CONTACTS 
0206 - CMS Region 9                                                                                                                                                       O-00000877 0605
020601 - Ms. Jullin Kwok; Kaiser Contract Manager                                                                                                                         O-00000877 0605
020603 - Kaiser Medicare Contract                                                                                                                                         O-00000877 0605

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 45 0000. ref SDS 44 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090519 1613 Millie responded, ref SDS 34 8V8H, to the Doctor's
040902 - letter earlier yesterday afternoon on 090519 1536, ref SDS 33 5K7H;
040903 - and, Millie asks the doctor to prescribe treatment so she can recover
040904 - from cancer, as done previously in patient history, ref SDS 34 TY3X,
040905 - and further as planned by the doctor during the meeting on 090515
040906 - 1140. ref SDS 32 655R  Millie also asked the doctor to call on
040907 - expediting treatment in time to be effective, see again on 090520
040908 - 1613, ref SDS 34 TY4W; and Millie asks Doctor Rugo for a "drop dead"
040909 - date on how soon treatment must start in order to be effective, also,
040910 - reported on 090519 1613. ref SDS 34 TX4W
040912 -  ..
040913 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
040914 - ref SDS 39 ZF4Q, then on 090521 0211 Millie's letter to Doctor Rugo at
040915 - UCSF with copy to Doctor Hsu asks about getting treatment with
040916 - hyperthermia and Doxil, while Kaiser resolves delays ordering MPA
040917 - prescribed by Doctor Rugo for Millie to recover from 8th relapse of
040918 - cancer, which Millie reports is getting worse every day, ref SDS 40
040919 - FM7Q, and since Kaiser has previosuly authorized treatment with
040920 - hyperthermia and Doxil, which Doctor Rugo recommended earlier on
040921 - 090129 for Millie to recover from the 7th relapse. ref SDS 40 6M4F
040923 -  ..
040924 - On 090521 2006, Millie received a letter from Doctor Johnson
040925 - responding to Millie's letter to the medical team on 090520 1710, and
040926 - requesting that Kaiser prescribe treatment suitable for Millie's
040927 - patient profile for recovering from 8th relapse of cancer. ref SDS 39
040928 - P65H   Doctor Johnson's letter was sent through Kaiser's Knowledge
040929 - Management System and so was not disclosed to the medical team, and it
040930 - did transmit the Doctor Johnson's medical chart for the meeting on
040931 - 090515, ref SDS 31 YT5N, and said that Millie could "choose" any
040932 - treatment she wants, and no treatment is superior for Millie's patient
040933 - profile, 090521 2006, ref SDS 42 9Q9H; the doctor noted Millie's
040934 - cancer is progressing and so she needs to start treatment by the end
040935 - of the week, which was in just 12 hours, which means today,
040936 - ref SDS 42 HC8O, and the doctor told Millie to call Medicare for
040937 - prescribing treatment to recover from the 8th relapse of cancer.
040938 - ref SDS 42 HC93
040940 -  ..
040941 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
040942 - 2006 and submitted copies to the medical team to maintain
040943 - collaboration that has been effective treating Millie the past 8
040944 - years.  Millie also sent a copy to Jullian Kwok to notify Medicare
040945 - that Kaiser is refusing treatment. ref SDS 43 RX6L  Millie asked
040946 - Kaiser to prepare a workup and Tumor Board to evaluate Millie's next
040947 - treatment, including trade-offs comparing all of the treatments
040948 - available for Millie. ref SDS 43 7Z5Y  Millie reports having called
040949 - Kaiser numerous times to speak with the doctor on prescribing
040950 - treatment. ref SDS 43 7Z9Y  Millie notifies medical team she chooses
040951 - hyperthermia and radiation, Doxil, or other agent suitable for
040952 - Millie's patient profile. ref SDS 43 715V
040954 -  ..
040955 - On 090522 1247 Millie received a response from Doctor Johnson to
040956 - Millie's letter on 090522 0813. ref SDS 43 RX6L who sent copies to the
040957 - medical team, and saying Kaiser has performed workups, but does not
040958 - submit any works, and says Millie's patient profile is too complex for
040959 - Tumor Board to evaluate best course of treatment, and that Millie's
040960 - patient profile resists single agent treatments like Gemzar and
040961 - Navelbine, and that Millie can choose Hospice instead of treatment
040962 - with drugs which her patient profile now resists. ref SDS 44 XO5O
040964 -  ..
040965 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
040966 - Johnson on 090522 1247, ref SDS 44 XO5O, confirming Millie needs
040967 - urgent treatment to start quickly, reported on 090522 1351,
040968 - ref SDS 45 7R7J; Millie asks if treatment with Gemzar and Navelbine
040969 - will be weeks of agony then progression of cancer that requires
040970 - another treatment "targeted" to treat Millie's patient profile.
040971 - ref SDS 45 2T4S  Millie requested advice on treatment with a clinical
040972 - trial at Kaiser, based on patient history, ref SDS 45 2T4V, and
040973 - further requested trade-offs getting more hyperthermia and radiation
040974 - and Doxil or other appropriate agent, including vaccines. ref SDS 45
040975 - 2T4Y
040976 -
040978 -  ..
040979 - Millie Over-treated Cannot Estimate Time to Progression
040980 - May Not Work at All Millie Over-treated Patient Profile Resists Chemo
040981 - Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
040982 - Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
040983 -
040984 - On 090522 1953 Millie received a letter from Doctor Johnson responding
040985 - to Millie's letter to the medical team at Kaiser and UCSF this
040986 - afternoon, reported on 090522 1351. ref SDS 45 7R7J  For some reason,
040987 - the doctor he did not submit copies to the medical team, demonstrating
040988 - uneven case management for coordination and collaboration; the doctor
040989 - confirms that treatment with single-agent chemotherapies presented as
040990 - the only choices for care may not work at all for Millie to recover
040991 - from 8th relapse of cancer. ref SDS 0 NV4L
040992 -
040993 -    1.  Subject:  Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
040994 -        Date: Fri, 22 May 2009 17:54:34 -0700
040998 -         ..
040999 -    2.  Usually CPT 11 is used in the treatment of colon cancer [Millie
041000 -        asked the medical team about CPT 11 being another name for
041001 -        bevacizumab, which Millie was given in 2004 and caused
041002 -        pulmonary embolism, reported on 090522 1351, ref SDS 45 2T9W]
041004 -  ..
041005 - The doctor does not confirm nor clarify correlations between CPT 11
041006 - which he listed in Millie's medical chart, and bevacizumab; nor
041007 - comment on whether this was a mistake; nor does the doctor explain
041008 - additional choices for treating Millie, contrary to Millie's request
041009 - in the letter on 090522 0813. ref SDS 43 715R
041011 -  ..
041012 - Kaiser's letter to Millie continues...
041013 -
041014 -    3.  I have no idea about time to progression with any of these
041015 -        agents because you are so over treated.  Unfortunately, they
041016 -        may not work at all.  That is what happens when you develop
041017 -        resistant disease.
041019 -  ..
041020 - Kaiser proposed treating Millie with Gemzar and Navelbine, saying
041021 - these are "good choices and known choices, listed in Doctor Johson's
041022 - letter on 090522 1247. ref SDS 44 4Q8H  Today, Kaiser discloses
041023 - knowing that these drugs may not work at all for Millie's complex
041024 - patient profile, listed on 090213 1140, ref SDS 21 ES7I, and in fact
041025 - the doctor has no idea how Millie will respond.
041026 -
041027 -            [On 090523 0148 Millie presents demand for timely care to
041028 -            Kaiser Member Services Claims Resolution. ref SDS 46 DQ8S
041030 -             ..
041031 -            [On 090528 1228 Kaiser failed to perform requirements to
041032 -            provide care; Millie notifies Kaiser she will get treatment
041033 -            and bill Kaiser, as prescribed by insurance agreement.
041034 -            ref SDS 47 4N4S
041036 -             ..
041037 -            [On 090531 1544 Millie notifies medical team of fears that
041038 -            treatment with Gemzar will weaken and devestate her with
041039 -            side effects and rising cancer, with zero quality of life,
041040 -            ref SDS 48 IH9S].
041042 -             ..
041043 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041044 -            and advised that Doctor Johnson prescribed treatment for
041045 -            Millie with Gemzar; advised that side effects of Gemzar
041046 -            will be very difficult for Millie to tolerate, and asked to
041047 -            verify that Millie agrees to get this treatment.
041048 -            ref SDS 49 8J8L
041050 -             ..
041051 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041052 -            and advised that Gemzar may not be effective for Millie
041053 -            because she has already had 8 different chemotherapy drugs;
041054 -            concerned that weakened immune system will cause infection
041055 -            and death. ref SDS 49 JH4K
041057 -             ..
041058 -            [On 090603 1128 Millie asks medical team again for work
041059 -            plan with criteria to evaluate progression of her cancer
041060 -            getting Gemzar chemotherapy, and with a list of additional
041061 -            treatments targeted to Millie's patient profile after
041062 -            Gemzar fails, which is expected not to work at all.
041063 -            ref SDS 50 028X
041065 -             ..
041066 -            [On 090603 1412 Doctor Johnson's reply letter to Millie did
041067 -            not respond with criteria for evaluating progression of
041068 -            disease, and when treatment must be changed. 090603 1507,
041069 -            ref SDS 51 07AD
041071 -             ..
041072 -            [On 090603 1524 Queenie called from Kaiser Pharmacy and
041073 -            Millie asks for criteria Kaiser will use to evaluate
041074 -            progressio of disease that signals requirement to change
041075 -            treatments; Queenie will discuss with the doctor and send a
041076 -            letter confirming understandings on Kaiser's work plan,
041077 -            including serious side effects of Gemzar. ref SDS 52 7J4I
041079 -             ..
041080 -            [On 090605 Millie received documentation from Kaiser that
041081 -            says Gemzar has high risks for Millie's patient profile;
041082 -            requires extreme caution given after getting treatment with
041083 -            radiation, which Millie received for 4 weeks in February
041084 -            and March, and contiues to suffer side effects; Kaiser
041085 -            further says treatment with Gemzar requires avoiding blood
041086 -            thinners, and Millie is required to take blood thinners
041087 -            every day to prevent death from pulmonary embolism; Gemzar
041088 -            can cause low blood counts that leads to infection and
041089 -            death, Millie has a history of low blood counts.
041090 -            ref SDS 53 V34K
041092 -  ..
041093 - Doctor Johnson confirms prior guidance that Millie's patient profile
041094 - resists single-agent chemotherapy treatments, and so requires
041095 - "targeted" drugs that destroy only cancer, and have minimal side
041096 - effects so that Millie can optimize treatment dose, as done with
041097 - cetuximab successfully for 2 years at UCSF, planned at Kaiser on
041098 - 070105,
041099 -
041112 -
041113 -
041114 -
041115 -
041116 -
041117 -
041118 -
041119 -
041120 -
041121 -
041122 -
041123 -
041124 -
041125 -
041126 -
041127 -
0412 -