CONTACTS 

SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 56 0000. ref SDS 55 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 -    1.  On 081229 had to coordinate getting CT test at Kaiser in Walnut
040902 -        Creek. ref SDS 9 T55G
040904 -         ..
040905 -    2.  On 081230 Millie had the last CT test. ref SDS 11 3G5I
040907 -         ..
040908 -    3.  On 090107 Millie received report for CT test on 081230,
040909 -        ref SDS 14 J85F, to prepare for meeting with UCSF on 090108,
040910 -        and discovered that Kaiser published 2 separate reports for the
040911 -        test again, ref SDS 14 RU6R, contrary to request on 081219 for
040912 -        a consolidated report. ref SDS 7 587G
040914 -         ..
040915 -    4.  On 090108 UCSF had difficulty applying results for the CT test
040916 -        on 081230 becasue the several reports presented conflicting
040917 -        findings. ref SDS 15 UE6X
040919 -         ..
040920 -    5.  On 090325 0830 Doctor Johnson ordered CT test on 090413 to be a
040921 -        consolidated report. ref SDS 54 TE4O
040922 -
040923 -
040925 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Since UCSF confirmed today on 090407 1121 that Millie is scheduled to
041302 - meet Doctor Rugo on 090423, ref SDS 57 4M6F, called this afternoon to
041303 - verify that Kaiser has scheduled Millie's CT test on 090413 1520 so
041304 - there are 10 days to allow for getting the blood test and CT tests
041305 - issued at Kaiser in time for Doctor to make examination on 090423, as
041306 - planned in the meeting with the primary care physician on 090325.
041307 - ref SDS 54 LX5I
041309 -  ..
041310 - Called Kaiser CT Department in Walnut Creek.
041312 -  ..
041313 - Talked to Loretta.
041315 -  ..
041316 - Asked to review scope.
041318 -  ..
041319 - Loretta confirmed that Millie has a test on 090413 1520.  She objected
041320 - to reviewing the scope of the test, saying patients do not get
041321 - involved with communications from doctors ordering medical services
041322 - provided by the CT Department.
041324 -  ..
041325 - We reviewed the record on 090106 showing Loretta's colleague, Chris,
041326 - found that the doctor ordered a consolidated report for the CT test on
041327 - 081230, and this was not performed. ref SDS 12 TQ6K
041329 -  ..
041330 - Loretta agreed to investigate.  She asked to hold the line.
041331 -
041333 -  ..
0414 -
0415 -
0416 - 1448
0417 -
041701 - Loretta came back online.
041702 -
041703 - She reported having called Interventional Radiology Services (IS).
041705 -  ..
041706 - Loretta advised that the IS manager asked to change the time of
041707 - Millie's CT test from 1520 to 1500, because IS staff, who can support
041708 - CT tests by supervising connection of contrast medium injection
041709 - equipment to the Huber needle accessed in the Oncology Chemotherapy
041710 - Department, end their work shift at 1530.  Starting the test at 1520
041711 - may require a few minutes overtime.  The IS Department objects to work
041712 - that may incur overtime expense for Millie's CT test.
041714 -  ..
041715 - Loretta said that the IS manager proposed doing the test on 090413
041716 - 1500, rather than 1520.
041717 -
041718 -        [...below in this record on 090407 1442, Katie reports that
041719 -        Loretta changed the date of the test from 090413 to 090414;
041720 -        feels this may be a typographical error changing the time froim
041721 -        1520 to 1500. ref SDS 0 YK64
041723 -         ..
041724 -        [On 090413 1500 IS nurse was delayed and so delayed the CT test
041725 -        until 1600. ref SDS 61 QO9X
041727 -  ..
041728 - Reviewed the record showing that advancing the CT test to 1500 will
041729 - reuire advancing Millie's blood draw to access the port, which the
041730 - doctor ordered for 1500, reported on 090325. ref SDS 54 TE4O
041732 -  ..
041733 - Loretta requested that Millie coordinate with the Kaiser Oncology
041734 - Chemotherapy Infusion Clinic to change the time of the lab on 090413
041735 - from 1500 to 1430.
041737 -  ..
041738 - Explained Doctor Johnson's request on 090325 that Millie coordinate
041739 - with the CT Department to verify Kaiser will consolidate findings in a
041740 - single report for the CT test on 090413. ref SDS 54 P53O
041742 -  ..
041743 - Loretta checked Kaiser's computer.  She said there is nothing in the
041744 - doctor's e-consult referral for Millie's CT test on 090413 that
041745 - requests a consolidated report.
041747 -  ..
041748 - Reviewed the record on 090325 showing the doctor entered in Kaiser's
041749 - computer Knowledge Management system for the e-consult referral that
041750 - findings for the CT test of the neck, chest, abdomen and pelvis should
041751 - be presented in a single consolidated report, ref SDS 54 LX7M, rather
041752 - than multiple reports that were issued for the CT tests on 081107 and
041753 - 081230.
041755 -  ..
041756 - Loretta checked Kaiser's computer and found that the e-consult
041757 - referral for the prior test on 081230 did specify a single report with
041758 - consolidated findings, shown in the record calling Chris on 090106.
041759 - ref SDS 12 OO82
041761 -  ..
041762 - Loretta indicated she would contact management in the CT Department
041763 - about this issue.
041764 -
041765 -     [...below in this record on 090407 1442 Katie called back to
041766 -     follow up on issues discussed with Loretta. ref SDS 0 0254
041767 -
041768 -
041769 -
041771 -  ..
0418 -
0419 -
0420 - 1503
0421 -
042101 - Called Chemotherapy Infuion Clinic.
042102 -
042103 - Talked to Becky.  She transferred the call to a voice mail.
042105 -  ..
042106 - Left a message to change the blood draw on 090413 from 1500 to 1430 or
042107 - 1415, per Loretta's request from the IS department, per above.
042108 - ref SDS 0 JZ95
042109 -
042110 -
042111 -
042113 -  ..
0422 -
0423 -
0424 - 1624
0425 -
042501 - Katie Garcia (925 295 7036) called back from the Kaiser Radiology
042502 - Department in Walnut Creek.  Katie advised that Loretta asked that
042503 - Katie follow up on the call earlier today, per above. ref SDS 0 475O
042505 -  ..
042506 - She manages the CT scheduling department.
042508 -  ..
042509 - Katie advised that Doctor Johnson's referral does not specify a
042510 - consolidated report on findings for Millie's CT test on 090413,
042511 - similar to Loretta's report earlier, per above. ref SDS 0 1163
042513 -  ..
042514 - We reviewed the record meeting at Kaiser on 090325, ref SDS 54 TE4O,
042515 - showing the primary care physician expressly ordered a consolidated
042516 - report, ref SDS 54 LX5J, and for the purpose of correcting problems
042517 - with tests on 081107 and on 081230, referenced on 090325, citing the
042518 - prior meeting on 090213. ref SDS 33 YG4F
042520 -  ..
042521 - Discussed concern that Katie's report this afternoon that Kaiser's
042522 - computer does not show the doctor ordered consolidated findings for
042523 - Millie's CT test on 090413 indicates people are changing the doctor's
042524 - order for patient care?
042526 -  ..
042527 - Katie feels that changing the doctor's order without notifying the
042528 - doctor would be a very serious matter for quality care.  She feels
042529 - that since the computer does not say the doctor ordered a consolidated
042530 - report, then the doctor must have made a mistake, or did not require
042531 - that findings be consolidated.
042533 -  ..
042534 - Katie seemed to further explain today that Kaiser started issuing
042535 - multiple reports with divided findings on CT tests to comply with
042536 - government regulations that require separate reports for each pass of
042537 - CT equipment in order to increase quality care for the patient.  This
042538 - rationale conflicts with discussions on 090109 with Dennis.
042539 - ref SDS 16 CE7R
042540 -
042541 -        [...below in this record on 090407 1442 Katie relates multiple
042542 -        reports may be required by government regulations on
042543 -        differences in tissue. ref SDS 0 YQ6F
042545 -  ..
042546 - Katie indicated that since government regulations require separate
042547 - reports for each pass of the CT equipment, Kaiser cannot comply with
042548 - the doctor's order on 090325 to consolidate findings in order to
042549 - avoid problems that harm patient care.
042551 -  ..
042552 - Asked for the regulation that subordinates patient care to CT test
042553 - equipment accounting.
042555 -  ..
042556 - Explained briefly medical delays, mistakes, and extra cost caused by
042557 - issuing multiple reports that compound complexity of patient medical
042558 - records, discussed with Chris in the CT scheduling department on
042559 - 090106, ref SDS 12 JE7N, and background meeting with Millie's primary
042560 - care physician on 090213. ref SDS 33 YG4F
042562 -  ..
042563 - Katie will check with Al Hutchins about complying with the doctor's
042564 - order to consolidate findings on Millie's CT test on 090413.
042565 -
042566 -         [...below in this record on 09407 1442 Katie called back, and
042567 -         plans to consult with Doctor Davidson on protocol for
042568 -         consolidating findings in a single report, ordered by Millie's
042569 -         doctor. ref SDS 0 YZ95
042571 -  ..
042572 - Katie said Kaiser's computer shows Millie's CT test is scheduled for
042573 - 090414 1500.
042575 -  ..
042576 - This also conflicts with the meeting at Kaiser on 090325, when the
042577 - primary care physician ordered the CT test on 090413 in order to
042578 - provide time for getting a report on findings in time for people be
042579 - prepared for a productive meeting at UCSF on 090423. ref SDS 54 TE4O
042581 -  ..
042582 - Katie feels Loretta may have made a typographical error changing the
042583 - time of the test to align with requirements of IS to avoid overtime,
042584 - per above. ref SDS 0 JZ87
042586 -  ..
042587 - Katie will investigate and call back to confirm the date and time of
042588 - the CT test.
042590 -  ..
042591 - Need to confirm with IS nurse is scheduled for 090413 and was not
042592 - changed to 090414.
042593 -
042594 -        [...below in this record on 090407 1442 Katie confirmed that
042595 -        Katie changed the date of Millie's CT test from 090413 to
042596 -        090414; that this was a typogrpahical mistake, and Katie
042597 -        corrected the record. ref SDS 0 YZ8L
042598 -
042600 -  ..
0427 -
0428 -
0429 - 1633
0430 -
043001 - Called Oncology Department and asked to talk with the schedule
043002 - attendant.  Asked if Millie's meeting on 090413 has been changed from
043003 - 1500 to 1430 or 0415, as requested in the message earlier to implement
043004 - changes ordered by the CT Department per above. ref SDS 0 W43J
043006 -  ..
043007 - The attendant said the computer does not show Millie's lab on 090413
043008 - has been changed.  It is still scheduled for 1500, which conflicts
043009 - with the change made in the CT Department to accomodate Interventional
043010 - Services refusal to assign nurses to support Millie's CT test at
043011 - 1520, because this would require overtime, and the IS department does
043012 - not want to incur overtime.
043014 -  ..
043015 - The attendant transferred the call to the Chemotherapy Infusion Clinic
043016 - again in order to request again the the lab scheduled on 090413 1500
043017 - be changed to 1430 or 1415.
043019 -  ..
043020 - Got a message saying the Chemotherapy Infusion Clinic is not accepting
043021 - messages patient care.
043022 -
043023 -     [On 090407 1009 called Arlette in the Oncology Department; she
043024 -     advised the telephone message system in the Chemotherapy Infusion
043025 -     clinic shuts down at 1600 rather than 1700 like the Oncology
043026 -     Department. ref SDS 56 YO8L
043028 -      ..
043029 -     [On 090409 1537 called Arlette; she coordinated with Bella in
043030 -     the Chemotherapy Infusion Clinic to change Millie's lab from
043031 -     090413 1500 to 090413 1330 which allows enough time to process
043032 -     results for creatinine needed for Millie's CT test at 1500.
043033 -     ref SDS 58 E54L
043034 -
043035 -
043036 -
043038 -  ..
0431 -
0432 -
0433 - 1648
0434 -
043401 - Katie called back.
043403 -  ..
043404 - She talked to Loretta, and confirmed that a typographical mistake
043405 - caused the date for the CT test to be changed today from 090413
043406 - ordered by the doctor to 090414.  Katie changed it back to 090413.
043407 - This corrects mistakes discovered by Katie during the earlier call,
043408 - per above. ref SDS 0 WC89
043410 -  ..
043411 - Katie will also verify that IS is also scheduled for 090413 1500 and
043412 - not 090414, also per above. ref SDS 0 4S71
043414 -  ..
043415 - Katie has talked to Al Hutchins, planned in Katie's call earlier
043416 - today, per above. ref SDS 0 L86F
043418 -  ..
043419 - Katie seemed to describe Al's explanation for Kaiser issuing multiple
043420 - reports for Millie's CT tests on 081107 and on 081230 was done to
043421 - comply with government regulations that require separate reports based
043422 - on differences in soft tissue in the neck from tissue below the neck.
043424 -  ..
043425 - We reviewed the record showing Mr Hutchins' new explanation received
043426 - today for issuing multiple reports is different Katie's understanding
043427 - that Kaiser is required to issue separate narrative reports on CT
043428 - scans for each pass of the CT equipment, per above. ref SDS 0 L86F  It
043429 - is also different from discussions with Kaiser on 090109 relating
043430 - important billing and revenue objectives. ref SDS 16 CE7R
043432 -  ..
043433 - Katie feels that in light of multiple explanations on why the CT
043434 - Department changed Doctor Johnson's order for consolidating findings
043435 - into a single report on Millie's CT test scheduled next week on 090413
043436 - this issue should be considered by Doctor Davidson, who is director
043437 - for Radiology for the Kaiser Mt Diablo region.  She advised that the
043438 - doctor has been in meetings all day.  She will meet with his to
043439 - explain the issue, and ask that Doctor Davidson explain government
043440 - regulations require separate reports on findings for Millie's CT test,
043441 - per above.
043443 -  ..
043444 - Katie will visit with Doctor Davidson, when he gets out of the
043445 - meeting he is attending, and ask him to call on coordinating getting
043446 - a single report.
043447 -
043448 -            [On 090409 1537 Doctor Johnson advised that Doctor Davidson
043449 -            is Director of Radiology for the Diablo Service Area, and
043450 -            he supported efforts in 2008 to upgrade CT Department
043451 -            capabilities by adding use of Power Port and Huber needle
043452 -            technology for injecting contrast medium. ref SDS 58 BT8O
043454 -             ..
043455 -            [On 090409 2018 received copy of Katie's letter to Doctor
043456 -            Davidson requesting review of patient request for
043457 -            correction of errors to Kaiser CT test practice publishing
043458 -            findings for tests in multiple reports. ref SDS 59 MO9I
043460 -  ..
043461 - Suggested he submit an email rather than call, so there is a record
043462 - of determination and the basis for taking action.
043463 -
043464 -            [On 090409 2018 Millie received from Doctor Davidson a copy
043465 -            of Katie's letter requesting that the doctor send a letter
043466 -            to the patient assistant on resolving errors in CT test
043467 -            reporting. ref SDS 59 5P5N
043469 -             ..
043470 -            [On 090409 2018 Doctor Davidson letter advises Kaiser made
043471 -            a mistake publishing multiple reports for each CT test that
043472 -            causes confusion and error presenting patient medical
043473 -            condition, ref SDS 59 L14I; advises future tests will
043474 -            consolidate findings into single report for each test that
043475 -            maintains a well ordered record for efficient case
043476 -            management essential to save lives, time, and money.
043477 -            ref SDS 59 XZ6U
043479 -             ..
043480 -            [On 090409 2347 letter to Doctor Davidson commends Katie
043481 -            for facilitating communication that corrects mistakes in
043482 -            Kaiser issuing multiple reports rather than consolidate
043483 -            findings for each CT test in a single report. ref SDS 60
043484 -            OW4P
043485 -
043486 -
043487 -
043488 -
043489 -
043490 -
043491 -
0435 -