CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 74 0000, ref SDS 73 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090121 1041 Glenna called and said that progression of Millie's
040902 - cancer, most notably in the breastbone area requires UCSF to change
040903 - treatments, as ordered by Doctor Johnson at Kaiser on 081219.  Doctor
040904 - Rugo needs a list of treatments from Millie's records which UCSF has
040905 - planned to treat Millie's cancer as a chronic disease, ref SDS 20 Y67L,
040906 - further ordered by Doctor Johnson at Kaiser on 081219. ref SDS 19 V93O
040908 -  ..
040909 - On 090123 1326 Doctor Johnson confirms prior guidance that multiple
040910 - (7) relapses have mutated Millie's cancer into a very aggressive
040911 - disease that requires immediate change in treatment in order for
040912 - Millie to recover. ref SDS 22 RK6O
040914 -  ..
040915 - On 090129 0800 UCSF delayed Millie's treatment 1 week due to problems
040916 - of missed communication between Oncology and Infusion, reported on
040917 - 090130 1722. ref SDS 23 AY8Q
040919 -  ..
040920 - On 090129 1036 Doctor Rugo at UCSF notified Kaiser that Millie needs
040921 - immediate treatment to recover from 7th relapse of cancer, which is
040922 - worse in the breastbone area, and proposes treatment in UCSF Radiation
040923 - Oncology Department with hyperthermia and Doxil, reported on 090130
040924 - 1722. ref SDS 23 TZ6H
040926 -  ..
040927 - On 090201 2017 UCSF delayed treatment for Millie's 7th relapse of
040928 - cancer, because the Radiation Oncology Department needed more time to
040929 - schedule the work. ref SDS 24 GV4M
040931 -  ..
040932 - On 090202 1047 Kaiser delayed authorization for Millie's treatment
040933 - because the doctor did not fill out a form correctly referring
040934 - Millie's treatment to UCSF. ref SDS 25 9Y5I
040936 -  ..
040937 - On 090202 1353 UCSF delayed treatment again for 6 weeks to maintain an
040938 - orderly schedule. ref SDS 26 SP6H
040940 -  ..
040941 - On 090202 1932 Doctor Rugo at UCSF Oncology Department notified the
040942 - medical team that Millie needs urgent treatment quickly in time to be
040943 - effective. ref SDS 27 Y15J
040945 -  ..
040946 - On 090203 1438 UCSF Radiation Oncology Department advances Millie's
040947 - treatment 4 weeks to begin in time to be effective. ref SDS 28 XX5I
040949 -  ..
040950 - On 090204 0219 Millie's letter asks Doctor Rugo to submit proactive
040951 - planning for follow on treatment after hyperthermia and Doxil for
040952 - Millie's 6th relapse of IBC. ref SDS 29 278T
040954 -  ..
040955 - On 090204 1914 Doctor Rugo defers teamwork for practice synergy and
040956 - proactive management to plan for alternate scenarios that optimize
040957 - coprehensive care is prevented because Millie's case is very
040958 - complicated. ref SDS 30 063I
040960 -  ..
040961 - On 090205 0830 Doctor Hsu examination in UCSF Radiation Oncology
040962 - Department finds Millie's cancer has progressed significantly due to
040963 - delays starting treatment; changes treatment protocol from
040964 - hyperthermia and Doxil to radiation and hyperthermia. ref SDS 31 EY5F
040966 -  ..
040967 - On 090213 1140 Doctor Johnson notifies Millie that she has less than 1
040968 - year to live, ref SDS 33 646L, unless she gets effective treatment
040969 - quickly for cancer that has mutated into aggressive disease that will
040970 - cascade out of control. ref SDS 33 ES7I
040972 -  ..
040973 - On 090218 1205 Millie notifies Doctor Rugo again that Doctor Johnson
040974 - has authorized UCSF Cancer Center to begin planning Millie's next
040975 - treatment after radiation and hyperthremia, because she has a narrow
040976 - margin for delay getting treatment to survive. ref SDS 34 TH6U
040978 -  ..
040979 - On 090219 1315 UCSF begins treatment 4-weeks late on referral from
040980 - Kaiser for Millie to recover from 7th relapse of cancer. ref SDS 35
040981 - E57G
040983 -  ..
040984 - On 090310 0351 after 3-weeks treatment with radiation and
040985 - hyperthermia Millie notifies medical team that cancer in the
040986 - breastbone area seems worse. ref SDS 37 O56X
040988 -  ..
040989 - On 090331 2947 Millie notified medical team of possible IBC
040990 - progression on lower left arm, and asked about starting treatment to
040991 - recover from 8th relapse of cancer. ref SDS 41 Q64R
040993 -  ..
040994 - On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower left
040995 - arm as progression of IBC. ref SDS 42 R24X
040997 -  ..
040998 - On 090401 0046 Millie asks about getting treatment of IBC spreading to
040999 - lower left arm, which establishes the 8th relapse of cancer diagnosed
041000 - by Doctor Hsu. ref SDS 43 RE8P
041002 -  ..
041003 - On 090401 0121 Doctor Rugo reports Millie's wound in breastbone area
041004 - diagnosed as reaction to 4-weeks of radiation that ended on 090317
041005 - must heal before starting treatment for IBC relapse, and so defers the
041006 - meeting scheduled on 090402 0800; Doctor Rugo expects full recovery
041007 - from IBC in areas treated with radiation and hyperthermia because this
041008 - regimen to be very effective. ref SDS 44 K56O
041010 -  ..
041011 - On 090412 2241 Millie reports again to the medical team that IBC on
041012 - lower left arm is getting worse, and requests immediate treatment in
041013 - order to prevent problems cited by Doctor Johnson that delay risks
041014 - losing control and death. ref SDS 45 9S8Y
041016 -  ..
041017 - On 090510 1220 Millie reports wound in the breastbone diagnosed as
041018 - reaction to radiation looks worse; asks if this might be IBC because
041019 - of a mistake in performing radiation treatments?   Millie further
041020 - asked about doing a biopsy to test for cancer, so that treatment can
041021 - begin immediately under Doctor Johnson's warning that immediate
041022 - treatment is essential for recovery. ref SDS 47 LJ5T
041024 -  ..
041025 - On 090514 0830 Doctor Rugo prescribes treatment with MPA, ref SDS 48
041026 - D647, and submits a letter to Kaiser submitting the protocol,
041027 - ref SDS 48 DI63, as previously requested by Doctor Johnson on 081219
041028 - 1140. ref SDS 19 V93O
041030 -  ..
041031 - On 090515 0800 Doctor Rugo notifies medical team that Kaiser failed to
041032 - perform requirements for referral to pay for Millie's treatment
041033 - recommended by UCSF Cancer Center as the best evidence of care that
041034 - has the best chance for Millie to recover, which Kaiser is required to
041035 - provide under section 2 of EOC. ref SDS 49 WP6S
041037 -  ..
041038 - On 090515 1017 Millie notified medical team that Doctor Rugo's letter
041039 - was received; that Kaiser is responsible for Millie's care, and Millie
041040 - will meet with the primary care doctor at Kaiser on 090515 1140 and
041041 - request that Kaiser prescribe care for Millie's 8th relapse of cancer
041042 - based on the best evidence, ref SDS 50 6Q8W, as shown in Doctor Rugo's
041043 - letter to Kaiser on 090514 0830. ref SDS 48 DI63
041045 -  ..
041046 - On 090515 1518 Doctor Rugo responds wishing Millie "good luck."
041047 - ref SDS 52 PW7H
041049 -  ..
041050 - On 090515 1140 Millie met with Doctor Johnson at Kaiser and the doctor
041051 - said that he was told by Doctor Mason that the primary care physician,
041052 - Doctor Johnson, cannot prescribe standard of care treatment for Millie
041053 - in a clinical trial, despite patient history having prescribed prior
041054 - clinical trials 4 times previously for standard of care in oncology,
041055 - and as a result, Doctor Johnson requested a draft to assist him
041056 - preparing an appeal to file with Member Services so that Kaiser can
041057 - expedite Millie's recovery from the 8th relapse of cancer. ref SDS 51
041058 - 655R
041060 -  ..
041061 - On 090516 0858 Millie notified Doctor Rugo that Doctor Johnson is
041062 - filing an appeal for Kaiser to treat Millie with MPA protocol
041063 - recommended by UCSF to recover from the 8th relapse of cancer.
041064 - ref SDS 53 SY4J
041066 -  ..
041067 - On 090518 0017 Millie submits letter to Doctor Johnson with copy to
041068 - Doctor Rugo at UCSF, and transmitting a draft to assist Doctor Johnson
041069 - filing his appeal with Member Services to assisting Kaiser implement
041070 - Doctor Johnson's strategy to treat Millie's cancer as a chronic
041071 - disease in time for Millie to recover from the 8th relapse of cancer.
041072 - ref SDS 54 R16I
041074 -  ..
041075 - On 090519 1536 Doctor Johnson changed his mind; he sent the draft
041076 - appeal to Doctor Mason, and tells Millie to file an appeal with Member
041077 - Services, which is incorrect since at this time Millie has not been
041078 - denied medical services; and the doctor further says he is suddenly
041079 - relieved of responsibility performed continuously the past 8 years to
041080 - prescribe treatment for Millie to recover from cancer, because
041081 - Kaiser's Outside Referrals Department has a better understanding of
041082 - Medicare. ref SDS 55 5K7H
041084 -  ..
041085 - On 090519 1613 Millie responded, ref SDS 56 8V8H, to the Doctor's
041086 - letter earlier yesterday afternoon on 090519 1536, ref SDS 55 5K7H;
041087 - and, Millie asks the doctor to prescribe treatment so she can recover
041088 - from cancer, as done previously in patient history, ref SDS 56 TY3X,
041089 - and further as planned by the doctor during the meeting on 090515
041090 - 1140. ref SDS 51 655R  Millie also asked the doctor to call on
041091 - expediting treatment in time to be effective, see again on 090520
041092 - 1613, ref SDS 56 TY4W; and Millie asks Doctor Rugo for a "drop dead"
041093 - date on how soon treatment must start in order to be effective, also,
041094 - reported on 090519 1613. ref SDS 56 TX4W
041096 -  ..
041097 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
041098 - ref SDS 62 ZF4Q, then on 090521 0211 Millie's letter to Doctor Rugo at
041099 - UCSF with copy to Doctor Hsu asks about getting treatment with
041100 - hyperthermia and Doxil, while Kaiser resolves delays ordering MPA
041101 - prescribed by Doctor Rugo for Millie to recover from 8th relapse of
041102 - cancer, which Millie reports is getting worse every day, ref SDS 63
041103 - FM7Q, and since Kaiser has previosuly authorized treatment with
041104 - hyperthermia and Doxil, which Doctor Rugo recommended earlier on
041105 - 090129 for Millie to recover from the 7th relapse. ref SDS 63 6M4F
041107 -  ..
041108 - On 090521 2006, Millie received a letter from Doctor Johnson
041109 - responding to Millie's letter to the medical team on 090520 1710, and
041110 - requesting that Kaiser prescribe treatment suitable for Millie's
041111 - patient profile for recovering from 8th relapse of cancer. ref SDS 62
041112 - P65H   Doctor Johnson's letter was sent through Kaiser's Knowledge
041113 - Management System and so was not disclosed to the medical team, and it
041114 - did transmit the Doctor Johnson's medical chart for the meeting on
041115 - 090515, ref SDS 51 YT5N, and said that Millie could "choose" any
041116 - treatment she wants, and no treatment is superior for Millie's patient
041117 - profile, 090521 2006, ref SDS 65 9Q9H; the doctor noted Millie's
041118 - cancer is progressing and so she needs to start treatment by the end
041119 - of the week, which was in just 12 hours, which means today,
041120 - ref SDS 65 HC8O, and the doctor told Millie to call Medicare for
041121 - prescribing treatment to recover from the 8th relapse of cancer.
041122 - ref SDS 65 HC93
041124 -  ..
041125 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
041126 - 2006 and submitted copies to the medical team to maintain
041127 - collaboration that has been effective treating Millie the past 8
041128 - years.  Millie also sent a copy to Jullian Kwok to notify Medicare
041129 - that Kaiser is refusing treatment. ref SDS 66 RX6L  Millie asked
041130 - Kaiser to prepare a workup and Tumor Board to evaluate Millie's next
041131 - treatment, including trade-offs comparing all of the treatments
041132 - available for Millie. ref SDS 66 7Z5Y  Millie reports having called
041133 - Kaiser numerous times to speak with the doctor on prescribing
041134 - treatment. ref SDS 66 7Z9Y  Millie notifies medical team she chooses
041135 - hyperthermia and radiation, Doxil, or other agent suitable for
041136 - Millie's patient profile. ref SDS 66 715V
041138 -  ..
041139 - On 090522 1247 Millie received a response from Doctor Johnson to
041140 - Millie's letter on 090522 0813. ref SDS 66 RX6L who sent copies to the
041141 - medical team, and saying Kaiser has performed workups, but does not
041142 - submit any works, and says Millie's patient profile is too complex for
041143 - Tumor Board to evaluate best course of treatment, and that Millie's
041144 - patient profile resists single agent treatments like Gemzar and
041145 - Navelbine, and that Millie can choose Hospice instead of treatment
041146 - with drugs which her patient profile now resists. ref SDS 67 XO5O
041148 -  ..
041149 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
041150 - Johnson on 090522 1247, ref SDS 67 XO5O, confirming Millie needs
041151 - urgent treatment to start quickly, reported on 090522 1351,
041152 - ref SDS 68 7R7J; Millie asks if treatment with Gemzar, Navelbine, and
041153 - possibly CTP, ref SDS 68 2T9W and ref SDS 68 2T4P, will be weeks of
041154 - agony then progression of cancer that requires another treatment
041155 - "targeted" to treat Millie's patient profile. ref SDS 68 2T4S  Millie
041156 - requested advice on treatment with a clinical trial at Kaiser, based
041157 - on patient history, ref SDS 68 2T4V, and further requested trade-offs
041158 - getting more hyperthermia and radiation and Doxil or other appropriate
041159 - agent, including vaccines. ref SDS 68 2T4Y
041160 -
041162 -  ..
041163 - Millie Over-treated Cannot Estimate Time to Progression
041164 - May Not Work at All Millie Over-treated Patient Profile Resists Chemo
041165 - Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
041166 - Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
041167 -
041168 - Follow up ref SDS 74 NM6J, ref SDS 73 NM6J.
041169 -
041170 - On 090522 1953 Millie received a letter from Doctor Johnson responding
041171 - to Millie's letter to the medical team at Kaiser and UCSF this
041172 - afternoon, reported on 090522 1351. ref SDS 68 7R7J  For some reason,
041173 - the doctor he did not submit copies to the medical team, demonstrating
041174 - uneven case management for coordination and collaboration; the doctor
041175 - confirms that treatment with single-agent chemotherapies presented as
041176 - the only choices for care may not work at all for Millie to recover
041177 - from 8th relapse of cancer. ref SDS 69 NV4L
041178 -
041179 -
041181 -  ..
041182 - Demand for Treatment Standard of Care Millie's Patient Profile
041183 -
041184 - Follow up ref SDS 74 ON8G, ref SDS 73 ON8G.
041185 -
041186 - On 090523 0148 Millie sent a letter to Paula in the Kaiser Claims
041187 - Resolution Department with copy to medical team demanding treatment to
041188 - recover from 8th relapse applying standard of care for Millie's
041189 - patient profile. ref SDS 70 2P6J
041191 -  ..
041192 - On 090528 0803 called Paula for progress processing Millie's claim for
041193 - treatment with standard of care for Millie's patient profile.
041194 - ref SDS 72 T04L
041196 -  ..
041197 - On 090528 1228 Millie sent a letter to Paula confirming claim
041198 - demanding timely treatment for 8th relapse of cancer. ref SDS 73 UD5H
041199 - and saying that she will get treatment through another provider and
041200 - bill Kaiser, because her doctor at Kaiser says Millie needs immediate
041201 - treatment, and Kaiser has failed to perform. 090528 1228, ref SDS 73
041202 - 4N8X
041203 -
041204 -
041206 -  ..
0413 -
0414 -
0415 - Progress
0416 -
041601 - Kaiser Defaults Insurance Contract Millie Orders Work from Others
041602 - UCSF Prescribes Gemcitabine Treatment for Millie at Kaiser
041603 -
041604 - Follow up ref SDS 74 UD5H.
041605 -
041606 - On 090528 1334 Millie sent a letter to Doctor Rugo and Doctor Hsu at
041607 - UCSF requesting treatment, and sent a copy to notify the medical team
041608 - she has been forced to get treatment from another provider to mitigate
041609 - damages from Kaiser's failure to provide care. ref SDS 74 UD5H
041611 -  ..
041612 - On 090528 1613 Doctor Rugo responds to Millie's letter on 090528 1334,
041613 - requesting prescription for treatment because Kaiser has defaulted on
041614 - insurance contract, ref SDS 74 2L7P; UCSF prescribes treatment with
041615 - gemcitabine starting next week. ref SDS 0 XZ4M
041616 -
041617 -    1.  Subject: RE: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041618 -        Date: Thu, 28 May 2009 14:56:21 -0700
041625 -         ..
041626 -    2.  I am guessing you can start treatment as soon as you decide to
041627 -        do so.
041628 -
041629 -            [...see below for conflicts with patient history.
041630 -            ref SDS 0 KM4K
041632 -         ..
041633 -    3.  Maybe you could start gemcitabine with Kaiser early next week?
041634 -        I don't anticipate a delay in Dr Johnson starting standard
041635 -        chemotherapy.
041636 -
041637 -            [...see below for conflicts with patient history.
041638 -            ref SDS 0 F66F
041640 -             ..
041641 -            [On 090528 1652 Millie responded to Doctor Rugo's letter
041642 -            notifying medical team again that she needs a prescription
041643 -            to recover from the 8th relapse of cancer, and asking for
041644 -            comparison of the new treatment gemcitabine proposed by
041645 -            Doctor Rugo with other treatments the team has presented.
041646 -            ref SDS 75 MZ7N
041648 -             ..
041649 -            [On 090529 1109 Millie letter to medical team reports
041650 -            research shows Doctor Rugo's prescription for gemcitatine
041651 -            is the same as Gemzar, ref SDS 76 0M5X; Doctor Johnson
041652 -            advised on 090515 that Gemzar is not standard of care for
041653 -            Millie's patient profile, and he would get in trouble at
041654 -            Kaiser if Gemzar was given to Millie, ref SDS 51 658J; on
041655 -            090522 1322 Doctor Johnson sent a letter advising that
041656 -            Gemzar and Navelbine problably won't work at all for
041657 -            Millie's patient profile. ref SDS 69 UW6G
041659 -             ..
041660 -            [On 090529 1109 Millie asks Doctor Rugo about getting
041661 -            treatment with bevacizumab at UCSF, rather than Gemzar,
041662 -            which has difficult side effects. ref SDS 76 0M6Q
041664 -             ..
041665 -            [On 090529 1109 Millie asks Doctor Rugo to schedule
041666 -            treatment with MPA at UCSF, because Kaiesr has not
041667 -            prescribed treatment, and getting treatment is critical for
041668 -            Millie to recover. ref SDS 76 0N4V
041670 -             ..
041671 -            [On 090529 1751 Doctor Johnson responds to Doctor Rugo's
041672 -            letter today proposeing Millie get Gemzar at Kaiser, by
041673 -            offering to treat Millie with Gemzar at Kaiser. ref SDS 77
041674 -            MV5G
041676 -             ..
041677 -            [On 090531 1544 Millie reports to medical team fear of
041678 -            getting treatment with Gemzar because of severe side
041679 -            effects, and that it will not be effective for her patient
041680 -            profile. ref SDS 78 IH9P
041682 -             ..
041683 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041684 -            and advised that Doctor Johnson prescribed treatment for
041685 -            Millie with Gemzar; advised that side effects of Gemzar
041686 -            will be very difficult for Millie to tolerate, and asked to
041687 -            verify that Millie agrees to get this treatment.
041688 -            ref SDS 79 8J8L
041690 -             ..
041691 -            [On 090605 Millie received documentation from Kaiser that
041692 -            says Gemzar has high risks for Millie's patient profile;
041693 -            requires extreme caution given after getting treatment with
041694 -            radiation, which Millie received for 4 weeks in February
041695 -            and March, and contiues to suffer side effects; Kaiser
041696 -            further says treatment with Gemzar requires avoiding blood
041697 -            thinners, and Millie is required to take blood thinners
041698 -            every day to prevent death from pulmonary embolism; Gemzar
041699 -            can cause low blood counts that leads to infection and
041700 -            death, Millie has a history of low blood counts.
041701 -            ref SDS 80 V34K
041703 -         ..
041704 -    4.  Then we can work out trial therapy moving forward.  There is no
041705 -        issue with that - but it will be billed to medicare so involve
041706 -        a share of cost.
041707 -
041708 -            [...see below for conflicts with patient history.
041709 -            ref SDS 0 VE8S
041710 -
041718 -  ..
041719 - Doctor Rugo errs in the UCSF letter today to the medical team, in the
041720 - following respects...
041722 -         ..
041723 -        Case Study Millie Cannot Decide When to Get Treatment
041724 -
041725 -
041726 -    a.  Guessing Millie can get treatment at Kaiser when Millie decides
041727 -        to do so, ref SDS 0 XZ4M, is not supported by the record...
041728 -
041729 -        1.  Patients need an order signed by the doctor to get
041730 -            chemotherapy treatment, which demonstrates that
041731 -            professional competence to investigate and judgement to
041732 -            identify the best evidence supports giving treatment;
041733 -            accordingly, Millie cannot go to the Chemotherapy Infusion
041734 -            Clinic when she decides to do so and get any treatment she
041735 -            wants.
041737 -             ..
041738 -        2.  On 030109 Millie could not start treatment for IBC based on
041739 -            the PET scan test on 021218 that identified 3 symptoms of
041740 -            IBC disease, ref SDS 1 GJ69, and based on the doctor's
041741 -            examination that identified inflammation in the left
041742 -            breast, a 4th symptom, ref SDS 1 KW5F, because at that time
041743 -            the doctor prescribed Keflex to treat Cellulitis.
041744 -            ref SDS 1 GK7T
041746 -             ..
041747 -        3.  On 030606 Millie requested emergency treatment for
041748 -            recurrent cancer because of recurrent inflammation in the
041749 -            left breast, ref SDS 2 7C6W, increased lump in the left
041750 -            axilla, ref SDS 2 Y45M, and rising cancer marker.
041751 -            ref SDS 2 NE7L  Millie could not get treatment, because
041752 -            the doctor would not prescribe treatment.
041754 -             ..
041755 -        4.  On 030710 Millie wanted treatment because clinical symptoms
041756 -            of IBC increased, and were supported by CT test report that
041757 -            expressly stated findings could be cancer which the doctor
041758 -            should correlate clinically. ref SDS 3 536O  Millie could
041759 -            not get treatment she wanted, because the doctor would not
041760 -            prescribe treatment. ref SDS 3 5E7J  Millie requested a
041761 -            biopsy to test for cancer relapse, and this could not be
041762 -            done, because the doctor would not order the work.
041763 -            ref SDS 3 T64L
041765 -             ..
041766 -        5.  On 040318 Kaiser diagnosed recurrent cancer; Millie
041767 -            requested treatment with established chemotehrapy; Kaiser
041768 -            denied Millie's choice, and prescribed instead treatment in
041769 -            a clinical trial for standard of care to treat Millie's
041770 -            patient profile. ref SDS 4 PU6M
041772 -             ..
041773 -        6.  On 040318 Millie chose to get get immediate treatment to
041774 -            reduce spread of disease, already 18 months active, and
041775 -            this was denied because Kaiser treated IBC as Cellulitis.
041776 -            ref SDS 4 IM6J
041778 -             ..
041779 -        7.  On 040812 Millie chose to adjust treatment with bevacizumab
041780 -            to reduce risks of pulmonary embolism and death, based on
041781 -            rising symptoms, family history, and public notice that
041782 -            bevacizumab had caused the death of patients due to
041783 -            pulmonary embolism. ref SDS 5 MG4G  Patients choice to
041784 -            adjust treatment was denied on grounds that CT testing did
041785 -            not report finding pulmonary embolism. ref SDS 5 W35K
041787 -             ..
041788 -        8.  On 041005 Millie chose again to adjust treatment with
041789 -            bevacizumab due to rising symptoms of pulmonary embolism,
041790 -            ref SDS 6 RZ4I; and, Kaiser denied Millie's choice because
041791 -            CT tests did not show PE. ref SDS 6 OG3I
041793 -             ..
041794 -        9.  On 041018 Doctor Benz at UCSF issued a 2nd opinion that
041795 -            Kaiser investigate more carefully need to adjust Millie's
041796 -            treatment with bevacizumab in order to reduce risks of
041797 -            death from pulmonary embolism. ref SDS 7 LX96
041799 -             ..
041800 -       10.  On 041104 Kaiser advised that an emergency CT test the day
041801 -            before recommended by Doctor Benz in the UCSF 2nd opinion
041802 -            and performed at Kaiser with a different scanning method
041803 -            designed to identify pulmonary embolism, in fact discovered
041804 -            pulmonary embolism that was causing symptoms the past 6
041805 -            months, and so required adjusting Millie's treatment,
041806 -            requested previously by Millie beginning on 040812, by
041807 -            completely ending bevacizumab and Taxol. ref SDS 8 RZ4I
041808 -            Millie chose to continue treatment with Taxol or Taxotere
041809 -            alone, which had been effective during 2002, ref SDS 8
041810 -            Q59K, and with bevacizumab during 2004.  Kaiser denied
041811 -            Millie's choice to continue treatment, because the
041812 -            substitute doctor would not order treatment until Millie's
041813 -            primary care physician returned from vacation in 4 weeks.
041814 -            ref SDS 8 WT60
041816 -             ..
041817 -       11.  On 041104 Millie needed a blood draw to evaluate new
041818 -            treatment for pulmonary embolism.  Her choice to continue
041819 -            getting blood draws from her port catheter to avoid trauma
041820 -            pain and suffering for herself and nurses who have
041821 -            difficulty finding a good vein, was denied by Kaiser
041822 -            because the doctor wrote the order for a blood draw through
041823 -            a vein. ref SDS 8 NH67
041825 -             ..
041826 -       12.  On 041130 the primary care physician advised that Millie
041827 -            needs to resume treatment immediately to recover from stage
041828 -            IV IBC. ref SDS 9 Y66F  Millie chose to get treatment with
041829 -            either Taxotere or Taxol alone because this had been
041830 -            effective in 2002 and with Bevacizumab in 2004, or start
041831 -            treatment immediately with capacitabine and Taxotere which
041832 -            was recommended by UCSF Cancer Center in Doctor Benz's 2nd
041833 -            opinion.  Kaiser denied Millie's choice for treatment
041834 -            because the primary care physician ordered the protocol
041835 -            nurse to delay treatment while looking for a clinical
041836 -            trial. ref SDS 9 028N
041838 -             ..
041839 -       13.  On 041230 clinical trial proposed for Millie could not be
041840 -            started due to conflicts between patient history and study
041841 -            participation protocol.  Millie then requested immediate
041842 -            treatment with Taxol which had been effective with
041843 -            bevacizumab, or with capacitabine and Taxotere recommended
041844 -            by Doctor Benz in a 2nd opinion, ref SDS 10 2V85.  Kaiser
041845 -            rejected Millie's choices, because the doctor ordered
041846 -            treatment with Adriamycin and Cytoxin, which had been
041847 -            ineffective in 2002, ref SDS 10 XQ88, and in order to
041848 -            qualify Millie for another clinical trial. ref SDS 10 XQ41
041850 -             ..
041851 -       14.  On 080423 Doctor Rugo notified the medical team that Millie
041852 -            cannot reduce the dose of carboplatin to recover blood
041853 -            counts, and then increase the dose to increase theraputic
041854 -            benefits when the immune system recovers. ref SDS 16 415F
041855 -            Millie notified the medical team that she choosed to
041856 -            maintain the dose of carboplatin in order to maintain
041857 -            recovery from the 4th relapse of cancer. ref SDS 16 XS6K
041858 -            On 090605 the medical team disclosed that the doctor wrote
041859 -            the chemoterhapy order reducing the dose of carboplatin
041860 -            contrary to patient choice. ref SDS 17 YD51
041862 -             ..
041863 -       15.  On 090521 Doctor Johnson for the first time asked Millie to
041864 -            "choose" a treatment, and without providing any choices.
041865 -            ref SDS 65 9Q9H
041867 -             ..
041868 -       16.  On 090521 Millie chose treatment with radiation and
041869 -            hyperthermia, ref SDS 66 715V, which was known to be
041870 -            effective, reported by Doctor Rugo on 090401, ref SDS 44
041871 -            K56O, shown to be effective from examinations by Tara Lacy
041872 -            and by Doctor Hsu on 090423, ref SDS 46 QR3M and
041873 -            ref SDS 46 YN5N, and later by Doctor Rugo's examination on
041874 -            090514, ref SDS 48 HX4L, and the next day on 090515 Doctor
041875 -            Johnson examined Millie at Kaiser and reported radiation
041876 -            and hyperthermia treatment was very effective. ref SDS 51
041877 -            D452  Despite history of effective recovery, the doctor
041878 -            failed to implement Millie's choice for treatment with
041879 -            radiation and hyperthermia.
041881 -         ..
041882 -    b.  Doctor Rugo's prescription for Kaiser to start gemcitabine at
041883 -        Kaiser early next week and without delay, ref SDS 0 4T6K,
041884 -        conflicts with the record...
041885 -
041886 -        1.  Kaiser has not prescribed treatment, reported in the letter
041887 -            on 090523 to Paula in Member Services Claim Resolution
041888 -            Deapartment. ref SDS 70 DQ9Q
041890 -             ..
041891 -        2.  Kaiser has not prescribed treatment because the doctor said
041892 -            on 090515 that the only treatments he can prescribe at
041893 -            Kaiser are Gemzar and Navelbine, and he would get in
041894 -            trouble prescribing these agents because they are not
041895 -            appropriate to treat Millie's patient profile. ref SDS 51
041896 -            658J
041897 -
041898 -               [On 090529 1109 Millie letter to medical team reports
041899 -               research shows Doctor Rugo's prescription for
041900 -               gemcitatine is the same as Gemzar, ref SDS 76 0M5X;
041901 -               Doctor Johnson advised on 090515 that Gemzar is not
041902 -               standard of care for Millie's patient profile, and he
041903 -               would get in trouble at Kaiser if Gemzar was given to
041904 -               Millie, ref SDS 51 658J; on 090522 1322 Doctor Johnson
041905 -               sent a letter advising that Gemzar and Navelbine
041906 -               problably won't work at all for Millie's patient
041907 -               profile. ref SDS 69 UW6G
041909 -                ..
041910 -               [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy
041911 -               called and advised that Doctor Johnson prescribed
041912 -               treatment for Millie with Gemzar; advised that side
041913 -               effects of Gemzar will be very difficult for Millie to
041914 -               tolerate, and asked to verify that Millie agrees to get
041915 -               this treatment. ref SDS 79 8J8L
041917 -                ..
041918 -               [On 090605 Millie received documentation from Kaiser
041919 -               that says Gemzar has high risks for Millie's patient
041920 -               profile; requires extreme caution given after getting
041921 -               treatment with radiation, which Millie received for 4
041922 -               weeks in February and March, and contiues to suffer side
041923 -               effects; Kaiser further says treatment with Gemzar
041924 -               requires avoiding blood thinners, and Millie is required
041925 -               to take blood thinners every day to prevent death from
041926 -               pulmonary embolism; Gemzar can cause low blood counts
041927 -               that leads to infection and death, Millie has a history
041928 -               of low blood counts. ref SDS 80 V34K
041930 -         ..
041931 -    c.  Doctor Rugo's work plan for Millie to recover from the 8th
041932 -        relapse of cancer by working out trial therapy moving forward
041933 -        and billing medicare and Millie a share of cost, ref SDS 0
041934 -        4T70, conflicts with the record...
041935 -
041936 -        1.  Waiting until Millie gets a treatment which has not yet
041937 -            been prescribed at Kaiser and then figuring out effective
041938 -            targeted therapy for the next relapse, conflicts with
041939 -            Doctor Johnson's consistent orders for UCSF to plan ahead
041940 -            for Millie's next treatment, reported in case study on
041941 -            090325. ref SDS 40 L15M
041943 -             ..
041944 -        2.  At no time has Millie requested trial therapy.  At all
041945 -            times Millie has demanded Kaiser rely on best evidence to
041946 -            prescribe standard of care for treating Millie's patient
041947 -            profile, required under insurance agreement EOC Section 2,
041948 -            reported on 070927. ref SDS 13 WS6M  Kaiser has from time
041949 -            to time prescribed treatment in clinical trials under EOC
041950 -            Section 2, for which Kaiser is liable under the insurance
041951 -            agreement, shown in case study on 070830 0807. ref SDS 12
041952 -            LQ5I  Billing medicare and Millie a share of costs for care
041953 -            conflicts with patient history.  On 061230 Kaiser referred
041954 -            Millie's care to UCSF and agreed to pay all costs not
041955 -            covered by the clinical trial, as the best possible care
041956 -            for Millie's patient profile. ref SDS 11 3X6K  On 070906
041957 -            Doctor Rugo notified the medical team that she knows
041958 -            nothing about billings, including medicare.  Kaiser has
041959 -            performed on the original agreement.  Kaiser's conduct has
041960 -            conveyed entitlement to Millie for care independent of the
041961 -            insurance agreement, shown in the record on 070927.
041962 -            ref SDS 13 WU6M
041963 -
041964 -
041965 -
041966 -
041967 -
041968 -
041969 -
041970 -
041971 -
041972 -
041973 -
0420 -