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 58 0000. ref SDS 57 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 -    1.  On 081229 had to coordinate getting CT test at Kaiser in Walnut
040902 -        Creek. ref SDS 10 T55G
040904 -         ..
040905 -    2.  On 081230 Millie had the last CT test. ref SDS 12 3G5I
040907 -         ..
040908 -    3.  On 090107 Millie received report for CT test on 081230,
040909 -        ref SDS 15 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 15 RU6R, contrary to request on 081219 for
040912 -        a consolidated report. ref SDS 8 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 16 UE6X
040919 -         ..
040920 -    5.  On 090325 0830 Doctor Johnson ordered CT test on 090413 to be a
040921 -        consolidated report. ref SDS 55 TE4O
040923 -         ..
040924 -    6.  On 090407 1421 Loretta reports Kaiser CT Department changed the
040925 -        time of the test from 090413 1520 to 1500 requested by the the
040926 -        IS Department to avoid overtime expenses that start at 1530.
040927 -        ref SDS 58 JZ87
040929 -         ..
040930 -    7.  On 090407 1421 Loretta reports Kaiser CT Department changed
040931 -        Doctor Johnson's referral order issued on 090325 to consolidate
040932 -        findings in a single report; Loretta advised that Kaiser's
040933 -        computer does not call for a consolidated report. ref SDS 58
040934 -        1163
040936 -         ..
040937 -    8.  On 090407 1421 Katie called back and advised that Loretta made
040938 -        a mistake in the Kaiser CT Department by accidentally changing
040939 -        the date of the test from 090413 to 090414, when she changed
040940 -        the time from 1520 to 1500. ref SDS 58 YK64
040942 -         ..
040943 -    9.  On 090407 1421 Katie confirmed Loretta's earlier report that
040944 -        somebody changed Doctor Johnson's order on 090325 to
040945 -        consolidate findings in a single report. ref SDS 58 YK5O
040947 -         ..
040948 -   10.  On 090407 1421 Katie advised that the doctor's order was
040949 -        changed because government regulations require issuing multiple
040950 -        reports for CT tests for each pass of CT scanning equipment.
040951 -        ref SDS 58 L86F
040953 -         ..
040954 -   11.  On 090407 1421 Katie discussed multiple and conflicting
040955 -        explanations Kaiser has presented for changing Doctor Johnson's
040956 -        order for Millie's CT test. ref SDS 58 L44K
040958 -         ..
040959 -   12.  On 090407 1421 Katie decided to ask Doctor Davidson, Director
040960 -        of Radiology for Kaiser Mt Diablo to support Millie's doctor
040961 -        prescribing a consolidated report for the CT test on 090413,
040962 -        and will ask Doctor Davidson to send an email to Millie
040963 -        explaining procedures on consolidating test findings into a
040964 -        single report. ref SDS 58 YZ95
040966 -         ..
040967 -   13.  On 090409 1537 Doctor Johnson asked about coordination with CT
040968 -        Department on implementing Doctor Johnson's order on 090325 to
040969 -        consolidate findings for the test on 090413 into a single
040970 -        report; and he was notified that Doctor Davidson was working
040971 -        the issue. ref SDS 59 FU6J
040972 -
040973 -
040974 -
040976 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Mistake CT Tests Failure Consolidate Findings Each Test
041302 -
041303 - Millie received a letter from Doctor Davidson, Director of Radiology
041304 - for the Kaiser Mt Diablo Service Area following up telecon with Katie
041305 - on 090407 1442, ref SDS 58 UO7G, and responding to Katie's letter on
041306 - 090407 explaining patient request to correct errors in the CT test
041307 - reports, per below, ref SDS 0 MO9I, and in accordance with request
041308 - made by Millie's primary care physician in Oncology during the meeting
041309 - at Kaiser on 090325 for the patient to coordinate with the Radiology
041310 - Department to make corrections, ref SDS 55 P53O, and further
041311 - reflecting Katie's letter to the doctor saying the patient assistant
041312 - requests written response, per below, ref SDS 0 5P5N,
041313 -
041314 -    1.  Subject:  Patient Request for clarification of CT dictations
041315 -        Date: Thu, 9 Apr 2009 17:13:05 -0700
041322 -         ..
041323 -    2.  I'm sorry for the inconvenience that this situation has caused
041324 -        you.  It appears that our CT Technologists updated the scans in
041325 -        error as two separate scans, one of the neck, and the other of
041326 -        the Chest, Abdomen and Pelvis.  Because of this error, the
041327 -        "two" studies [Doctor Davidson refers to the Kaiser CT study on
041328 -        081107, reviewed on 081113, ref SDS 7 TP8L, and the test on
041329 -        081230, which was again issued in 2 reports, reported on
041330 -        090107, ref SDS 15 DA6Q] demand two dictations, legally.
041331 -
041332 -            [On 090409 2347 letter thanks Doctor Davidson for
041333 -            correcting problems with CT test reporting, and explains
041334 -            problems for doctors caused by multiple reports on Kaiser
041335 -            CT tests. ref SDS 60 4R4K
041337 -             ..
041338 -            [On 090415 1642 CT test report consolidates findings for
041339 -            scans above neck and below the neck in single report, as
041340 -            ordered by the doctor today. ref SDS 64 RU6R
041342 -         ..
041343 -    3.  I'm sorry, but once the updates are entered into the medical
041344 -        record, they cannot be removed, under my understanding, again
041345 -        due to the laws surrounding electronic medical records (someone
041346 -        might be trying to "cheat the system" and say that an exam was
041347 -        never done if it was allowed that a scan could be deleted from
041348 -        the record).
041350 -         ..
041351 -    4.  So, I'm sorry, but in this case, we cannot combine the reports
041352 -        into one report.  We CAN, if you like, print them out so that
041353 -        they "appear" as one continuous report, but there will still be
041354 -        the report of the CT of the neck, with it's separate
041355 -        Impression, and the CT of the Chest, Abdomen, and Pelvis, with
041356 -        it's impression.
041357 -
041359 -  ..
041360 - Consolidate Findings One Report Each CT Test for Medical Necessity
041361 - Kaiser Apologizes Prior Erroneous Policy Choice Will Correct the Work
041362 - CT Tests Published Correction Consolidate Findings for Each Test
041363 -
041364 -
041365 -    5.  I apologize on behalf of my department that this has occurred,
041366 -        and rest assured that the individuals involved will be
041367 -        counselled to assure that such an exam in the future is entered
041368 -        into the medical record as a CT of the "Neck, Chest, Abdomen
041369 -        and Pelvis," but in this case, there is not much else that can
041370 -        be done.
041372 -  ..
041373 - Doctor Davidson's analysis conforming the work to patient medical
041374 - needs reflects Doctor Johnson's report earlier today on 090409 1530
041375 - that Doctor Davidson previously supported transformation of CT
041376 - Department to use Power Port and Huber Needle technology for injecting
041377 - contrast medium. ref SDS 59 BT8O
041378 -
041379 -            [On 090409 2347 letter thanks Doctor Davidson for
041380 -            correcting problems with CT test reporting, and explains
041381 -            problems for doctors caused by multiple reports on Kaiser
041382 -            CT tests. ref SDS 60 4R4K
041384 -             ..
041385 -            [On 090410 0143 Millie notifies medical team that Doctor
041386 -            Davidson has ordered corrections to work pracitces for CT
041387 -            test reports to consolidate findings for each test in a
041388 -            single report. ref SDS 61 JT9Y
041390 -             ..
041391 -            [On 090413 1500 meeting with CT Department for Millie's
041392 -            test there was no record in the Kaiser computer that Doctor
041393 -            Davidson notified the department to correct prior mistakes
041394 -            publishing multiple reports for a single CT test.
041395 -            ref SDS 62 NJ5M; Chris investigated and found nobody in the
041396 -            CT Department had talked with Doctor Davidson and been
041397 -            counseled to correct CT test reports to consolidate
041398 -            findings, rather than issue multiple reports for each test.
041399 -            ref SDS 62 LF6J
041401 -             ..
041402 -            [On 090415 1642 CT test report consolidates findings for
041403 -            scans above neck and below the neck in single report, as
041404 -            ordered by the doctor today. ref SDS 64 RU6R
041406 -             ..
041407 -            [On 090415 0949 letter to medical team included copy to
041408 -            Doctor Davidson, and advised that the doctor's plan on
041409 -            090409 to notify the CT Department to consolidate findings
041410 -            for each test in a single report had not been carried out
041411 -            on 090413 at the time of the test. ref SDS 63 KG8Y
041413 -             ..
041414 -            [On 090617 0842 radiology report on Millie's CT test on
041415 -            090612 was again issued in multiple, separate, and
041416 -            overlapping reports, ref SDS 65 6V4S, contrary to Doctor
041417 -            Davidson's instructions today, per above, ref SDS 0 XZ6U;
041418 -            Al Hutchins, Manager of Reporting for Radiology, apologized
041419 -            for continuing difficulty implementing policy to use good
041420 -            management that avoids mistakes. ref SDS 65 6V5I
041422 -             ..
041423 -            [On 090617 1737 Kaiser Radiology Department failed to
041424 -            consolidated findings for Millie's CT test on 090612.
041425 -            ref SDS 66 SQ8M
041426 -
041427 -
041446 -
041448 -  ..
041449 - Doctor Davidson's letter attaches correspondence from Katie...
041450 -
041451 -    1.  Subject:  Patient Request for clarification of CT dictations
041452 -        Date:  4/09/2009 10:33 AM
041456 -         ..
041457 -    2.  HI
041458 -
041459 -        I just spoke to Mr Buck. He gave me his e mail address if you
041460 -        would like to respond in writing. [reflects telecon with Katie
041461 -        on 090407 1430, ref SDS 58 UO7G]
041463 -
041465 -         ..
041480 -
041482 -  ..
041483 - Doctor Davidson's letter attaches initial correspondence from Katie
041484 - explaining need for review of Kaiser Radiology practice and requesting
041485 - consolidating findings into a single report for each test, as
041486 - discussed with Katie on 090407. ref SDS 58 W47V
041487 -
041488 -    1.  Subject:  Patient Request for clarification of CT dictations
041489 -        Date:  4/09/2009 10:24 AM
041493 -         ..
041494 -    2.  HI
041495 -
041496 -        Mr Buck is upset that he can't get  the CT scan of his wife on
041497 -        one report [the patient]
041499 -        has had many CT's.  He states in the past he has been able
041500 -        to get everything on one report .  Her e consult is for a Neck
041501 -        soft tissue, chest and abdomen.
041503 -         ..
041504 -        Should I ask Dr Shirazi to call the patient?  pt number 925
041505 -        680-8947
041506 -
041507 -            [On 090409 2347 letter to Doctor Davidson commends Katie
041508 -            for facilitating communication that corrects mistakes in
041509 -            Kaiser issuing multiple reports rather than consolidate
041510 -            findings for each CT test in a single report. ref SDS 60
041511 -            OW4P
041513 -         ..
041514 -        Thanks
041516 -         ..
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