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 05:51 PM Friday; Rod Welch

Kaiser proposes treating Millie with Gemzar or Navelbine next week.

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
10...Complex Patient History Causes Confusion Mistakes Conflict
11...Misleading Correspondence Kaiser Complains Against Patient
12...Misleading Erroneous Kaiser Correspondence Ignores Patient History


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

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 84 0000. ref SDS 83 0000.
040502 -
040503 -
040505 -  ..
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 26 Y67L,
040906 - further ordered by Doctor Johnson at Kaiser on 081219. ref SDS 25 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 28 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 29 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 29 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 30 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 31 9Y5I
040936 -  ..
040937 - On 090202 1353 UCSF delayed treatment again for 6 weeks to maintain an
040938 - orderly schedule. ref SDS 32 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 33 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 34 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 35 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 36 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 37 EY5F
040966 -  ..
040967 - On 090213 1140 Doctor Johnson notifies Millie that she has less than 1
040968 - year to live, ref SDS 39 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 39 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 40 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 41
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 43 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 47 Q64R
040993 -  ..
040994 - On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower left
040995 - arm as progression of IBC. ref SDS 48 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 49 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 50 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 25 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 69 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 70
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 70 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 69
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 72 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 72 HC8O, and the doctor told Millie to call Medicare for
041121 - prescribing treatment to recover from the 8th relapse of cancer.
041122 - ref SDS 72 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 73 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 73 7Z5Y  Millie reports having called
041133 - Kaiser numerous times to speak with the doctor on prescribing
041134 - treatment. ref SDS 73 7Z9Y  Millie notifies medical team she chooses
041135 - hyperthermia and radiation, Doxil, or other agent suitable for
041136 - Millie's patient profile. ref SDS 73 715V
041138 -  ..
041139 - On 090522 1247 Millie received a response from Doctor Johnson to
041140 - Millie's letter on 090522 0813. ref SDS 73 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 74 XO5O
041148 -  ..
041149 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
041150 - Johnson on 090522 1247, ref SDS 74 XO5O, confirming Millie needs
041151 - urgent treatment to start quickly, reported on 090522 1351,
041152 - ref SDS 75 7R7J; Millie asks if treatment with Gemzar, Navelbine, and
041153 - possibly CTP, ref SDS 75 2T9W and ref SDS 75 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 75 2T4S  Millie
041156 - requested advice on treatment with a clinical trial at Kaiser, based
041157 - on patient history, ref SDS 75 2T4V, and further requested trade-offs
041158 - getting more hyperthermia and radiation and Doxil or other appropriate
041159 - agent, including vaccines. ref SDS 75 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 84 NM6J, ref SDS 83 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 75 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 76 NV4L
041178 -
041179 -
041181 -  ..
041182 - Demand for Treatment Standard of Care Millie's Patient Profile
041183 -
041184 - Follow up ref SDS 84 ON8G, ref SDS 83 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 77 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 79 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 80 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 80
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 84 UD5H, ref SDS 83 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 81 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 81 2L7P; UCSF prescribes treatment with
041616 - gemcitabine starting next week. ref SDS 82 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 82 XZ4M, and asks
041621 - for comparison with other treatments to recover from 8th relapse of
041622 - cancer. ref SDS 83 MZ7N
041624 -  ..
041625 - On 090529 1109 since Kaiser has failed to order treatment, Millie
041626 - requests treatment date and time from UCSF, ref SDS 84 448K, and to
041627 - compare advantages and costs of treatment options.
041628 -
041630 -  ..
041631 - Complex Patient History Causes Confusion Mistakes Conflict
041632 - Misleading Correspondence Kaiser Complains Against Patient
041633 -
041634 - On 090529 1751 Doctor Johnson responds to Millie's letter earlier in
041635 - the day, ref SDS 84 448K; Kaiser complains that patient correspondence
041636 - is confusing and misleading, ref SDS 0 SZ9J, and proposes treating
041637 - Millie with Gemzar and Navelbine starting next week. ref SDS 0 MV5G
041638 -
041639 -    1.  Subject: Re: MPA Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041640 -        Date: Fri, 29 May 2009 15:47:44 -0700
041647 -         ..
041648 -    2.  These emails have become very confusing to me.
041650 -  ..
041651 - Millie's patient history is very complex shown by case study reported
041652 - on, ref SDS 13 T25H, and difficulty creating a well ordered record
041653 - causes confusion to rise, explained in NWO, ref OF 5 XX6N, under the
041654 - 2nd law of thermodynamics, reported on 040312. ref SDS 4 W46M
041656 -  ..
041657 - Doctor Johnson's letter from Kaiser continues...
041658 -
041659 -        Your statement:
041660 -
041661 -        "Your letter yesterday said Kaiser can treat me with
041662 -        gemcitabine.  At the time I thought this was a new treatment.
041663 -        I asked Kaiser for a prescription.  As of noon today, Kaiser
041664 -        has not ordered treatment of any kind, and my medical condition
041665 -        requires urgent treatment, as noted in your letter on 090202,
041666 -        and again yesterday." [citing Millie's letter earlier to the
041667 -        medical team on 090529 1109. ref SDS 84 0M4Y
041668 -
041669 -        ....is somewhat misleading.
041671 -         ..
041672 -    3.  In an email to you dated 05/20/09 I stated:
041673 -
041674 -        "I offered Millie 2 possible current choices of treatment;
041675 -        single agent Navelbine or Gemzar.  I also counseled Millie
041676 -        regarding risk/benefits in heavily treated patients who are
041677 -        exhibiting signs of drug resistance.  I suggested that Member
041678 -        Services and Outside Authorizations will have to interpret the
041679 -        regulations regarding Clinical Trials at UCSF." [Doctor Johnson
041680 -        in his letter today cites his letter to the medical team,
041681 -        ref SDS 65 UC9G]
041682 -
041684 -  ..
041685 - Misleading Erroneous Kaiser Correspondence Ignores Patient History
041686 -
041687 - Kaiser's letter today is significantly misleading and erroneous
041688 - repeating past mistakes, as set out in the record on 090520,
041689 - ref SDS 65 LE5G, and was explained in a response to the medical team
041690 - on 090520 1137. ref SDS 66 SR5W
041692 -  ..
041693 - Doctor Johnson's letter from Kaiser continues...
041694 -
041695 -    4.  For further clarification and demonstration of an understanding
041696 -        that the next step in therapy needed to be selected soon, the
041697 -        following email was sent via Kaiser Secure Mail on 05/21/09:
041699 -         ..
041700 -        "You can choose which next treatment regimen that you want.  At
041701 -        this time, no treatment would be considered more superior than
041702 -        another.  In that you are beginning to progress again, you need
041703 -        to make this decision soon.  Please let me know by the end of
041704 -        the week.  If you consider the Clinical Trial at UCSF, you can
041705 -        call 1-800-MEDICARE and they will determine if it is
041706 -        appropriate." [reported in the record on 090521 2006.
041707 -        ref SDS 72 9Q9H
041709 -         ..
041710 -    5.  I have not yet heard your respnse.
041712 -  ..
041713 - Doctor Johnson's assertion that Millie has not responded conflicts
041714 - with the record shown on 090521, and listing numerous responses,
041715 - ref SDS 72 Q69F, and including Millie's letter yesterday, reported on
041716 - 090529 1109. ref SDS 84 448K, and asking for comparisons of treatment
041717 - choices, ref SDS 84 0N3U, repeating prior request in Millie's letter
041718 - to the team on 090522 0813, ref SDS 73 7Z5Y, to which Kaiser fails to
041719 - respond in Doctor Johnson's letter today, per above. ref SDS 0 U33Q
041720 -
041721 -            [On 090531 1544 Millie reported higher energy and increased
041722 -            exercise, CT tests showing no internal cancer, and with
041723 -            ECOG performance score 0 show she is a good candidate for
041724 -            aggressive treatment to recover from 8th relapse of cancer.
041725 -            ref SDS 85 LD4O  Millie worried cancer spreading to areas
041726 -            not treated with radiation; cancer marker CA 15-3 320, 400%
041727 -            higher than criteria Kaiser applies to treat cancer,
041728 -            ref SDS 85 IH4Q; Millie requests Kaiser prescribe treatment
041729 -            based on best evidence showing standard of care for her
041730 -            patient profile. ref SDS 85 IH6S
041732 -  ..
041733 - Millie's letter on 090522 complained that Kaiser's letter on 090521
041734 - asks Millie to choose a treatment without listing any choices.  Millie
041735 - further complained that Kaiser has not provided sufficient guidance
041736 - for a rational choice, and that asking the patient to choose
041737 - treatments without analysis comparing costs and benefits conflicts
041738 - with patient history where the doctor has at all times prescribed
041739 - treatment. ref SDS 73 7Z4R
041740 -
041741 -            [On 090725 2017 Millie's letter to medical team cites
041742 -            research showing published guidance for standard of care
041743 -            requires doctors compare trade-offs for treatments on
041744 -            effectiveness, side effects (suffering), and cost.
041745 -            ref SDS 88 T58U
041747 -  ..
041748 - Doctor Johnson's letter from Kaiser continues...
041749 -
041750 -    6.  We can easily start treating you with either Gemzar or
041751 -        Navelbine, 2 very acceptable agents used in the treatment of
041752 -        breast cancer, this coming week.  Again, I need to hear fron
041753 -        you want you want to do next.
041754 -
041755 -           [On 090605 Millie received documentation from Kaiser that
041756 -           says Gemzar requires "extreme caution" given after a
041757 -           patient has been treated with radiation, which Millie
041758 -           received for 4 weeks in February and March, and contiues to
041759 -           suffer side effects; Kaiser further says treatment with
041760 -           Gemzar requires avoiding blood thinners, and Millie is
041761 -           required to take blood thinners every day for PE.
041762 -           ref SDS 87 V34K
041764 -  ..
041765 - Doctor Johnson's letter today aligns with Doctor Rugo's letter to the
041766 - medical team yesterday proposing treatment at Kaiser with Gemzar,
041767 - reported on 090528 1613. ref SDS 82 4T6K
041769 -  ..
041770 - Kaiser's assertion today that Kaiser can easily start treating Millie
041771 - with single-agent Gemzar or Navelbine, conflicts with the record for 8
041772 - months where the doctor warned the medical team that Kaiser only has
041773 - single-agent treatments which are not effective for Millie, shown in
041774 - case study of patient history on 090325. ref SDS 46 L15M  The study
041775 - cites Doctor Johnson's notice during the meeting at Kaiser on 090515
041776 - 1140 that he would get in trouble for prescribing single-agent
041777 - treatments like Gemzare and Navelbine for Millie's patient profile.
041778 - ref SDS 57 658J
041780 -  ..
041781 - Kaiser's assertion that Gemzar or Navelbine are "very acceptable
041782 - agents in the treatment of breast cancer" seems very misleading,
041783 - because he has previously warned single-agent treatments are not
041784 - effective for Millie's patient profile, cited previously in Millie's
041785 - letters to the medical team on...
041786 -
041787 -                 090518 0017................ ref SDS 60 W84S
041788 -                 090520 1137................ ref SDS 66 SR6U
041789 -                 090520 1710................ ref SDS 69 ZF3U
041790 -                 090522 0813................ ref SDS 73 7Z5R
041791 -                 090522 1351................ ref SDS 75 2T4S
041792 -                 090528 1238................ ref SDS 80 4N5R
041793 -                 090529 1109................ ref SDS 84 0M5X
041795 -  ..
041796 - This record shows Kaiser has ample grounds for prescribing a treatment
041797 - for Millie's patient profile, listed in the record on 090121.
041798 - ref SDS 26 EV53, and submitted again to the team in Millie's letter
041799 - on
041800 -
041812 -
041813 -
041814 -
041815 -
041816 -
0419 -