CONTACTS 
020304 -

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 52 0000. ref SDS 51 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
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 31 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 32 ZL6T  Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 31 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 32 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 31 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 32 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 31 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 31 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 31
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 31 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 31 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 32 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 32 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 32 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 33 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 34 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 34 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 35 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 36 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 36 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 37 RF4J
040967 -  ..
040968 - On 090511 2313, Millie notified Doctor Rugo that case study on 090325,
040969 - ref SDS 23 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 38 YN4L
040973 -  ..
040974 - On 090512 Millie went to Kaiser for the lab.  ref SDS 39 6Z4F
040976 -  ..
040977 - On 090513 1654 Millie submitted results of Kaiser's lab to UCSF,
040978 - ref SDS 40 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 40 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 30 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 41 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 42 PQ5N
040999 -  ..
041000 - On 090514 0830 Millie met with Doctor Rugo, ref SDS 43 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 43 A13N  The doctor
041003 - was encouraged about powerful new treatments becoming available to
041004 - treat Millie, ref SDS 43 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 43 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 43 DI63
041011 -  ..
041012 - On 090514 2346, Millie sent a letter notifying the medical team,
041013 - ref SDS 44 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 44 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 44 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 45 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 46 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 47 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 47 655R
041039 -  ..
041040 - On 090515 1518 Millie received a letter from Doctor Rugo wishing
041041 - Millie "good luck" assisting Kaiser perform the agreement to prescribe
041042 - standard of care treatment for Millie's 8th relapse of cancer.
041043 - ref SDS 48 PW7H
041045 -  ..
041046 - On 090516 0858, Millie notified Doctor Rugo that Doctor Johnson going
041047 - to bat for Millie at Kaiser to prescribe treatment by filing appeas
041048 - with Memeber Services. ref SDS 49 SY4O
041050 -  ..
041051 - On 090518 0017 prepared a draft appeal for Doctor Johnson to file with
041052 - Member Services on requirements for prescribing Millie's treament to
041053 - recover from the 8th relapse of cancer. ref SDS 50 R16I
041055 -  ..
041056 - On 090519 1536 Doctor Johnson responded to Millie's letter submitted
041057 - to Kaiser yesterday on 090518 0017, ref SDS 50 R16I, and telling
041058 - Millie he changed his mind and so would not expedite treatment by
041059 - sending an appeal to Member Services, and instead tells Millie to
041060 - submit an appeal for treatment to recover from Millie's 8th relapse of
041061 - cancer. ref SDS 51 5K7H
041063 -  ..
041064 - On 090519 1613 Millie responded, ref SDS 52 8V8H, to the Doctor's
041065 - letter earlier yesterday afternoon on 090519 1536, ref SDS 51 5K7H;
041066 - and, Millie asks the doctor to prescribe treatment so she can recover
041067 - from cancer, as done previously in patient history, ref SDS 52 TY3X,
041068 - and further as planned by the doctor during the meeting on 090515
041069 - 1140. ref SDS 47 655R  Millie also asked the doctor to call on
041070 - expediting treatment in time to be effective, see again on 090520
041071 - 1613, ref SDS 52 TY4W; and Millie asks Doctor Rugo for a "drop dead"
041072 - date on how soon treatment must start in order to be effective, also,
041073 - reported on 090519 1613. ref SDS 52 TX4W
041075 -  ..
041076 - On 090520 1052, since the doctor did not call nor write to respond to
041077 - Millie's letter on 090519 1613, this morning called Kaiser Oncology
041078 - Department and asked for Doctor Johnson to schedule treatment, and was
041079 - told the doctor would be busy in meetings all day and could not call
041080 - to schedule treatment for Millie. ref SDS 54 IW6O
041082 -  ..
041083 - Today, on 090520 1113 Millie received the following letter from Doctor
041084 - Johnson, responding to Millie's letter yesterday on 090519 1613
041085 - requesting that Kaiser prescribe treatment for the 8th relapse of
041086 - cancer. ref SDS 52 TY3X
041087 -
041088 -    1.  Subject:  Draft Appeal to Member Services Authorize Clinical Trial at UCSF
041089 -        Date: Wed, 20 May 2009 10:11:02 -0700
041096 -         ..
041097 -    2.  I offered Millie 2 possible current choices of treatment;
041098 -        single agent Navelbine or Gemzar.
041100 -         ..
041101 -    3.  I also counseled Millie regarding risk/benefits in heavily
041102 -        treated patients who are exhibiting signs of drug resistance.
041104 -  ..
041105 - This representation conflicts with understandings from the meeting at
041106 - Kaiser on 090515 1140; at that time the doctor said that Gemzar and
041107 - Navelbine are single-agent chemotherapy treatments which are not
041108 - appropriate for Millie patient profile because her blood counts cannot
041109 - hold up, and her metastatic disease has mutated through 8 relapses
041110 - over 8 years into aggressive cancer cells that resist these drugs,
041111 - reported on, 090515 1140, ref SDS 47 658J
041113 -             ..
041114 -            [On 090520 1137 Millie submitted a response to Kaiser and
041115 -            presenting understandings to Doctor Johnson that in the
041116 -            meeting at Kaiser on 090515 the doctor advised Millie that
041117 -            Gemzar and Navelbine were not appropriate for Millie's
041118 -            patient profile, and that he would get in trouble from an
041119 -            audit for prescribing these treatments for Millie at this
041120 -            stage of her care. ref SDS 55 SR5W
041122 -             ..
041123 -            [On 090520 1137 Millie submitted a response to Kaiser and
041124 -            noting Doctor Johnson confirms single-agent treatments
041125 -            present risks for Millie's patient profile. ref SDS 55 SR6U
041127 -             ..
041128 -            [On 090520 1203 Millie asks Kaiser Expedited Claims
041129 -            Department to assist the Oncology Department prescribing
041130 -            treatment appropriate for Millie's patient profile and in
041131 -            time to be effective. ref SDS 56 9595
041133 -             ..
041134 -            [On 090520 1710 Millie asks again for Kaiser to prescribe
041135 -            treatment and explain trade-offs between treatment options
041136 -            for Millie to recover from the 8th relapse of cancer.
041137 -            ref SDS 57 ZF4Y
041139 -             ..
041140 -            [On 090521 2006 Millie received a letter from Doctor
041141 -            Johnson saying Millie can choose which next treatment
041142 -            regimen that Millie wants, and that no treatment would be
041143 -            considered more superior than another, ref SDS 58 UD5H; the
041144 -            doctor says Millie needs urgent treatment and so should
041145 -            notify Kaiser which treatment Millie chooses by the end of
041146 -            the week, which is the next day in roughly 12 hours.
041147 -            ref SDS 58 HC8O; the doctor further tells Millie to call
041148 -            Medicare for prescribing appropriate treatment. ref SDS 58
041149 -            HC93
041151 -             ..
041152 -            [On 090605 1447 Millie received documentation from Kaiser
041153 -            with additional problems Gemzar presents for Millie's
041154 -            patient profile, saying that Gemzar requires extreme
041155 -            caution given after a patient has been treated with
041156 -            radiation, which Millie received for 4 weeks in February
041157 -            and March, and contiues to suffer side effects; Kaiser
041158 -            further says treatment with Gemzar requires avoiding blood
041159 -            thinners, and Millie is required to take blood thinners
041160 -            every day for PE. ref SDS 59 V34K
041162 -         ..
041163 -    4.  I suggested that Member Services and Outside Authorizations
041164 -        will have to interpret the regulations regarding Clinical
041165 -        Trials at UCSF.
041166 -
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