THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: May 15, 2009 09:52 AM Friday;
UCSF notifies medical team Kaiser refuses treatment Millie's 8th relapse cancer.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 34 0000. ref SDS 32 0000.
040506 - ..
0408 - Background
040901 - On 090423 Millie met with Tara in the Breast Care Clinic at UCSF for
040902 - examination, which showed recovery from side effects of radiation and
040903 - hyperthermia treatments during February and March 2009. ref SDS 21 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 22 ZL6T Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 21 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 22 ZL7P
040909 - ..
040910 - At that time, on 090423 Tara planned to discuss with Doctor Hsu in the
040911 - UCSF Radition Oncology Department concerns about slow healing of
040912 - radiation side effects in Millie's breastbone area. ref SDS 21 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 22 ZL7V
040916 - ..
040917 - In the afternoon on 090423 1315 Millie met with Doctor Hsu to check on
040918 - recovery from radiation side effects. ref SDS 21 4H5G Doctor Hsu gave
040919 - Millie a "thumbs up" that she was well enough to take time from
040920 - treatment to go on a 2-week vacation, ref SDS 21 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 21
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 21 EX4I The doctor
040924 - recommended against taking a biopsy because the skin was thought to be
040925 - radiated, and surrounding tissue was radiated, and so this would delay
040926 - and prevent normal recovery from a biopsy wound. ref SDS 21 456H
040928 - ..
040929 - On 090423 2337 Millie's letter to medical team reports Doctor Hsu's
040930 - favorable report that IBC cannot recur in treated areas, because
040931 - nothing can grow in treated areas. ref SDS 22 ZL9V The letter further
040932 - confirms UCSF plans to treat IBC recurrence on the lower left arm as a
040933 - chronic disease with systemic agents prescribed by Doctor Rugo in the
040934 - Breast Care Clinic, ref SDS 22 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 22 ZL5Q
040937 - ..
040938 - Yesterday on 090510 1553, Millie submitted an agenda for the meeting
040939 - on 090514 to start treatment of the 8th relapse. ref SDS 23 QH9J The
040940 - letter was hurried to fit commitments for attending Mother's Day
040941 - family event. In the afternoon on 090510 1953, after retrurning home,
040942 - Millie sent a second letter to further explain the agenda for meeting
040943 - on Thursday 090514 at UCSF with Doctor Rugo. ref SDS 24 FJ3G
040945 - ..
040946 - This morning, called and talked to Amanda about coordinating to
040947 - facilitate the agenda for meeting with Doctor Rugo on Thursday,
040948 - 090514, particularly on requirements for blood tests at Kaiser, as
040949 - discussed in Millie's letter on 090510 1953. ref SDS 24 LJ7X
040951 - ..
040952 - Amanda requested a copy of Millie's letter to the medical team that
040953 - explains details about getting a lab. Millie sent the letter to
040954 - Amanda and requested clarification on requirements for a lab.
040955 - ref SDS 25 YN33 After sending the letter to Amanda this afternoon,
040956 - Kaiser notified Millie on 090511 1427 that Doctor Johnson has a
040957 - standing order at Kaiser for Millie to get a monthly blood test,
040958 - ref SDS 26 FJ5L; so, Millie then sent a letter notifying the medical
040959 - team that the blood draw will be done on 090512, so that people can be
040960 - prepared for a productive meeting at UCSF on 090514. ref SDS 26 FJ6G
040962 - ..
040963 - On 090511 2013, Doctor Rugo sent a letter saying that scope for labs
040964 - at Kaiser performed to support examinations at UCSF should be
040965 - determined by Kaiser rather than by UCSF. ref SDS 27 RF4J
040967 - ..
040968 - On 090511 2313, Millie notified Doctor Rugo that case study on 090325,
040969 - ref SDS 14 KZ6N, shows UCSF has been setting the scope on labs at
040970 - Kaiser for the past 3 years that are used to guide the work for
040971 - Millie's care at UCSF on referral from Kaiser, ref SDS 28 YN4L
040973 - ..
040974 - On 090512 Millie went to Kaiser for the lab. ref SDS 29 6Z4F
040976 - ..
040977 - On 090513 1654 Millie submitted results of Kaiser's lab to UCSF,
040978 - ref SDS 30 N54I, and notifies Doctor Mason at Kaiser's Outside
040979 - Referrals Department about more mistakes at Kaiser that causes poor
040980 - coordination of Millie's care at UCSF on referral from Kaiser.
040981 - ref SDS 30 ZH6W, and follows up Doctor Mason's plan on 090420 for
040982 - Kaiser to work harder with greater diligence to avoid mistakes in
040983 - order to continue doing labs at Kaiser rather than include labs for
040984 - referral at UCSF for Millie's treatments at UCSF. ref SDS 20 8G3N
040986 - ..
040987 - Millie received a letter from Pam who works for Doctor Mason in
040988 - Kaiser's Outside Referrals Department, and asking why the Outside
040989 - Referrals Department was notified about mistakes at Kaiser performing
040990 - labs required for Millie's care at UCSF on referral from Kaiser.
040991 - ref SDS 31 2T5L
040993 - ..
040994 - Millie replied to Pam's letter explaining patient history assists
040995 - Doctor Mason evaluate requirements for effective coordination because
040996 - chronic mistakes at Kaiser can be avoided by performing labs at UCSF
040997 - for Millie's care at UCSF. ref SDS 32 PQ5N
040999 - ..
041000 - On 090514 0830 Millie met with Doctor Rugo, ref SDS 33 TP9L, and the
041001 - doctor prescribed treatment in the MPA clinical trial to help Millie
041002 - recover from the 8th relapse of cancer. ref SDS 33 A13N The doctor
041003 - was encouraged about powerful new treatments becoming available to
041004 - treat Millie, ref SDS 33 3F7M, but was very discouraged saying Kaiser
041005 - would never get on board to treat Millie's cancer as a chronic
041006 - disease. ref SDS 33 3F82
041008 - ..
041009 - Last night on 090514 2346, Millie sent a letter notifying the medical
041010 - team, ref SDS 34 LF3H, about the new MPA treatment prescribed by UCSF,
041011 - and cited the letter Doctor Rugo sent to Kaiser explaining prospects
041012 - for recover, ref SDS 34 WF9V; and Millie's letter further submitted
041013 - the agenda for meeting tomorrow with Doctor Johnson at Kaiser to
041014 - perform oversight review. ref SDS 34 WF9Y
041016 - ..
041017 - This morning, Millie received a reply from Doctor Rugo saying...
041019 - 1. Subject: Examination and Work Plan 7th Relapse IBC
041020 - Date: Fri, 15 May 2009 08:33:38 -0700
041028 - ..
041029 - 2. I want to reiterate, kindly but still, I just cannot read these
041030 - emails. I need bullets in a short email summarizing what you
041031 - are trying to communicate.
041033 - [On 090515 1017 Millie's reply to the medical team provided
041034 - some "bullets" at the top of letter that summarizes issues
041035 - presented, for the purpose of assisting the doctor, and as
041036 - requested in this part of Doctor Rugo's letter today.
041037 - ref SDS 35 6Q7R
041039 - ..
041040 - 3. I have heard from the referral group at Kaiser via Dr Johnson
041041 - that you should use your medicare to cover the care at UC,
041042 - nothing new, no authorization required. Next step is yours!
041044 - ..
041045 - Doctor Rugo's letter responding to Millie's letter last night on
041046 - 090514 2346, ref SDS 34 LF3H, and notifying Millie that Kaiser refuses
041047 - treatment for Millie to recover from the 8th relapse of cancer,
041048 - conflicts with Kaiser's requirements to provide care based on best
041049 - evidence, called out in Section 2 of EOC reviewed on 070927 1311.
041050 - ref SDS 6 WS6M, and further reflects Doctor Rugo's discouraged
041051 - comments yesterday during the meeting at UCSF saying that Kaiser would
041052 - never support Doctor Johnson's strategy to save lives, time, and money
041053 - by treating Millie's cancer as a chronic disease. ref SDS 33 3F82
041055 - [On 090520 1153 Paula in Kaiser's Memeber Services Claims
041056 - Resolution Department confirmed that Kaiser policy requires
041057 - doctors to use "best evidence" for prescribing effective
041058 - care. ref SDS 41 HX3O
041060 - ..
041061 - Doctor Rugo errs saying Kaiser's failure to perform insurance contract
041062 - requirements that the primary care physician order effective treatment
041063 - based on best evidence is "nothing new." ref SDS 0 WP6S Until today,
041064 - Kaiser has at all times prescribed, ordered, authorized, and provided
041065 - Millie's care, as required by EOC contract. Doctor Johnson has told
041066 - the patient repeatedly to have UCSF prescribe Millie's treatment, and
041067 - so is necessarily unprepared to provide treatment which Doctor Johnson
041068 - says is essential to start quickly to prevent cancer from spinning out
041069 - of control.
041071 - ..
041072 - [On 090515 1017 Millie notifies medical team that Doctor
041073 - Rugo's letter today was received, that Kaiser is
041074 - responsible for Millie's care, and Millie will meet with
041075 - the primary care doctor at Kaiser on 090515 1140 and
041076 - request that Kaiser prescribe care for Millie's 8th relapse
041077 - of cancer based on the best evidence, ref SDS 35 6Q8W, as
041078 - shown in Doctor Rugo's letter to Kaiser on 090514 0830.
041079 - ref SDS 33 DI63
041081 - ..
041082 - [On 090515 1518 Doctor Rugo responds wishing Millie "good
041083 - luck." ref SDS 37 PW7H
041085 - ..
041086 - [On 090515 1140 Millie met with Doctor Johnson at Kaiser
041087 - and the doctor said that he was told by Doctor Mason that
041088 - the primary care physician, Doctor Johnson, cannot
041089 - prescribe standard of care treatment for Millie in a
041090 - clinical trial, despite patient history having prescribed
041091 - prior clinical trials 4 times previously for standard of
041092 - care in oncology, and as a result Doctor Johnson requested
041093 - a draft to assist him preparing an appeal to file with
041094 - Member Services so that Kaiser can expedite Millie's
041095 - recovery from the 8th relapse of cancer. ref SDS 36 655R
041097 - ..
041098 - [On 090516 0858 Millie notified Doctor Rugo that Doctor
041099 - Johnson sponsoring appeal for Kaiser to treat Millie with
041100 - MPA protocol recommended by UCSF to recover from the 8th
041101 - relapse of cancer. ref SDS 38 SY4J
041103 - ..
041104 - [On 090518 0017 Millie submits letter to Doctor Johnson
041105 - with copy to Doctor Rugo at UCSF, and transmitting a draft
041106 - to assist Doctor Johnson file his appeal with Member
041107 - Services assisting Kaiser to implement Doctor Johnson's
041108 - strategy treating Millie's cancer as a chronic disease in
041109 - time for Millie to recover from the 8th relapse of cancer.
041110 - ref SDS 39 R16I
041112 - ..
041113 - [On 090519 1536 Doctor Johnson changed his mind; he sent
041114 - the draft appeal to Doctor Mason, and tells Millie to file
041115 - an appeal with Member Services, which is incorrect since at
041116 - this time Millie has not been denied medical services; and
041117 - the doctor further says he is suddenly relieved of
041118 - responsibility performed continuously the past 8 years to
041119 - prescribe treatment for Millie to recover from cancer,
041120 - because Kaiser's Outside Referrals Department has a better
041121 - understanding of Medicare. ref SDS 40 5K7H
041123 - ..
041124 - [On 090616 1245 Doctor Rugo advised that "everybody is now
041125 - on board" for Millie's treatment going forward, ref SDS 43
041126 - D647, referring to Millie's proposal on 090518 treating
041127 - "Stage V" patients for long term survival. ref SDS 39 W93Q