THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: April 13, 2009 03:00 PM Monday;
Millie CT scan at Kaiser Walnut Creek plan next treatment at UCSF.
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CT Test Neck Chest Abdomen Pelvis Diagnostics Evaluate Progression C
0703 - ..
0704 - Summary/Objective
070501 - Follow up ref SDS 42 0000. ref SDS 19 0000.
070506 - [On 090415 0911 Arlette called at 1454 and reviewed the report
070507 - for the CT test and advised the test makes findings for
070508 - progression of lung nodules, which she feels indicate lung
070509 - cancer, ref SDS 51 RW9K; Arlette coordinated with Doctor
070510 - Johnson to review the CT test scans. ref SDS 51 RZ64
070512 - ..
070513 - [On 090415 1519 Doctor Johnson called and advised that he
070514 - reviewed the CT scans for Millie's test on 090413 and
070515 - determined that findings in the report do not indicate lung
070516 - cancer. ref SDS 53 GT4M
070518 - ..
070519 - [On 090420 2352 Millie notified medical team that Doctor
070520 - Johnson made an independent review of CT scans and
070521 - determined CT test report findings of lung nodules do not
070522 - present health care threats of cancer nor other resperatory
070523 - problems. ref SDS 54 MS4U
070527 - ..
0708 - Progress
070901 - Barbara in the Infusion Clinic accessed the Power Port for Millie's CT
070902 - test at 1500, reported in another record today on 090413 1330.
070903 - ref SDS 41 UQ6L We walked to the cafeteria on the 1st floor, and
070904 - played dominos until 1445.
070906 - ..
070907 - Millie finished the second bottle of Barium Sulfate suspension at
070908 - 1400, required an hour before getting the CT test, and for the purpose
070909 - of providing contrast medium for CT testing, and which was ordered by
070910 - the doctor during the call on 090325. ref SDS 46 G58N
070912 - ..
070913 - Walked from the cafeteria to the CT Department in the basement, and
070914 - arrived about 1502.
070916 - ..
070917 - Talked to Chris at the reception desk.
070919 - ..
070920 - Chris gave Millie forms to fill out for getting the test. She found
070921 - on the computer that results have already been reported for the blood
070922 - test Millie had in the Chemotherapy Infusion Clinic on the 2nd floor
070923 - at 1330, ref SDS 50 VF6G, and said that Creatinine 0.69, ref SDS 50
070924 - 8U4N, is within the standard for Millie to get the CT test today.
070926 - ..
070927 - Asked Chris if the computer shows Doctor Davidson's instructions on
070928 - 090410 for the analyst to consolidate findings from the test today
070929 - into a single report, as ordered by Doctor Johnson in the referral for
070930 - Millie's test on 090325? ref SDS 46 LX7M
070932 - ..
070933 - Chris checked her computer and advised that there is nothing shown in
070934 - the computer on this. She explained that Kaiser's policy is to issue
070935 - reports for scans below the neck, and a seperate report for scans
070936 - above the neck in order to comply with government regulations.
070938 - ..
070939 - Chris checked further and could not find instructions in the computer
070940 - entered by Doctor Davidson on consolidating findings in a single
070941 - report for Millie's CT test, and as committed in the doctor's letter
070942 - on 090409 2018. ref SDS 48 XZ6U
070944 - ..
070945 - Chris left the CT Department reception counter to consult with the
070946 - testing staff. She returned in 10 minutes and advised the CT
070947 - Department staff had not been contacted by Doctor Davidson. Chris
070948 - explained having talked to the CT scan analysts, also, and was told
070949 - nobody had talked to Doctor Davidson about consolidating findings for
070950 - CT tests into a single report for each test.
070952 - ..
070953 - Chris said she would try to find out what Doctor Davidson wants the
070954 - Department to do with respect to reporting on Millie's CT test today.
070956 - [On 090415 0949 letter to medical team included copy to Doctor
070957 - Davidson, and advised that the doctor's plan on 090409 to
070958 - notify the CT Department to consolidate findings for each test
070959 - in a single report had not been carried out on 090413 at the
070960 - time of the test. ref SDS 52 KG8Y
070962 - ..
070963 - Pat came into the patient waiting room and said Millie's test would be
070964 - delayed because the nurse from Interventional Radiology Services (IS)
070965 - has been delayed.
070967 - ..
070968 - After 20 minutes, walked to the IS Department and talked to a nurse.
070970 - ..
070971 - The nurse in IS said the staff was suddenly busy handling a cardiac
070972 - emergency. The nurse said IS would send a nurse for Millie's CT
070973 - test in about 15 minutes.
070975 - ..
070976 - About 40 minutes later at 1600 Nurse Nora from the IS Department
070977 - arrived in the CT Department for Millie's test. When Nora arrived
070978 - there was another 15 minute delay, while the CT Department completed
070979 - tests on other patients who had been moved ahead of Millie.
070983 - ..
0712 - 1618
071301 - Millie was called into the testing area.
071303 - The CT test scheduled for 1500 and which had been advanced from the
071304 - original schedule at 1520, at the request of the IS Department,
071305 - reported on 090407, ref SDS 47 L76N, was performed today about 1625.
071307 - [On 090415 0911 Arlette called at 1454 and reviewed the report
071308 - for the CT test and advised the test makes findings for
071309 - progression of lung nodules, which she feels indicate lung
071310 - cancer, ref SDS 51 RW9K; Arlette coordinated with Doctor
071311 - Johnson to review the CT test scans. ref SDS 51 RZ64
071313 - ..
071314 - [On 090415 1519 Doctor Johnson called and advised that he
071315 - reviewed the CT scans for Millie's test on 090413 and
071316 - determined that findings in the report do not indicate lung
071317 - cancer. ref SDS 53 GT4M
071319 - ..
071320 - [On 090420 2352 Millie notified medical team that Doctor
071321 - Johnson made an independent review of CT scans and
071322 - determined CT test report findings of lung nodules do not
071323 - present health care threats of cancer nor other resperatory
071324 - problems. ref SDS 54 MS4U
071326 - ..
071327 - During this delay, Millie suffered multiple recurrence of upset
071328 - stomach caused by Barium Sulfate Suspension contrast medium, which
071329 - occurred on the prior test on 081230, ref SDS 42 FF4K, and which
071330 - Millie requested be changed on 090325 0830. ref SDS 46 G58N On 090409
071331 - 2347 letter to Doctor Davidson, Chief Radiology Imaging Services
071332 - Diablo Service Area asked for alternate contrast medium using
071333 - Gastrogafin, or equivalent, rather than Barium Sulfate Suspension that
071334 - causes medical problems. ref SDS 49 OW5Q Neither Doctor Johnson nor
071335 - Doctor Mason provided a remedy for this problem.
071337 - ..
071338 - The technologist said that the 90 minute delay from the original
071339 - schedule at 1500 for Millie's test did not impair effectivensss of
071340 - Barium Sulfate Suspension taken an hour prior to the scheduled test.
071341 - It was unclear why if the patient instruction is to injest oral
071342 - contrast medium 2 hours ahead and then an hour ahead of the test time,
071343 - a delay of 90 minutes would not be a factor in test results.
071345 - ..
071346 - Today, Nora recalled that she supported Millie's first CT test using
071347 - the Power Port for injecting contrast medium, reported on 080718.
071348 - ref SDS 3 2U8V
071350 - ..
071351 - She explained that work today will go more smoothly than on 080718,
071352 - ref SDS 3 LK3R, because the IS Department now has more experience
071353 - accessing Power Port technology using Huber needles.
071355 - ..
071356 - Advised Nora that Millie's Power Port was accessed in the Chemotherapy
071357 - Infusion Clinic at 1330, ref SDS 50 XJ55, and so her only task was to
071358 - observe the CT technologist connecting the injeciton equipment to the
071359 - Huber needle.
071361 - ..
071362 - Asked Nora to call the Chemotherapy Infusion Clinic and let them know
071363 - Millie will be at least an hour late to remove the Huber needle after
071364 - the CT test, due to complications in IS that delayed observing
071365 - Millie's CT test scheduled for 1500.
071367 - ..
071368 - Nora said she can remove the needle. She will call the Chemotherapy
071369 - Infusion Clinic in the Oncology Department on the 2nd floor, and
071370 - apologize for delays, and further advise that nobody has to wait for
071371 - Millie to return for removing the Huber needle, because she will do
071372 - this work.
071374 - ..
071375 - As noted, while waiting for Nora to arrive, 3 or so other patients
071376 - were taken ahead of Millie. When Nora finally arrived, there was
071377 - about a 15 minute wait, while other patients were given CT scan tests.
071378 - ref SDS 0 QO95
071380 - ..
071381 - When Millie's turn came, the test was accomplished in about 20
071382 - minutes. The Department has new equipment and facilities. There are
071383 - now 2 scan rooms. Millie was given the CT test in the new facilities.
071384 - The technologist explained the new equipment can perform scans at a
071385 - faster rate than was possible for Millie's prior tests.
071387 - ..
071388 - Since there were no delays injecting contrast medium using Millie's
071389 - Power Port, the technologist said Millie's test was very fast today.
071391 - ..
071392 - Afer the test, Nora removed the Huber needle. She had to walk back to
071393 - IS and get Heprin and saline to service and flush the port. This took
071394 - another 20 minutes. After finishing up, Nora commented that she was
071395 - glad the work today went better than on 080718, as her colleague Kathi
071396 - expected would be the case, ref SDS 3 A39Q, and Dennis noted citing
071397 - lessons learned on 080718. ref SDS 3 FM74
071399 - ..
071400 - Millie thanked everyone for excellent work, completing the CT test in
071401 - only 20 minutes, not counting Nora's time going back to the IS for
071402 - treatments to service the Power Port.
071404 - [On 090415 0911 Arlette called at 1454 and reviewed the report
071405 - for the CT test and advised the test makes findings for
071406 - progression of lung nodules, which she feels indicate lung
071407 - cancer, ref SDS 51 RW9K; Arlette coordinated with Doctor
071408 - Johnson to review the CT test scans. ref SDS 51 RZ64
071410 - ..
071411 - [On 090415 1519 Doctor Johnson called and advised that he
071412 - reviewed the CT scans for Millie's test on 090413 and
071413 - determined that findings in the report do not indicate lung
071414 - cancer. ref SDS 53 GT4M
071416 - ..
071417 - [On 090420 2352 Millie notified medical team that Doctor
071418 - Johnson made an independent review of CT scans and
071419 - determined CT test report findings of lung nodules do not
071420 - present health care threats of cancer nor other resperatory
071421 - problems. ref SDS 54 MS4U