THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: May 29, 2009 11:09 AM Friday; Rod Welch

Millie asks Doctor Rugo for treatment at UCSF because Kaiser has failed
to prescribe treatment to recover from worsening 8th relapse of cancer.

1...Summary/Objective
2...Millie Over-treated Cannot Estimate Time to Progression
3...May Not Work at All Millie Over-treated Patient Profile Resists Chemo
4...Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
5...Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
6...Demand for Treatment Standard of Care Millie's Patient Profile
7...Kaiser Defaults Insurance Contract Millie Orders Work from Others
8...UCSF Prescribes Gemcitabine Treatment for Millie at Kaiser
9...Millie Requests Prescription and Comparison of Treatment Choices


..............
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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 82 0000. ref SDS 81 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
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 24 Y67L,
040906 - further ordered by Doctor Johnson at Kaiser on 081219. ref SDS 23 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 26 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 27 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 27 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 28 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 29 9Y5I
040936 -  ..
040937 - On 090202 1353 UCSF delayed treatment again for 6 weeks to maintain an
040938 - orderly schedule. ref SDS 30 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 31 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 32 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 33 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 34 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 35 EY5F
040966 -  ..
040967 - On 090213 1140 Doctor Johnson notifies Millie that she has less than 1
040968 - year to live, ref SDS 37 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 37 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 38 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 39
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 41 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 45 Q64R
040993 -  ..
040994 - On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower left
040995 - arm as progression of IBC. ref SDS 46 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 47 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 48 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 51 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 53 LJ5T
041024 -  ..
041025 - On 090514 0830 Doctor Rugo prescribes treatment with MPA, ref SDS 54
041026 - D647, and submits a letter to Kaiser submitting the protocol,
041027 - ref SDS 54 DI63, as previously requested by Doctor Johnson on 081219
041028 - 1140. ref SDS 23 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 55 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 56 6Q8W, as shown in Doctor Rugo's
041043 - letter to Kaiser on 090514 0830. ref SDS 54 DI63
041045 -  ..
041046 - On 090515 1518 Doctor Rugo responds wishing Millie "good luck."
041047 - ref SDS 58 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 57
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 59 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 60 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 61 5K7H
041084 -  ..
041085 - On 090519 1613 Millie responded, ref SDS 62 8V8H, to the Doctor's
041086 - letter earlier yesterday afternoon on 090519 1536, ref SDS 61 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 62 TY3X,
041089 - and further as planned by the doctor during the meeting on 090515
041090 - 1140. ref SDS 57 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 62 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 62 TX4W
041096 -  ..
041097 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
041098 - ref SDS 68 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 69
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 69 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 68
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 57 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 71 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 71 HC8O, and the doctor told Millie to call Medicare for
041121 - prescribing treatment to recover from the 8th relapse of cancer.
041122 - ref SDS 71 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 72 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 72 7Z5Y  Millie reports having called
041133 - Kaiser numerous times to speak with the doctor on prescribing
041134 - treatment. ref SDS 72 7Z9Y  Millie notifies medical team she chooses
041135 - hyperthermia and radiation, Doxil, or other agent suitable for
041136 - Millie's patient profile. ref SDS 72 715V
041138 -  ..
041139 - On 090522 1247 Millie received a response from Doctor Johnson to
041140 - Millie's letter on 090522 0813. ref SDS 72 RX6L who sent copies to the
041141 - medical team, and saying Kaiser has performed workups, but does not
041142 - submit any workups, and says Millie's patient profile is too complex
041143 - for Tumor Board to evaluate best course of treatment, and that
041144 - Millie's patient profile resists single agent treatments like Gemzar
041145 - and Navelbine, and that Millie can choose Hospice instead of treatment
041146 - with drugs which her patient profile now resists. ref SDS 73 XO5O
041148 -  ..
041149 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
041150 - Johnson on 090522 1247, ref SDS 73 XO5O, confirming Millie needs
041151 - urgent treatment to start quickly, reported on 090522 1351,
041152 - ref SDS 74 7R7J; Millie asks if treatment with Gemzar, Navelbine, and
041153 - possibly CTP, ref SDS 74 2T9W and ref SDS 74 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 74 2T4S  Millie
041156 - requested advice on treatment with a clinical trial at Kaiser, based
041157 - on patient history, ref SDS 74 2T4V, and further requested trade-offs
041158 - getting more hyperthermia and radiation and Doxil or other appropriate
041159 - agent, including vaccines. ref SDS 74 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 82 NM6J, ref SDS 81 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 74 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 75 NV4L
041178 -
041179 -
041181 -  ..
041182 - Demand for Treatment Standard of Care Millie's Patient Profile
041183 -
041184 - Follow up ref SDS 82 ON8G, ref SDS 81 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 76 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 78 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 79 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 79
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 - Millie Requests Prescription and Comparison of Treatment Choices
041604 -
041605 - Follow up ref SDS 82 UD5H, ref SDS 81 UD5H.
041606 -
041607 - On 090528 1334 Millie sent a letter to Doctor Rugo and Doctor Hsu at
041608 - UCSF requesting treatment, and sent a copy to notify the medical team
041609 - she has been forced to get treatment from another provider to mitigate
041610 - damages from Kaiser's failure to provide care. ref SDS 80 UD5H
041612 -  ..
041613 - On 090528 1613 Doctor Rugo responds to Millie's letter on 090528 1334,
041614 - requesting prescription for treatment because Kaiser has defaulted on
041615 - insurance contract, ref SDS 80 2L7P; UCSF prescribes treatment with
041616 - gemcitabine starting next week. ref SDS 81 XZ4M
041618 -  ..
041619 - On 090528 1652 Millie letter to medical team thanks Doctor Rugo for
041620 - her letter today suggesting a new treatment, ref SDS 81 XZ4M, and asks
041621 - for comparison with other treatments to recover from 8th relapse of
041622 - cancer. ref SDS 82 MZ7N
041624 -  ..
041625 - On 090529 1109 since Kaiser has failed to order treatment, Millie
041626 - requests treatment date and time from UCSF, ref SDS 0 448K, and to
041627 - compare advantages and costs of treatment options.
041628 -
041629 -    1.  Subject: MPA Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041630 -        Date: Fri, 29 May 2009 11:43:08 -0700
041640 -         ..
041641 -    2.  So you don't have to read a long letter [requested in Doctor
041642 -        Rugo's letter to the medical team on 081017 0021. ref SDS 21
041643 -        215I, and again in the doctor's letter on 090514 0830 citing
041644 -        hectic schedule with many patients who need emergency care; so,
041645 -        there is not enough time for comprehensive communication to
041646 -        avoid mistakes. ref SDS 54 LS6I].  I am requesting a treatment
041647 -        date and time with MPA proposed in your letter to Kaiser on
041648 -        090514, ref SDS 54 DI63, or such other treatment that you feel
041649 -        might be effective for me.  Please advise when I can come in
041650 -        for treatment.
041652 -         ..
041653 -    3.  This request is made for the following reasons...
041655 -         ..
041656 -    4.  Your letter yesterday said Kaiser can treat me with gemcitabine
041657 -        [reported on 090528 1613. ref SDS 81 4T6K].
041659 -         ..
041660 -    5.  At the time I thought this was a new treatment [shown in
041661 -        Millie's letter to the medical team on 090528 1652. ref SDS 82
041662 -        MZ7N].  I asked Kaiser for a prescription [reported on 090528
041663 -        1652, ref SDS 82 RS4H and to recover from 8th relapse of cancer
041664 -        reported to the medical team on 090401 0143. ref SDS 49 R43V
041665 -        ref SDS 49 R43V, again on 090406 1512. ref SDS 50 RE6V, and
041666 -        again on 090412 2241. ref SDS 51 9S9Y].  As of noon today,
041667 -        Kaiser has not ordered treatment of any kind, and my medical
041668 -        condition requires urgent treatment, as noted in your letter on
041669 -        090202, ref SDS 31 Y15J, and again yesterday [reported on
041670 -        090528 1613. ref SDS 81 4T6K].
041672 -         ..
041673 -    6.  Additionally, I looked up "gemcitabine" on the Internet and
041674 -        learned this is another name for Gemzar.  Side effects seem
041675 -        very severe, e.g., vomiting, fatigue, can't sleep, nausea,
041676 -        weakness, shortness of breath.  Additionally, Doctor Johnson
041677 -        advised in a letter on 090522 that Gemzar probably will not be
041678 -        effective because my patient profile has highly resistant
041679 -        disease. ref SDS 75 UW6G
041680 -
041681 -           [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041682 -           and advised that Doctor Johnson prescribed treatment for
041683 -           Millie with Gemzar; advised that side effects of Gemzar will
041684 -           be very difficult for Millie to tolerate, and asked to
041685 -           verify that Millie agrees to get this treatment. ref SDS 84
041686 -           8J8L
041688 -            ..
041689 -           [On 090605 Millie received documentation from Kaiser that
041690 -           says Gemzar has high risks for Millie's patient profile;
041691 -           requires extreme caution given after getting treatment with
041692 -           radiation, which Millie received for 4 weeks in February and
041693 -           March, and contiues to suffer side effects; Kaiser further
041694 -           says treatment with Gemzar requires avoiding blood thinners,
041695 -           and Millie is required to take blood thinners every day to
041696 -           prevent death from pulmonary embolism; Gemzar can cause low
041697 -           blood counts that leads to infection and death, Millie has a
041698 -           history of low blood counts. ref SDS 85 V34K
041700 -         ..
041701 -    7.  In our meeting on 090514 at UCSF you discussed bevacizumab, and
041702 -        seemed to say that research in 2004 never established a causal
041703 -        correlation with pulmonary embolism. ref SDS 54 CZ7J  Doctor
041704 -        Benz reported I responded well to this agent. ref SDS 9 OU9U
041706 -         ..
041707 -    8.  I also recall tolerating side effects of bevacizumab, except
041708 -        for PE.  If PE is not associated with bevacizumab, how would
041709 -        you compare this treatment, possibly in combination with
041710 -        another agent?
041712 -         ..
041713 -    9.  Kaiser's guidance calls for providers to disclose the amount
041714 -        for out-of-pocket expense owed to UCSF for the 20% Medicare
041715 -        coinsurance charged for treatment in a clinical trial [reported
041716 -        on 070829 1328. ref SDS 14 SF52  Your letter to Doctor Johnson
041717 -        on 090514 explained how reduced costs make the MPA
041718 -        (medroxyprogesterone revisited) study an attractive treatment
041719 -        for me.
041721 -         ..
041722 -   10.  Can you please ask your accounting people to disclose the
041723 -        amount UCSF will charge for me to participate in the MPA study,
041724 -        as called out in Kaiser's guidance?  How much will 20%
041725 -        coinsurance be under your understanding in the letter on
041726 -        090514? ref SDS 54 DI63  I am interested in how this compares
041727 -        to co-payments I owe at Kaiser for standard of care.
041728 -
041729 -            [On 090531 2227 Kaiser failed to perform, UCSF failed
041730 -            to disclose coinsurance charges, so Millie asked UCSF
041731 -            if a deposit is required to arrange for starting urgent
041732 -            treatment quickly at UCSF. ref SDS 83 GH3R
041734 -             ..
041735 -            [On 090725 2017 Millie's letter to medical team cites
041736 -            research showing published guidance for standard of care
041737 -            requires doctors compare trade-offs for treatments on
041738 -            effectiveness, side effects (suffering), and cost.
041739 -            ref SDS 86 T58U
041741 -         ..
041742 -   11.  You also explained in the meeting on 090514 that MPA would be
041743 -        expected to have less side effects than cetuximab. ref SDS 54
041744 -        DI4F  Since I tolerated cetuximab well, this makes MPA
041745 -        attractive.
041747 -         ..
041748 -   12.  On 070105 Doctor Johnson advised that he prescribed treatment
041749 -        in the cetuximab and Carboplatin treatment at UCSF because his
041750 -        research indicated cetuximab at UCSF would be more effective
041751 -        than Navelbine and Gemzar at Kaiser, because cetuximab is a
041752 -        "targeted" drug, and the others are not. ref SDS 13 PK7L
041754 -         ..
041755 -   13.  Does Kaiser's 2007 analysis of the UCSF proposal for cetuximab
041756 -        hold for the 2009 proposal to treat me with MPA, i.e., do you
041757 -        expect a better response with MPA than with Gemzar?
041759 -         ..
041760 -   14.  Assuming this is so, that MPA has a comparable chance of being
041761 -        effective for my patient profile, as cetuximab was, and since
041762 -        time is of the essence to start my care this week, as stated in
041763 -        your letter to the medical team yesterday [reported on 090528
041764 -        1613. ref SDS 81 4T6K, and further in light of Doctor Rugo's
041765 -        instruction during the meeting at UCSF on 090514 for Millie to
041766 -        advise Kaiser that treatment with MPA should be begin
041767 -        immediately in order for Millie to recover from the 8th relapse
041768 -        of cancer that is spreading rapidly, ref SDS 54 D647, then in
041769 -        the absence of advice, prescription, and referral from my
041770 -        doctor at Kaiser requested numerous times the past 2 months, I
041771 -        would like to come in and get treatment with the MPA, as soon
041772 -        as possible.
041774 -         ..
041775 -   15.  Please tell me when to come in to UCSF for treatment?
041776 -
041783 -
041784 -
041785 -
041786 -
041787 -
041788 -
041789 -
041790 -
041791 -
0418 -