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 10:17 AM Friday;
Medical team notified Kaiser responsible to treat 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 39 0000. ref SDS 38 0000.
040507 - ..
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 25 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 26 ZL6T Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 25 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 26 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 25 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 26 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 25 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 25 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 25
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 25 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 25 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 26 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 26 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 26 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 27 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 28 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 28 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 29 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 30 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 30 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 31 RF4J
040967 - ..
040968 - On 090511 2313, Millie notified Doctor Rugo that case study on 090325,
040969 - ref SDS 18 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 32 YN4L
040973 - ..
040974 - On 090512 Millie went to Kaiser for the lab. ref SDS 33 6Z4F
040976 - ..
040977 - On 090513 1654 Millie submitted results of Kaiser's lab to UCSF,
040978 - ref SDS 34 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 34 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 24 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 35 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 36 PQ5N
040999 - ..
041000 - On 090514 0830 Millie met with Doctor Rugo, ref SDS 37 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 37 A13N The doctor
041003 - was encouraged about powerful new treatments becoming available to
041004 - treat Millie, ref SDS 37 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 37 3F82
041008 - ..
041009 - Last night on 090514 2346, Millie sent a letter notifying the medical
041010 - team, ref SDS 38 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 38 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 38 WF9Y
041016 - ..
041017 - Doctor Rugo sent a reply this morning to Millie and the medical team
041018 - saying that Kaiser notified UCSF that Kaiser refused to treat Millie
041019 - for recovering from the 8th relapse of cancer. ref SDS 39 GR4O
041021 - ..
041022 - Millie notified the medical team that Kaiser is responsible for her
041023 - care must prescribe treatment based on the best evidence...
041025 - 1. Subject: Examination and Work Plan 7th Relapse IBC
041026 - Date: Fri, 15 May 2009 10:24:46 -0700
041034 - ..
041035 - 2. Here are a few "bullets" that summarize analysis in this letter
041036 - [responding to Doctor Rugo's request for summary
041037 - communications, ref SDS 39 GR4O]...
041039 - ..
041040 - 1. Kaiser is liable for the cost of my care under EOC section
041041 - 2.
041043 - ..
041044 - 2. Kaiser EOC section 7 on clinical trials says the provider
041045 - (here UCSF) must disclose the costs of care I will be
041046 - charged for 20% coinsurance in order for the patient to
041047 - determine ability to pay, i.e., what are my co-payment
041048 - charges for the care you propose?
041050 - [On 090529 1109 Millie asks Doctor Rugo again for the
041051 - amount UCSF will charge Millie for treatment to recover
041052 - from 8th relapse of cancer, and citing Kaiser guidance.
041053 - ref SDS 44 0M6Y
041055 - ..
041056 - [On 090531 2227 Kaiser failed to perform, UCSF failed
041057 - to disclose coinsurance charges, so Millie asked UCSF
041058 - if a deposit is required to arrange for starting urgent
041059 - treatment quickly at UCSF. ref SDS 45 GH3R
041061 - ..
041062 - 3. If I can afford co-payments at UCSF, I would love to
041063 - participate in the clinical trial you propose for treating
041064 - my 7th relapse, cited in your letter yesterday, because it
041065 - provides the best chance for continued quality of life.
041067 - ..
041068 - 4. If I cannot afford the cost of the clinical trial, then
041069 - Kaiser must prescribe my treatment and demonstrate this
041070 - meets requirements for quality care of my patient profile.
041072 - [On 090520 1153 Paula advised that Kaiser must
041073 - prescribed treatment based on best evidence. ref SDS 43
041074 - 4M9G
041076 - ..
041077 - 3. Thanks for timely response in your letter this morning
041078 - notifying that Kaiser proposes using Medicare at this time for
041079 - treatment of my 7th relapse of IBC, ref SDS 39 WP6S, diagnosed
041080 - in your letter to Kaiser yesterday [reported on 090514 0830,
041081 - ref SDS 37 DI63, and cited in Millie's letter to the medical
041082 - team also 090514 2346. ref SDS 38 WF9V]. I am seeing Doctor
041083 - Johnson this morning at 1140, and will ask for Kaiser's
041084 - prescription of care under EOC section 2.
041086 - [On 090520 1153 Paula advised that Kaiser must
041087 - prescribed treatment based on best evidence. ref SDS 43
041088 - 4M9G
041090 - ..
041091 - 4. Kaiser attempted to force "self-referral" during 2007, which
041092 - conflicted with the record showing Kaiser referred my care to
041093 - UCSF under EOC section 2 [reported on 061230, ref SDS 4 3X6K,
041094 - and on 070927. ref SDS 8 WS6M, and discussed with Paula McPhail
041095 - in Kaiser's Appeals Department on 071006. ref SDS 9 TM59]. In
041096 - that case, UCSF attempted to collect some $20K - $30K annually
041097 - from me for so called "co-insurance." [also reviewed on 071006,
041098 - ref SDS 9 PRWW]. We were never able to get UCSF to give a
041099 - total cost nor to justify any amount billed [reviewed with
041100 - Paula on 071006, ref SDS 9 454M]. Initial review showed many
041101 - errors in the first UCSF billing [reported on 070830,
041102 - ref SDS 7 7X5G]. Kaiser eventually performed their obligation
041103 - under EOC section 2 [reported on 071128, ref SDS 10 TH8L].
041104 - They used their expertise and standing to force UCSF through
041105 - normal accounting and auditing to correct errors and
041106 - overcharges in billings. I do not have the capacity to perform
041107 - that function. I do not have the energy, time, nor expertise
041108 - to wade through UCSF billings. I cannot withstand constant
041109 - calls from UCSF bill collectors harassing me for money that is
041110 - not owed.
041112 - ..
041113 - 5. Kaiser's EOC section 7 says that in the event of patient
041114 - self-referral for a clinical trial, the provider must notify
041115 - Kaiser of the amount that will be billed to the patient for 20%
041116 - self-referral co-insurance costs. EOC section 2 says the
041117 - primary care provider is responsible to coordinate referral
041118 - arrangements for covered services, here Oncology. The primary
041119 - care physician can then say to the patient you can get this
041120 - "xyz" care at UCSF for "x" amount of dollars for co-insurance
041121 - per treatment, or I can give another treatment with other
041122 - expected outcomes and you will be billed your normal co-payment
041123 - costs at Kaiser.
041125 - ..
041126 - 6. If UCSF and Kaiser will come up with a cost per treatment, and
041127 - I can afford it, then I will waive my rights under EOC for
041128 - Kaiser to be liable for my care, and go forward with the
041129 - Medicare scenario presented in your letter this morning.
041130 - However, at all times I reserve my entitlement for my doctor to
041131 - prescribe my care, and for Kaiser to pay for that care.
041133 - [On 090520 1153 Paula advised that Kaiser must
041134 - prescribed treatment based on best evidence. ref SDS 43
041135 - 4M9G
041137 - ..
041138 - 7. Previously, UCSF has refused to notify me prospectively of the
041139 - costs I will be charged, and Kaiser has refused to coordinate
041140 - the work to obtain costs in advance of ordering work on
041141 - referral for clinical trials, as called out in the EOC. So, we
041142 - have a complex problem, which hopefully can be resolved
041143 - equitably in time for care to be effective.
041145 - ..
041146 - 8. Ideally, Doctor Johnson can turn to support in the Outside
041147 - Referral office, and Doctor Rugo can turn to support in the
041148 - many and varied accounting offices at UCSF to run the numbers
041149 - so there is agreement in advance of getting care what I will be
041150 - charged.
041152 - ..
041153 - 9. Looking forward to meeting Doctor Johnson this morning at 1140
041154 - for guidance on getting the care recommended in your letter
041155 - yesterday.
041157 - [On 090515 1140 Millie met with Doctor Johnson at Kaiser and
041158 - the doctor said that he was told by Doctor Mason that the
041159 - primary care physician, Doctor Johnson, cannot prescribe
041160 - treatment for Millie in a clinical trial, despite patient
041161 - history having prescribed prior clinical trials 4 times
041162 - previously, and as a result Doctor Johnson requested a draft
041163 - to assist him preparing an appeal to file with Member
041164 - Services so that Kaiser can expedite Millie's recovery from
041165 - the 8th relapse of cancer. ref SDS 40 655R
041167 - ..
041168 - [On 090518 0017 Millie submits letter to Doctor Johnson
041169 - with copy to Doctor Rugo at UCSF, and transmitting a draft
041170 - to assist Doctor Johnson file his appeal with Member
041171 - Services assisting Kaiser implement Doctor Johnson's
041172 - strategy to treat Millie's cancer as a chronic disease in
041173 - time for Millie to recover from the 8th relapse of cancer.
041174 - ref SDS 41 R16I
041176 - ..
041177 - [On 090519 1536 Doctor Johnson changed his mind; he sent
041178 - the draft appeal to Doctor Mason, and tells Millie to file
041179 - an appeal with Member Services, which is incorrect since at
041180 - this time Millie has not been denied medical services; and
041181 - the doctor further says he is suddenly relieved of
041182 - responsibility performed continuously the past 8 years to
041183 - prescribe treatment for Millie to recover from cancer,
041184 - because Kaiser's Outside Referrals Department has a better
041185 - understanding of Medicare. ref SDS 42 5K7H
041187 - ..
041188 - [On 090616 1245 Doctor Rugo advised that "everybody is now
041189 - on board" for Millie's treatment going forward, ref SDS 47
041190 - D647, referring to Millie's proposal on 090518 treating
041191 - "Stage V" patients for long term survival. ref SDS 41 W93Q
041193 - ..
041194 - 10. By copy to Pam in Outside Referrals, notifying Kaiser
041195 - management that I hold Kaiser liable for costs of my care
041196 - prescribed by my doctor. I am further notifying Paula in
041197 - Kaiser's claims department that we may need additional support
041198 - to align this transaction with EOC requirements for Kaiser to
041199 - provide treatment in time to be effective.
041201 - ..
041202 - [On 090520 1153 Paula advised that Kaiser must prescribed
041203 - treatment based on best evidence. ref SDS 43 4M9G