THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: April 20, 2009 02:51 PM Monday;
Amanda called from UCSF for authorization Millie's treatment at UCSF.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 28 0000.
040508 - ..
0408 - Progress
040901 - Amanda said she has still not received authorization from Kaiser for
040902 - Doctor Rugo to see Millie on Thursday, 090423 0830.
040904 - ..
040905 - She talked to Doctor Rugo. The doctor asked Amanda to contact Millie
040906 - about getting the proper documentation on file at UCSF in time for the
040907 - meeting on Thursday.
040909 - ..
040910 - Thanked Amanda for timely notice.
040914 - ..
0412 - 1538
041301 - Called Pam at Kaiser Outside Referrals.
041303 - Pam said she vaguely recalled getting a call from Doctor Rugo's
041304 - assistant. She gets a lot of calls.
041306 - ..
041307 - She looked up the computer file and found a reference to a call from
041308 - Amanda.
041310 - ..
041311 - We reviewed Amanda's concern in her call earlier today that Doctor
041312 - Rugo cannot see Millie on Thursday, even though the meeting has been
041313 - scheduled for a month, because UCSF has not received the amended
041314 - authorization from Kaiser.
041316 - ..
041317 - Pam feels Amanda is incorrect.
041319 - ..
041320 - She looked up in the computer and found that authorization for
041321 - Millie's treatment at UCSF includes Doctor Rugo in the Breast Care
041322 - Clinic, and Doctor Hsu in the Radiation Oncology Department.
041327 - ..
0416 - 1643
041701 - Doctor Mason called.
041703 - He said that a letter was sent a week ago overturning Millie's primary
041704 - care physician's order for labs at UCSF, and that Millie should be
041705 - getting a copy shortly.
041707 - [On 090508 1338 Millie received a letter from Kaiser
041708 - unsigned and dated 090429, approximately 15 days later than
041709 - the explanation provided today. ref SDS 30 RF4I
041711 - ..
041712 - Doctor Mason said that he reversed the doctor's order for Millie
041713 - getting labs at UCSF, because other patients getting treatment on
041714 - referral at UCSF are getting labs at Kaiser without any problems. The
041715 - doctor said he has not had time to review patient history in this
041716 - case, listed in the record meeting with Doctor Johnson on 090325,
041717 - ref SDS 26 KZ6N, showing Kaiser has been unable to perform lab work in
041718 - time to be effective for Millie's expanding patient profile, listed on
041719 - 090213. ref SDS 19 ES7I
041721 - ..
041722 - He asked why labs need to be done for Millie at UCSF, when other
041723 - Kaiser patients seem to be doing okay getting treatment at UCSF and
041724 - doing labs at Kaiser?
041726 - ..
041727 - Reviewed case study on 090325 0830 showing chronic delays submitting
041728 - data on Millie's labs at Kaiser in time for effective care at UCSF.
041729 - ref SDS 26 KZ6N
041731 - ..
041732 - Millie is different from other patients, now suffering her 7th relapse
041733 - in 8 years of continuous treatment for cancer. Doctor Johnson advised
041734 - on 090213 that very few patients survive Millie's illness of stage IV
041735 - cancer for even 5 years. Research on 080606 indicates that less than
041736 - 15% of stage IV patients survive in continuous treatment for 7 years.
041737 - ref SDS 15 SG4M Doctor Johnson also advised that timeliness becomes a
041738 - bigger factor for survival going forward. Therefore, basing practice
041739 - modalities for Millie's care on what has seemed to work for other
041740 - patients is a medical mistake.
041742 - ..
041743 - Bad management presents an illusion that only "seems" to be cost free
041744 - because problems are ignored for a long time before exploding.
041746 - ..
041747 - Worldcom, BOA, Merrill Lynch, NASA, Bear Sterns, GM, Intel, Enron,
041748 - AIG, DOD, et al, were able to hang on for years because failure to
041749 - perform "seems" to slip by without causal effect on performance and
041750 - income. Everyone said, like today...
041752 - Hey, nobody's complaining about problems using bad management,
041753 - so why should we change?
041755 - ..
041756 - This myth was exploded by the Challenger Space Shuttle in 1986, the
041757 - Columbia Space Shuttle in 2002, the savings and loan industry in the
041758 - 1980s, the World Trade Center and the Pentagon in 2001, and the entire
041759 - world is now paying the price for bad management, that didn't seem to
041760 - be effecting other customers, other patients, other vendors, other
041761 - people for a long time.
041763 - ..
041764 - When Millie started treatment at Kaiser in 2007, everyone tried very
041765 - hard doing blood tests at Kaiser and sending the data to UCSF, but
041766 - this failed.
041768 - ..
041769 - Doctor Mason asked what went wrong?
041771 - ..
041772 - Chronic problems getting lab data from Kaiser to UCSF conflicts with
041773 - Kaiser policy for timely, effective care. Case study on patient
041774 - history shows Millie's care has been delayed 38 times with Kaiser
041775 - attempting to transfer labs to UCSF, considered during the meeting
041776 - with the primary care physician on 090325. ref SDS 26 KZ6N
041778 - ..
041779 - Doctor Mason feels Kaiser can solve all of these problems with greater
041780 - diligence working harder, so that Millie's labs are submitted to UCSF
041781 - in time to maintain quality of care. He offered no evidence showing
041782 - Kaiser has been able to improve delivery of lab date to UCSF.
041784 - [On 090508 1338 Millie received a letter from Kaiser
041785 - unsigned and dated 090429, approximately 15 days later than
041786 - the explanation provided today. ref SDS 30 RF4I
041788 - ..
041789 - [On 090513 1654 Millie transmits Kaiser lab report with
041790 - more mistakes, ref SDS 31 N54I, and notifies the medical
041791 - team that Doctor Mason is working to improve coordination
041792 - at Kaiser to reduce medical mistakes. ref SDS 31 ZA3R
041794 - ..
041795 - [On 090514 0811 Pam in Doctor Mason's office asked why
041796 - Doctor Mason was notified about continuing failure at
041797 - Kaiser to perform lab work correctly resulting from
041798 - Kaiser's failure to make referral for blood work at UCSF to
041799 - support Millie's treatment on referral to UCSF. ref SDS 32
041800 - KV3I
041802 - ..
041803 - [On 090514 0818 Millie replies to Pam that submitting the
041804 - record on implementing Doctor Mason's work plan for Kaiser
041805 - to work harder avoiding mistakes offers a viable solution
041806 - to get effective care at UCSF on referral from Kaiser,
041807 - rather than have the work done at UCSF that reduces
041808 - opportunity for errors to occur. ref SDS 33 WR3U
041810 - ..
041811 - Emphasized during the call today that Kaiser has outstanding,
041812 - talented, and dedicated doctors and nurses. The "problem" is not with
041813 - Kaiser. Inevitable mistakes performing hundreds of small details that
041814 - delay lab work at Kaiser, also, occur at UCSF. The difference is that
041815 - rework can be done to adjust in realtime at UCSF while Millie is
041816 - sitting in the chemotherapy chair, and implemented immediately. When
041817 - Millie was treated at Kaiser in 2002 - 2006, coordination between the
041818 - nurses and the lab enabled work to go smoothly.
041820 - ..
041821 - Doctor Johnson prescribed labs at UCSF for Millie at this time,
041822 - because her expanding patient profile has reduced the tolerance for
041823 - error toward emergency care, reported on 090213. ref SDS 19 ES7I
041825 - ..
041826 - Doctor Mason noted doctors are trained to easily transfer units of
041827 - measure between Kaiser and UCSF labs. The record of Millie's patient
041828 - history on 070301 does not support Doctor Mason's explanation today.
041829 - ref SDS 9 X85F On 071019 1232 UCSF used value for neutrophils on
041830 - Kaiser report for NEUTS on UCSF lab reports, which is an error because
041831 - NEUTS correlates to ANC. ref SDS 13 4Q8I
041833 - ..
041834 - Doctor Mason asked how Doctor Johnson at Kaiser has been getting
041835 - Millie's labs from UCSF the past 2 years?
041837 - ..
041838 - Millie's work at UCSF is submitted to Kaiser and the record of care at
041839 - Kaiser is submitted to UCSF. Doctor Johnson commented on 090213 that
041840 - getting data submitted to the medical team into the doctor's computer
041841 - system is a big challenge, because this takes will power. ref SDS 19
041842 - J28K "Will power" is another way of calling for Kaiser to use more
041843 - diligence for improving coordination with UCSF, proposed by Doctor
041844 - Mason to maintain Kaiser's standards of care. ref SDS 0 8G3N
041846 - ..
041847 - Doctor Mason said Millie benefits doing blood tests at Kaiser because
041848 - the data is quickly available to all of Millie's doctors at Kaiser on
041849 - computers at Kaiser. Doctors have become dependent on speed and
041850 - accuracy getting lab data from the computer. Doctor Mason feels
041851 - therefore that having all of the labs on Kaiser's computer is a big
041852 - benefit for Millie's care at Kaiser.
041854 - ..
041855 - The past 8 years 90% of Millie's care is for cancer. For the past 2
041856 - years all of this care has been at UCSF because she has been given all
041857 - of treatments available at Kaiser, and UCSF has presented treatments
041858 - that have been very effective. Doctor Mason's reasoning that Millie
041859 - benefits by doctors having access to labs on the computer requires
041860 - doing labs at UCSF for treating Millie's cancer.
041862 - ..
041863 - The doctor advised that since he issued a letter last week reversing
041864 - Doctor Johnson's order for labs at UCSF, he does not have authority to
041865 - conform this postion with patient history. He said Millie will get a
041866 - copy of his letter in a few days. He recommends that Millie file an
041867 - appeal to the correct the problem so that labs are performed to meet
041868 - patient needs.
041870 - [On 090508 1338 Millie received a letter from Kaiser
041871 - unsigned and dated 090429, approximately 15 days later than
041872 - the explanation provided today. ref SDS 30 RF4I
041874 - ..
041875 - [On 090513 1654 Millie transmits Kaiser lab report with
041876 - more mistakes, ref SDS 31 N54I, and notifies the medical
041877 - team that Doctor Mason is working to improve coordination
041878 - at Kaiser to reduce medical mistakes. ref SDS 31 ZA3R
041881 - ..
0421 - 1933
042201 - Millie received a call from UCSF confirming Millie is meeting with
042202 - Doctor Rugo on 090423 0830.