THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: May 16, 2009 08:58 AM Saturday;
Millie notifies Doctor Rugo that Doctor Johnson filing appeal for Kaiser
to provide treatment enabling Millie to recover 8th relapse of cancer.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 42 0000. ref SDS 40 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 As a first step to order treatment, Doctor
041007 - Rugo sent a letter to Kaiser recommending treatment for Millie with
041008 - the MPA protocol that is targeted to Millie's patient profile.
041009 - ref SDS 37 DI63
041011 - ..
041012 - On 090514 2346, Millie sent a letter notifying the medical team,
041013 - ref SDS 38 LF3H, about the new MPA treatment prescribed by UCSF, and
041014 - cited the letter Doctor Rugo sent to Kaiser explaining prospects for
041015 - recover, ref SDS 38 WF9V; and Millie's letter further submitted the
041016 - agenda for meeting tomorrow with Doctor Johnson at Kaiser to perform
041017 - oversight review. ref SDS 38 WF9Y
041019 - ..
041020 - On 090515 0952, Doctor Rugo sent a reply this morning to Millie and
041021 - the medical team saying that Kaiser notified UCSF that Kaiser refused
041022 - to treat Millie for recovering from the 8th relapse of cancer.
041023 - ref SDS 39 GR4O
041025 - ..
041026 - On 090515 1017, Millie notified the medical team that Kaiser is
041027 - responsible for her care, must prescribe treatment based on the best
041028 - evidence, and that Millie will meet with the primary care physician
041029 - today at 090515 1140 and support review for ordering treatment
041030 - recommended by Doctor Rugo, and in time to effective. ref SDS 40 EY5L
041032 - ..
041033 - On 090515 1140 Millie met with Doctor Johnson, primary care physician
041034 - at Kaiser to prescribe treatment for Millie's 8th relapse of cancer.
041035 - ref SDS 41 J47M The doctor asked Millie to assist him preparing an
041036 - appleal to Memeber Services for clarification of incorrect guidance he
041037 - received from Doctor Mason. ref SDS 41 655R
041039 - ..
041040 - On 090515 1518 Millie received a letter from Doctor Rugo wishing
041041 - Millie good luck. ref SDS 42 PW7H
041043 - ..
041044 - Today, on 090515 0907, Millie notified Doctor Rugo about results from
041045 - meeting with Doctor Johnson at Kaiser...
041047 - ..
041048 - Today, on 090515 0907, Millie notified Doctor Rugo that Doctor Johnson
041049 - is going to bat for Millie at Kaiser to prescribe treatment by filing
041050 - appeas with Memeber Services...
041052 - 1. Subject: Examination and Work Plan 7th Relapse IBC
041053 - Date: Sat, 16 May 2009 09:07:35 -0700
041054 - From: Millie Buck
041055 - To: "Rugo, Hope"
041057 - ..
041058 - 2. Had a good meeting with Doctor Johnson at Kaiser yesterday [on
041059 - 090515 1140, ref SDS 41 J47M, and as planned in Millie's letter
041060 - to the medical team on 090514 2314, ref SDS 38 WF9Y, and cited
041061 - again in Millie's letter yesterday on 090515 1017, ref SDS 40
041062 - EY5L, responding to Doctor Rugo's letter on 090515 0923
041063 - advising that Kaiser notified UCSF that Kaiser refuses to treat
041064 - Millie for recovering from the 8th relapse of cancer.
041065 - ref SDS 39 WP6S]
041067 - ..
041068 - 3. He feels frustrated by difficulties other patients he sees are
041069 - having getting care under Kaiser's new policy of cutting off
041070 - support for Medicare patients getting treatment with clinical
041071 - trials, since this has been a critical component for standard
041072 - of care in Kaiser Oncology.
041074 - ..
041075 - 4. Doctor Johnson agreed to sponsor an appeal on my behalf (which
041076 - Rod will help draft to save time), and submit to member
041077 - services. This is a very big issue for lots of folks, so any
041078 - ideas you may have are welcome. We will submit a draft to
041079 - Doctor Johnson probably on Sunday or early Monday, because time
041080 - is of the essence.
041082 - ..
041083 - 5. So I don't know if I will ever see you again, but I'm grateful
041084 - for your support, and for Doctor Johnson making a proactive
041085 - effort this time around.
041087 - [On 090518 0017 Millie submits letter to Doctor Johnson
041088 - with copy to Doctor Rugo at UCSF, and transmitting a draft
041089 - to assist Doctor Johnson file his appeal with Member
041090 - Services assisting Kaiser to implement Doctor Johnson's
041091 - strategy treating Millie's cancer as a chronic disease in
041092 - time for Millie to recover from the 8th relapse of cancer.
041093 - ref SDS 43 R16I
041095 - ..
041096 - [On 090519 1536 Doctor Johnson changed his mind; he sent
041097 - the draft appeal to Doctor Mason, and tells Millie to file
041098 - an appeal with Member Services, which is incorrect since at
041099 - this time Millie has not been denied medical services; and
041100 - the doctor further says he is suddenly relieved of
041101 - responsibility performed continuously the past 8 years to
041102 - prescribe treatment for Millie to recover from cancer,
041103 - because Kaiser's Outside Referrals Department has a better
041104 - understanding of Medicare. ref SDS 44 5K7H
041106 - ..
041107 - [On 090616 1245 Doctor Rugo advised that "everybody is now
041108 - on board" for Millie's treatment going forward, ref SDS 46
041109 - D647, referring to Millie's proposal on 090518 treating
041110 - "Stage V" patients for long term survival. ref SDS 43 W93Q
041112 - ..
041113 - Previously, the doctor was reluctant to support the patient, claiming
041114 - ignorance and lack of standing to treat the patient.