millie has less than a year to live.
040962 - ref SDS 3 9L7N  So, the immediate crisis is over for the moment.
040964 -  ..
040965 - Unfortunately, Millie suffered a 7th relapse a few days ago on 090331
040966 - 2047, ref SDS 8 Q64R, and based on Doctor Hsu's diagnosis the next day
040967 - on 090401 0032. ref SDS 9 R24X
040969 -  ..
040970 - Asked Pam about procedures under Kaiser's referral for Millie's
040971 - continuing care to resolve IBC?   On 090129 Doctor Rugo referred
040972 - Millie's case to the UCSF Radiation Oncology Department to achieve
040973 - local control in order for the Breast Care Clinic to treat Millie's
040974 - cancer as a chronic disease, reported in Millie's letter to the
040975 - medical team on 090130, and noted again in Doctor Rugo's letter on
040976 - 090204 1914. ref SDS 1 278T
040978 -  ..
040979 - Pam explained that estimating duration for referral care is difficult,
040980 - because many factors influence how long treatment is needed.  She
040981 - cited Millie's treatment at UCSF in 2007 and 2008 with cetuximab and
040982 - Carboplatin, which was effective for nearly 2 years helping Millie
040983 - recover from the 4th and 5th relapse of cancer.  UCSF wants
040984 - clarification that the current authorization enables continuity of
040985 - care, since this can entail more hyperthermia, possibly radation, or
040986 - combinations of chemotherapy and vacinnes.  They have to experiment to
040987 - discover effective treatment for Millie's 7th relapse of IBC.
040989 -  ..
040990 - Pam advised that Kaiser's referral authorization A0232470 for Millie's
040991 - treatment at UCSF expires on 090602 (June 2nd). ref SDS 2 LP7U  Pam
040992 - further advised that Kaiser "automatically" extends authorization to a
040993 - year, which will be 100202, without UCSF submitting additional
040994 - justification, so that Millie is covered to get treatment for IBC.
040996 -  ..
040997 - Pam asked who should be listed on Kaiser's referral for Millie's care
040998 - at UCSF in order to simplify processing?
041000 -  ..
041001 - Advised that in addition to Doctor Rugo in the Breast Care Clinic, who
041002 - ordered Millie's treatment with hyperthermia and chemotherapy, the
041003 - Referral should list Doctor I-chow (Joe) Hsu and Chris Diederich in
041004 - the Radiation Oncology Department.
041006 -  ..
041007 - Pam said she will update Kaiser's Refferal record to facilitate
041008 - continuity of Millie's care at UCSF.
041010 -  ..
041011 - Discussed problems doing labs at Kaiser and transferring data to UCSF,
041012 - reviewed with Doctor Johnson on 090325. ref SDS 5 KZ6N  Pam explained
041013 - that Doctor Johnson's referral for Millie's care at UCSF did not
041014 - include lab work.  She explained that Doctor Johnson can file an
041015 - updated referral that included labs for Millie at UCSF for cost
041016 - effective care.
041017 -
041018 -            [On 090402 0119 medical team notified problems transferring
041019 -            lab data from Kaiser to UCSF can be solved by primary care
041020 -            physician filing amended referral that specifies Millie's
041021 -            labs at UCSF. ref SDS 12 WC7Y
041023 -             ..
041024 -            [On 090407 1107 left message for Arellete to coordinate
041025 -            with Doctor Johnson about amending referral to include labs
041026 -            at UCSF for cost effective care. ref SDS 16 IF59
041028 -  ..
041029 - Thanked Pam for comprehensive treatment of Millie's treatment
041030 - requirements.
041031 -
041032 -
041033 -
041034 -
041035 -
041036 -
041037 -
041038 -
041039 -
041040 -
0411 -