CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 25 0000. ref SDS 22 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Authorization Representation Filed for Millie Kaiser Claims Resolution
040902 -
040903 - Follow up ref SDS 22 4V5I.
040904 -
040905 - Millie went to Kaiser this morning for physical therapy on her
040906 - dislocated shoulder.  At Kaiser in Park Shadelands, one of the staff
040907 - faxed the authorization for Millie's representation to the Kaiser
040908 - Claims Department, which Millie received yesterday from Paula, in
040909 - Member Services Claims Resolution Department, and as planned by Paula
040910 - in a call on 090528 0803. ref SDS 22 4V5I
040912 -  ..
040913 - Millie received a "Send Received" response from Kaiser.
040914 -
040915 -     [...below Kaiser Expedited Claims continue to deny service for
040916 -     Millie on grounds Kaiesr has not received Authorization for
040917 -     Representation. ref SDS 0 HY56
040918 -
040919 -
040920 -
040922 -  ..
0410 -
0411 -
0412 - 0820
0413 -
041301 - Treatment Arranged with UCSF Millie Recover 8th Relapse of Cancer
041302 -
041303 - Follow up ref SDS 29 2E4K.
041304 -
041305 - Since Millie does not have an appointment to get treatment at Kaiesr,
041306 - shown in the letter to Doctor Rugo last night on 090531 2227,
041307 - ref SDS 29 2E4K, called and left message for Mike at UCSF that Millie
041308 - wants to come in and sign consent documents to participate in the
041309 - clinical trial for MPA.
041311 -             ..
041312 -            [...below, Brad called with Kaiser Pharmacy and notified
041313 -            Millie that Doctor Johnson prescribed immediate treatment
041314 -            this week with Gemzar for Millie in the Chemotherapy
041315 -            Infusion Clinic, recommended by Doctor Rugo. ref SDS 0 PQ7V
041317 -             ..
041318 -            [...below, Sheree called with Kaiser Chemotherapy Infusion
041319 -            Clinic and advised that Millie cannot get immediate
041320 -            treatment, because Doctor Johnson did not sign the
041321 -            chemotherapy order for Gemzar, and went home with a
041322 -            headache, and so the order cannot be signed until the
041323 -            doctor recovers and returns to work. ref SDS 0 PQ4F
041325 -  ..
041326 - Advised Mike of letter to Doctor Rugo on 090531. ref SDS 29 2E4K
041327 -
041328 -            [...below Millie received letter from Mike confirming
041329 -            arrangments for treatment at UCSf to recover from Kaiser's
041330 -            failure to perform.6ref SDS 0 SQ5G
041331 -
041332 -
041334 -  ..
0414 -
0415 -
0416 - 0830
0417 -
041701 - Sent a letter responding to Mike's letter on 090514 submitting consent
041702 - to treatment, and confirming telecon message requesting UCSF make
041703 - arrangements for Millie to start treatment, because Kaiser has not
041704 - scheduled care...
041705 -
041706 -    1.  Subject: Re: UCSF MPA Study
041707 -        Date: Mon, 01 Jun 2009 08:30:05 -0700
041714 -         ..
041715 -    2.  Thanks for your letter on 090514 submitting documentation on
041716 -        the MPA study. ref SDS 13 A144  I sent a letter to Doctor Rugo
041717 -        yesterday saying I want to get treatment. ref SDS 29 2E4K  Can
041718 -        you please coordinate arrangements for me to start treatment.
041720 -             ..
041721 -            [...below, Brad called with Kaiser Pharmacy and notified
041722 -            Millie that Doctor Johnson prescribed immediate treatment
041723 -            this week with Gemzar for Millie in the Chemotherapy
041724 -            Infusion Clinic, recommended by Doctor Rugo. ref SDS 0 PQ7V
041726 -             ..
041727 -            [...below, Sheree called with Kaiser Chemotherapy Infusion
041728 -            Clinic and advised that Millie cannot get immediate
041729 -            treatment, because Doctor Johnson did not sign the
041730 -            chemotherapy order for Gemzar, and went home with a
041731 -            headache, and so the order cannot be signed until the
041732 -            doctor recovers and returns to work. ref SDS 0 PQ4F
041734 -             ..
041735 -            [...below Millie received letter from Mike confirming
041736 -            arrangments for treatment at UCSf to recover from Kaiser's
041737 -            failure to perform.6ref SDS 0 SQ5G
041739 -         ..
041740 -    3.  Doctor [Hsu] ordered a CT test on 090413 in order for me to
041741 -        start treatment in the new study.  There have been unfortunate
041742 -        delays in me starting treatment, so I am hoping I don't need
041743 -        another CT test, but please let me know if I do so I can make
041744 -        arrangements at Kaiser for the test.  I think all of the other
041745 -        criteria for participating have been met.
041747 -         ..
041748 -    4.  Thanks for your assistance.  Looking forward to working with
041749 -        you.
041750 -
041757 -
041758 -
041759 -
041760 -
041761 -
041762 -
042525 -  ..
0426 -
0427 -
0428 - 1051
0429 -
042901 - Called Mike again at UCSF.
042902 -
042903 - Mike received the phone message this morning, and the follow up
042904 - letter, per above. ref SDS 0 1P8M
042906 -  ..
042907 - Explained that Millie submitted the documents on MPA received from
042908 - Mike during the meeting with Doctor Rugo on 090514, to Doctor Johnson
042909 - the next day at Kaiser for review and approval.
042911 -  ..
042912 - Mike said that UCSF never received the documents from Kaiser.
042914 -  ..
042915 - Mike said the CT test on 090413 is outside the 4 week window required
042916 - by the MPA protocol, so Millie needs another CT test.
042918 -  ..
042919 - Mike will prepare another consent form, which Millie can come in and
042920 - sign today.  Millie has to sign and date the consent before the date
042921 - of the CT test.
042923 -  ..
042924 - Mike will respond to Millie's letter this morning confirming these
042925 - instructions.
042926 -
042927 -            [...below Millie received letter from Mike confirming
042928 -            arrangments for treatment at UCSf to recover from Kaiser's
042929 -            failure to perform.6ref SDS 0 SQ5G
042931 -  ..
042932 - He needs to talk to Doctor Rugo.
042934 -  ..
042935 - Requested a meeting on Thursday at 0800 or 0830.
042937 -  ..
042938 - Mike said Millie may not need to see Doctor Rugo, since all Millie
042939 - needs is the pills to start MPA treatment for the 8th relapse of
042940 - cancer.
042941 -
042942 -            [...below, Kaiser called and notified Millie that Doctor
042943 -            Johnson prescribed treatment for Millie with Gemzar,
042944 -            recommended by Doctor Rugo. ref SDS 0 PQ7V
042946 -             ..
042947 -            [...below, called Mike and discussed updated planning.
042948 -            ref SDS 0 H14T
042949 -
042950 -
042952 -  ..
0430 -
0431 -
0432 - 1111
0433 -
043301 - Called Kaiser Oncology in Walnut Creek, talked to Jen at the front
043302 - desk.
043304 -  ..
043305 - Asked for Arlette to see about scheduling a CT test.
043307 -  ..
043308 - Jen said that Arlette is off Mondays.
043310 -  ..
043311 - Asked for Doctor Johnson.
043313 -  ..
043314 - Jen said the doctor is out the office all day today in a training
043315 - class to implement a new computer system at Kaiser.
043316 -
043317 -
043318 -
043319 -
043321 -  ..
0434 -
0435 -
0436 - 1123
0437 -
043701 - Called Kaiser CT Department.
043702 -
043703 - Talked to Ilmira.
043705 -  ..
043706 - She said they have CT test slots available today, tomorrow and
043707 - Wednesday.
043709 -  ..
043710 - She needs a referral from Millie's doctor.
043711 -
043713 -  ..
0438 -
0439 -
0440 - 1132
0441 -
044101 - Brad called with the Kaiser Oncology Pharmacy in Walnut Creek.
044107 -  ..
044108 - Brad advised that Doctor Johnson has issued a chemotherapy order today
044109 - to treat Millie with Gemzar starting this week.
044110 -
044111 -        [On 090601 1847 Millie's letter notifies medical team of work
044112 -        plan for starting treatment with Gemzar to recover from 8th
044113 -        relapse of cancer. ref SDS 31 9M6F
044115 -  ..
044116 - The doctor's order conflicts with Millie's request for Kaiser to
044117 - provide treatment of Millie's patient profile to recover from the 8th
044118 - relapse of cancer, reported on 090531 1544, ref SDS 28 IH6S and
044119 - ref SDS 28 IH8W, responding to Doctor Johnson's letter on 090529
044120 - saying he can start Gemzar next week. ref SDS 27 MV5G
044122 -  ..
044123 - Treatments that can work for Millie's patient profile were reviewed
044124 - with UCSF on 090121 1017, ref SDS 8 EV53, and drugs targeted to
044125 - Millie's patient profile were submitted to Doctor Johnson on 090326
044126 - 0058. ref SDS 11 DW5S
044128 -             ..
044129 -            [...below, Sheree called with Kaiser Chemotherapy Infusion
044130 -            Clinic and advised that Millie cannot get immediate
044131 -            treatment, because Doctor Johnson did not sign the
044132 -            chemotherapy order for Gemzar, and went home with a
044133 -            headache, and so the order cannot be signed until the
044134 -            doctor recovers and returns to work. ref SDS 0 PQ4F
044136 -  ..
044137 - Doctor Johnson's prescription today to treat Millie with Gemzar aligns
044138 - with Doctor Rugo's letter to the medical team. ref SDS 24 4T6K
044140 -  ..
044141 - Earlier on 090515 Doctor Johnson disclosed that he would get in
044142 - trouble for prescribing Gemzar and Navelbine because these
044143 - single-agent drugs are not suitable for Millie's patient profile.  On
044144 - 090522 1323 Doctor Johnson wrote a letter confirming that these drugs
044145 - may not work at all for Millie. ref SDS 20 UW6G
044146 -
044147 -        [On 090603 1524 Queenie called Millie and repeated the same
044148 -        information Brad presented today; Queenie was not aware of
044149 -        Brad's prior call today. ref SDS 35 6W9H
044151 -  ..
044152 - Requested treatment this week, because Millie has been without
044153 - treatment since 090122.  Doctor Johnson has been ademant that Millie
044154 - needs timely treatment in order to have a chance of recovering from
044155 - the 8th relapse of cancer, shown by case study of patient history on
044156 - 090325. ref SDS 10 L15M
044158 -  ..
044159 - Brad feels that lack of treatment for 5 months is a long time for a
044160 - patient suffering an 8th relapse of cancer.  He will coordinate to
044161 - ensure Millie gets treatment this week.
044162 -
044163 -        [On 090601 1847 Millie's letter notifies medical team of work
044164 -        plan for starting treatment with Gemzar to recover from 8th
044165 -        relapse of cancer. ref SDS 31 9M6F
044167 -         ..
044168 -        [On 090610 0122 notified Paula in Claims Resolution
044169 -        Department that UCSF medical mistakes require UCSF to
044170 -        provide treatment for Millie to recover. ref SDS 39 855G
044172 -         ..
044173 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
044174 -        for fixing medical mistakes performing radiation services
044175 -        for Millie on referral from Kaiser. ref SDS 40 855G
044177 -  ..
044178 - Brad advised that Doctor Johnson prescribed a reduced dose of Gemzar
044179 - because Millie's blood counts are already too low in the most recent
044180 - test on 090512 ANC 1320, ref SDS 12 B35J,
044182 -  ..
044183 - This aligns with the doctor's comments on 090515 during the meeting at
044184 - Kaiser.  He was concerned that Millie would have difficulty holding
044185 - blood counts, based on experience with sunitinib during November and
044186 - December.  On 081219 Millie's lab showed nearly everything had dropped
044187 - to below safe levels. ref SDS 7 JK7H  Doctor diagnosed this condition
044188 - in the medical chart as cytopenia. ref SDS 7 465J  As well the medical
044189 - chart under Assessment lists "Pancytopenia due to chemotherapy,"
044190 - ref SDS 7 NE6M, which is another form of low blood counts.
044192 -  ..
044193 - Brad said he is calling to notify Millie that side effects of Gemzar,
044194 - even with a reduced dose, are very severe for a patient with Millie's
044195 - patient profile, having relapsed 8 times.  He related that Gemzar side
044196 - effects will be similar to Adriamycin Cytoxan (AC), and capecitabine
044197 - with Taxol.  Brad's report of severe side effects aligns with research
044198 - reported to the medical team on 090529 1109. ref SDS 26 0M5X  During
044199 - the call today, we reviewed the record on 050516 when Millie felt she
044200 - would rather die than get more capecitabine with Taxol. ref SDS 1 AQ6G
044201 - The doctor then reduced the dose.
044203 -  ..
044204 - Brad's report today of severe side effects for Millie's patient
044205 - profile aligns with Doctor Johnson's report on 090515 that he would
044206 - get in trouble for prescribing Gemzar and Navelbine because these
044207 - single-agent drugs are not suitable for Millie's patient profile.
044208 - ref SDS 14 658J  On 090522 1323 Doctor Johnson wrote a letter
044209 - confirming that these drugs may not work at all for Millie.
044210 - ref SDS 20 UW6G  On 090531 Millie notified the medical team of fearing
044211 - Gemzar would bring weeks and months of agony with devestating side
044212 - effects, then progression cancer. ref SDS 28 IH9S
044213 -
044214 -        [On 090601 1847 Millie reported Brad's warnings to the medical
044215 -        team, and notified the team that she agreed accept the risk of
044216 -        severe side effects from Gemzar based on trust in her doctor to
044217 -        have made a thorough review and determined safety of treatment
044218 -        for Millie's patient profile. ref SDS 31 0C6W
044220 -         ..
044221 -        [On 090603 1524 Queenie called with Kaiser Pharmacy and
044222 -        indicated most patients toleate side effects of Gemzar; she was
044223 -        not aware of Brad's concerns; Queenie will send a letter to
044224 -        Millie confirming Kaiser's guidance on taking Gemzar.
044225 -        ref SDS 35 6W9H
044227 -         ..
044228 -        [On 090605 Millie received documentation from Queenie at Kaiser
044229 -        that discloses Gemzar has high risks for Millie's patient
044230 -        profile; requires extreme caution given after getting treatment
044231 -        with radiation, which Millie received for 4 weeks in February
044232 -        and March, and contiues to suffer side effects; Kaiser further
044233 -        says treatment with Gemzar requires avoiding blood thinners,
044234 -        and Millie is required to take blood thinners every day to
044235 -        prevent death from pulmonary embolism; Gemzar can cause low
044236 -        blood counts that leads to infection and death, Millie has a
044237 -        history of low blood counts. ref SDS 37 V34K
044239 -         ..
044240 -        [On 090609 1427 Kaiser plans blood transfusions to enable
044241 -        Millie to cope with severe effects reducing blood counts that
044242 -        expose risks of infection, and cause pain and suffering getting
044243 -        Gemzar treatments. ref SDS 38 WU3N
044245 -         ..
044246 -        [On 100301 0005 Zan called to verify Millie agreed to treatment
044247 -        for 10th relapse of cancer with Abraxane that has severe side
044248 -        effects. ref SDS 43 OO5X
044250 -  ..
044251 - Brad said that, since Millie is a stage IV cancer patient who has had
044252 - 8 different chemotherapy regimens over the past 8 years, her cancer
044253 - has mutated to resist chemotherapy.  Brad asked if Millie is aware
044254 - that Gemzar chemotherapy may not be effective?  Reviewed patient
044255 - history showing that Doctor Johnson has emphasized many times that
044256 - Millie's cancer resists chemotherapy, shown in case study during the
044257 - meeting at Kaiser on 090213 1130. ref SDS 9 R75G
044258 -
044259 -            [On 100219 1453 Doctor Johnson prescribed Abraxane
044260 -            chemotherapy, ref SDS 42 ER95; Zan the pharmacist called
044261 -            and reported more chemotherapy will not be effective for
044262 -            Millie to recover from cancer, ref SDS 42 LY5F; and has
044263 -            severe risks of fatal infection, ref SDS 42 LY5O; Zan sent
044264 -            a letter confirming severe side effects. ref SDS 42 LP3U
044266 -  ..
044267 - Most recently, Doctor Johnson's letter on 090522 warned the medical
044268 - team that treating Millie with Gemzar may not work at all, because her
044269 - patient profile cannot respond to single-agent treatments like Gemzar
044270 - and Navelbine. ref SDS 20 UW6G
044271 -
044272 -        [On 090603 1128 Millie asks medical team again for work
044273 -        plan with criteria to evaluate progression of her cancer
044274 -        getting Gemzar chemotherapy, and with a list of additional
044275 -        treatments targeted to Millie's patient profile after
044276 -        Gemzar fails, which is expected not to work at all.
044277 -        ref SDS 34 028X
044279 -         ..
044280 -        [On 090605 1447 Kaiser published guidance says Gemzar can cause
044281 -        low blood counts. ref SDS 37 0G49
044283 -         ..
044284 -        [On 090610 0122 notified Paula in Claims Resolution
044285 -        Department that UCSF medical mistakes require UCSF to
044286 -        provide treatment for Millie to recover. ref SDS 39 855G
044288 -         ..
044289 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
044290 -        for fixing medical mistakes performing radiation services
044291 -        for Millie on referral from Kaiser. ref SDS 40 855G
044293 -  ..
044294 - Brad is concerned that Millie's patient history of chronic low blood
044295 - counts (see case study of labs past 6 months below, ref SDS 0 FR4F),
044296 - presents severe risks of fatal infection caused by Millie getting more
044297 - chemotherapy, in this case with Gemzar.  He feels more chemotherapy
044298 - will cause infection, even death.
044299 -
044300 -            [On 100104 1115 Millie suffering severe pain, emergency
044301 -            care at Kaiser diagnosed with very severe shingles,
044302 -            ref SDS 41 0P9S, Doctor Zhang prescribes immediate
044303 -            treatment citing risk of complications. ref SDS 41 PS4J
044305 -             ..
044306 -            [On 100219 1453 Doctor Johnson prescribed Abraxane
044307 -            chemotherapy, ref SDS 42 ER95; Zan the pharmacist called
044308 -            and reported more chemotherapy will not be effective for
044309 -            Millie to recover from cancer, ref SDS 42 LY5F; and has
044310 -            severe risks of fatal infection, ref SDS 42 LY5O; Zan sent
044311 -            a letter confirming severe side effects. ref SDS 42 LP3U
044313 -             ..
044314 -            [On 100601 0830 Doctor Johnson diagnosed Phlebitis, which
044315 -            can be fatal causing blood clots; he ordered treatment with
044316 -            Relafen for 2 weeks, ref SDS 44 OP4G; this is the 2nd major
044317 -            infection from treating Millie with chemotherapy that
044318 -            conflicts with patient profile, reported on 090601 0818.
044319 -            ref SDS 30 FR8L
044321 -  ..
044322 - Millie cited this problem yesterday in a letter to the medical team,
044323 - reported on 090531 1544, ref SDS 28 IH7X, and which reviewed Doctor
044324 - Johnson's analysis that treatment "targeted" to Millie's cancer is
044325 - more effective and does not present risks of low blood counts.
044326 - ref SDS 28 IH8Q
044328 -  ..
044329 - Brad feels that Millie might get 1 or 2 cycles of Gemzar, then her
044330 - cancer will certainly progress and a new treatment will be needed.
044332 -  ..
044333 - Brad is also concerned about Millie missing Gemzar treatments due to
044334 - low blood counts.  An example of Kaiser withholding treatment for
044335 - blood counts to recover is on 060810. ref SDS 2 0001  Brad feels that
044336 - Millie's patient history missing treatments, getting Neupogen to
044337 - increase blood counts, and reducing the dose of treatment, which is
044338 - shown in a case study on 060810. ref SDS 2 HV45, will be a bigger
044339 - problem with Gemzar because she has now had a lot more chemotherapy
044340 - treatments.  This past December, Doctor Rugo had to pause daily
044341 - treatments for a week and reduce chemotherapy in order for Millie to
044342 - get sunitinib, discussed with Doctor Johnson at Kaiser on 081219.
044343 - ref SDS 7 SU9Q
044345 -         ..
044346 -        [On 090605 Millie received documentation from Queenis at Kaiser
044347 -        that disclosing that Gemzar has high risks for Millie's patient
044348 -        profile; requires extreme caution given after getting treatment
044349 -        with radiation, which Millie received for 4 weeks in February
044350 -        and March, and contiues to suffer side effects; Kaiser further
044351 -        says treatment with Gemzar requires avoiding blood thinners,
044352 -        and Millie is required to take blood thinners every day to
044353 -        prevent death from pulmonary embolism; Gemzar can cause low
044354 -        blood counts that leads to infection and death, Millie has a
044355 -        history of low blood counts. ref SDS 37 V34K
044356 -
044358 -  ..
044359 - Case Study Chronic Low Blood Counts 6 Months Prior Considering Gemzar
044360 -
044361 - The labs on 081218 showed nearly all of the CBC elements below the
044362 - level for safe chemotherapy treatments, discussed with Doctor Johnson
044363 - at Kaiser on 081219. ref SDS 7 JK7H  Brad was concerned that Doctor
044364 - Johnson's medical chart since that time has consistently reported
044365 - Millie's low blood counts, even when not getting chemotherapy...
044367 -             ..
044368 -            Cytopenia so MXT chemotherapy
044369 -            discontinued.................... 081219, ref SDS 7 465J
044371 -             ..
044372 -            Pancytopenia due to
044373 -            chemotherapy.................... 081219, ref SDS 7 NE6M
044375 -             ..
044376 -            Cytopenia cited in the
044377 -            History section................. 081219, ref SDS 7 465J
044379 -             ..
044380 -            Anemia due to
044381 -            chemotherapy.................... 090213, ref SDS 9 IH88
044383 -             ..
044384 -            Anemia due to
044385 -            chemotherapy.................... 090325, ref SDS 10 IH88
044387 -             ..
044388 -            Cytopenia cited in the
044389 -            History section................. 090515, ref SDS 14 TJ8L
044391 -  ..
044392 - Brad wants Millie to get a blood test today.  If blood counts are
044393 - below 1000, then he will will not approve Doctor Johnson's
044394 - prescription for Gemzar.  Sounded like Millie's doctor can override
044395 - this and allow Millie to be treated.  There is no record of Millie
044396 - being treated with chemotherapy when ANC below is 1000.
044397 -
044398 -        [On 090601 1847 Millie's letter notifies medical team of work
044399 -        plan for starting treatment with Gemzar to recover from 8th
044400 -        relapse of cancer. ref SDS 31 9M6F
044402 -         ..
044403 -        [On 090602 1518 Millie notifies medical team lab shows blood
044404 -        counts good to go for starting Gemzar chemotherapy at Kaiser.
044405 -        ref SDS 33 J47U
044407 -  ..
044408 - Brad is concerned that Millie's blood counts are already very low, and
044409 - since she has not been treatment for 5 months; the liklihood is very
044410 - low that she can hold blood counts for this treatment.
044411 -
044412 -        [On 090602 1300 Millie had a blood test at Kaiser in Martinez,
044413 -        CA, ref SDS 32 VF6G; results show blood counts increase
044414 -        sufficient to start treatment with Gemzar. ref SDS 32 B35J
044416 -         ..
044417 -        [On 090605 Millie received documentation from Queenis at Kaiser
044418 -        that disclosing that Gemzar has high risks for Millie's patient
044419 -        profile; requires extreme caution given after getting treatment
044420 -        with radiation, which Millie received for 4 weeks in February
044421 -        and March, and contiues to suffer side effects; Kaiser further
044422 -        says treatment with Gemzar requires avoiding blood thinners,
044423 -        and Millie is required to take blood thinners every day to
044424 -        prevent death from pulmonary embolism; Gemzar can cause low
044425 -        blood counts that leads to infection and death, Millie has a
044426 -        history of low blood counts. ref SDS 37 V34K
044428 -  ..
044429 - Thanked Brad for support.
044430 -
044431 -
044433 -  ..
0445 -
0446 -
0447 - 1153
0448 -
044801 - Sheree called implementing Brad's work plan, per above. ref SDS 0 HX86
044803 -  ..
044804 - Sheree said Kaiser's schedule in the Oncology Chemotherapy Infusion
044805 - Clinic is for Millie to get a blood draw and test for suitability to
044806 - get treatment the same day she gets the treatment.  This follows the
044807 - practice at UCSF the past 2 years.
044808 -
044809 -
044811 -  ..
044812 - Chemotherapy Order Gemzar Conflicts Patient Profile Gives Doctor Headache
044813 - Headache Doctor Goes Home after Submitting Unsigned Chemotherapy Order
044814 - Doctor Submits Unsigned Chemotherapy Order Went Home with Headache
044815 -
044816 - Asked what time Millie can come in today for the blood draw and get
044817 - treatment, which has been needed for weeks?
044819 -  ..
044820 - Sheree said Millie cannot come today for treatment, because the
044821 - doctor has not signed the chemothearpy order.
044823 -  ..
044824 - She explained that Doctor Johnson brought the Chemotherapy order into
044825 - the Infusion Clinic this morning, but did not sign it.  She does not
044826 - know why.  Normally Chemo Orders are signed when they are received in
044827 - the Clinic.  Sherree said they will not give Millie treatment without
044828 - a Chemotherapy Order signed by the doctor.
044830 -  ..
044831 - Mentioned that Jen said this morning that the doctor was in a training
044832 - class, per above. ref SDS 0 HX93  Can he be paged and reminded to sign
044833 - the Chemotherapy Order to expedite the work for Millie.
044835 -  ..
044836 - Sheree advised that Doctor Johnson went home sick with a migrane
044837 - headache after he delivered the Chemoterhapy Order for Millie to be
044838 - treated with Gemzar.
044839 -
044840 -        [On 090601 1847 Millie's letter notifies medical team of work
044841 -        plan for starting treatment with Gemzar to recover from 8th
044842 -        relapse of cancer was delayed because Chemotherapy Order was
044843 -        not signed by the doctor, and the doctor went home with a
044844 -        headache. ref SDS 31 0C7S
044846 -  ..
044847 - Getting a headache submitting an unsigned order for Millie to get
044848 - Gemzar chemotherapy may reflect deep emotional stress Doctor Johnson
044849 - expressed saying during the meeting at Kaiser on 090515 that he will
044850 - get in trouble for prescribing Navelbine and Gemzar because these
044851 - treatments are not standard of care for Millie's patient profile.
044852 - ref SDS 14 658J
044854 -  ..
044855 - Sheree said that Kaiser's work plan is for Millie to come in on
044856 - Thursday or Friday.  She feels by that time the problem getting the
044857 - doctor's signature can be resolved.  Millie can get a blood draw at
044858 - that time to see if her counts are high enough, and if so she will get
044859 - treatment.
044860 -
044861 -        [On 090603 1511 Queenie called and schedule Millie's treatment
044862 -        on 090611. ref SDS 35 6W9H
044864 -         ..
044865 -        [On 090604 1114 Bella advised that Sheree made a mistake
044866 -        scheduling Millie's Gemzar treatment this week, and planning
044867 -        for same day lab work; Bella said to follow Queenie's schedule
044868 -        for treatment on 090611. ref SDS 36 ZF5S
044870 -  ..
044871 - Asked if Millie can come in today for a blood test to see if she able
044872 - to get treatment with Gemzar, and then if not, then Kaiser will have
044873 - to prescribe another treatment, and if none is prescribed, then Millie
044874 - can get treatment at UCSF, per planning earlier this morning, per
044875 - above. ref SDS 0 VT8M
044877 -  ..
044878 - Sheree said Millie cannot come in today.  Kaiser's work plan is for
044879 - Millie to come in later in the week, on Thursday or Friday.  Millie
044880 - will get a blood draw at that time to see if her counts are high
044881 - enough to get treatment.
044882 -
044883 -        [On 090602 1300 Millie had a blood test at Kaiser in Martinez,
044884 -        CA, ref SDS 32 VF6G; results show blood counts increase
044885 -        sufficient to start treatment with Gemzar. ref SDS 32 B35J
044887 -  ..
044888 - Asked about getting the blood draw today, so that if the counts are
044889 - not high enough then other plans can be made to give Millie treatment
044890 - at UCSF in time to be effective.
044892 -  ..
044893 - Sheree said that since Doctor Johnson has not signed the chemothearepy
044894 - order she also cannot schedule Millie for a blood draw today.
044896 -  ..
044897 - Hopefully, this is not a ploy by Kaiser to force Millie into violation
044898 - of the insurance agreement, but without placing the doctor in jeparody
044899 - for violating standard of care by prescribing Gemzar for Millie's
044900 - patient profile, again as presented by the doctor at Kaiser on 090515.
044901 - ref SDS 14 658J
044903 -  ..
044904 - We reviewed patient history showing Doctor Johnson has standing order
044905 - for Millie to get a blood draw once a month, and the scope is adequate
044906 - to evaluate Millie's blood counts for safely getting chemotherapy with
044907 - Gemzar.
044909 -  ..
044910 - Sheree checked the computer.  She found the doctor's standing order.
044912 -  ..
044913 - Sheree said the Chemotherapy Infusion Department is very busy today
044914 - and tomorrow, and they are short-handed, because people called in sick
044915 - for 2 days.  She suggested calling Kaiser in Martinez.  She provided a
044916 - telephone number for Millie to coordinate with the Martinez Kaiser
044917 - Infusion clininc, so that Millie can be blood drawn from her port.
044919 -  ..
044920 - Sheree entered an order in Kaiser's computer for Millie to get a blood
044921 - draw at Kaiser Infusion Clinic in Martinez, and she specified the
044922 - scope for the Gemzar treatment.
044924 -  ..
044925 - Thanked Sheree for excellent assistance.
044926 -
044927 -        [On 090602 1300 Millie had a blood test at Kaiser in Martinez,
044928 -        CA, ref SDS 32 VF6G; results show blood counts increase
044929 -        sufficient to start treatment with Gemzar. ref SDS 32 B35J
044930 -
044931 -
044932 -
044933 -
044935 -  ..
0450 -
0451 -
0452 - 1215
0453 -
045301 - Called Kaiser Martinez Infusion Clinic.  Talked to Mary Beth.
045302 -
045303 - They will do the blood draw on 090602 1130.
045304 -
045305 -              925 372 1824
045307 -         ..
045308 -        [On 090602 1300 Millie had a blood test at Kaiser in Martinez,
045309 -        CA, ref SDS 32 VF6G; results show blood counts increase
045310 -        sufficient to start treatment with Gemzar. ref SDS 32 B35J
045311 -
045313 -  ..
0454 -
0455 -
0456 - 1227
0457 -
045701 - Millie received a letter from Mike at UCSF confirming telecon this
045702 - morning ordering treatment for cancer to recover from Kaiser's failure
045703 - to perform, per above. ref SDS 0 PP6U
045705 -  ..
045706 - Mike's letter says...
045707 -
045708 -    1.  Subject: RE: UCSF MPA Study
045709 -        Date: Mon, 1 Jun 2009 11:27:48 -0700
045713 -         ..
045714 -    2.  Hi Millie,
045716 -         ..
045717 -    3.  Thank you for informing me of your decision. For the purposes
045718 -        of this study, tumor imaging must be done within 4 weeks of
045719 -        starting treatment, so the CT of the neck, chest, abdomen, and
045720 -        pelvis done on April 14, 2009 is now considered out of window.
045721 -        Another CT must be ordered before starting on study, and a
045722 -        signed consent must be obtained before this procedure can be
045723 -        performed.  Please let me know when you can come in to sign the
045724 -        consent.
045725 -
045726 -            [On 090602 1518 sent copy to Mike of letter notifying
045727 -            medical team that lab shows blood counts have improved
045728 -            enough for starting Gemzar treatment at Kaiser, ordered by
045729 -            Doctor Johnson, and so treatment at UCSF is deferred
045730 -            pending Kaiser attempts to remedy default on insurance
045731 -            contract. ref SDS 33 J48Q
045733 -         ..
045734 -    4.  I will coordinate with Dr. Rugo's schedule to get you in clinic
045735 -        ASAP to start you on treatment.  I will also let you know if
045736 -        there are any other pre-treatment evaluations that need to be
045737 -        performed.
045738 -
045744 -
045745 -
045747 -  ..
0458 -
0459 -
0460 - 1412
0461 -
046101 - Received a call from someone in Kaiser's Expedited Claims department..
046102 -
046103 - The name sounded like "Lacosta" or maybe "Latricia"?
046105 -  ..
046106 - She said that Kaiser has not received Millie's authorization for
046107 - representation.
046109 -  ..
046110 - Advised that Kaiser's letter dated 090527 transmitting Statement of
046111 - Authorized Representative was received on 090529.  Millie signed the
046112 - statement on 090530, and this morning, Millie transmitted the signed
046113 - authorization for represenation, and then faxed the document to Kaiser
046114 - this morning on 090601 0831.  Millie received a "send succesful
046115 - notice" at 0834, per above. ref SDS 0 UD5H
046117 -  ..
046118 - The Kaiser claims woman explained that she received all of the
046119 - correspondence on Millie's claim from Paula in Kaiser's Member
046120 - Services Cliams Resolution Department.  This seems to reflect Paula's
046121 - call on 090528 saying she sent Millie's claim to Expedited Cliams,
046122 - after Expedited Claims sent the claim received from Paula back to
046123 - Paula's office, making a loop. ref SDS 22 PP6Q
046125 -  ..
046126 - Kaiser's claims woman said today during the call that she does not
046127 - understand Millie's claim, and does not have time to read the record.
046128 - She asked what Millie wants?
046130 -  ..
046131 - Referred her to the "subject" of the correspondence that requests a
046132 - plan for urgent treatment of Millie's 8th relapse of cancer applying
046133 - oncology standard of care, as presented to Pamela Powel in Kaiser
046134 - Expedited Claims Department on 090520 1203. ref SDS 17 9595  Reviewed
046135 - telecon with Paula on 090528, who seemed to understand the claim is
046136 - for treatment using standard of care for Millie's patient profile.
046137 - ref SDS 22 PX4H  This was confirmed in Millie's letter to the medical
046138 - team on 090528 1228. ref SDS 23 4N3R
046140 -  ..
046141 - The Kaiser claims woman said that Paula is not handling this claim.
046142 -
046143 -        [On 090610 0122 notified Paula in Claims Resolution
046144 -        Department that UCSF medical mistakes require UCSF to
046145 -        provide treatment for Millie to recover. ref SDS 39 855G
046147 -         ..
046148 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
046149 -        for fixing medical mistakes performing radiation services
046150 -        for Millie on referral from Kaiser. ref SDS 40 855G
046152 -  ..
046153 - The Kaiser claims woman then claimed, without having read the record,
046154 - that Millie's claim is for treatment in a clinical trial, and that
046155 - Kaiser's policy is for Medicare patients to call Medicare about
046156 - clinical trials.  She said Kaiser has no further obligations to review
046157 - Millie's claim.
046159 -  ..
046160 - This aligns with Pamela's call on 090521 relating that most claims
046161 - filed wtih Expedited Claims Department are for Medicare patients
046162 - requesting referral to a clinical trial. ref SDS 18 IZ8M  Classifyng
046163 - Millie's claim as requesting referral for a clinical trial seems like
046164 - a fast and easy to avoid the work of investigation and analysis.
046166 -  ..
046167 - Advised again that Millie's claim was presented on 090520 for Kaiser
046168 - to submit a treatment plan that applies oncology standard of care for
046169 - her patient profile, ref SDS 17 9595, and that time is of the essence,
046170 - since Millie has been without systemic treatment since January.
046172 -  ..
046173 - Asked the caller, if she knows Pamela Powell, who also works in the
046174 - Expedited Claims Department?  The woman caller said she knows Pamela.
046176 -  ..
046177 - Reviewed the record on 090521 when Pamela called and said that since
046178 - Millie's claim is for a plan applying standard of care to recover from
046179 - the 8th relapse by treating Millie's cancer as a chronic disease, as
046180 - ordered by her doctor, this case "falls through the cracks" at
046181 - Expedited Claims.  Pamela said Kaiser cannot deny Millie's claim
046182 - because Kaiesr cannot deny the patient treatment. ref SDS 18 UD5H
046183 - Pamela planned to call and assist the doctor in submitting a treatment
046184 - plan for Millie, and send the case back to Paula in Member Services
046185 - Claim Resolution for further processing. ref SDS 18 X68I
046187 -  ..
046188 - The woman said that Pamela Powell is no longer handling Millie's case;
046189 - she asked again for another statement of Millie's claim.
046191 -  ..
046192 - Asked the claims woman to review Kaiser's file on 090521 showing her
046193 - colleague Pamela Powell has processed Millie's claim, and sent the
046194 - matter to the Claims Resolution Department. ref SDS 18 UD5H
046196 -  ..
046197 - The woman said the department is not required to read the case record.
046199 -  ..
046200 - Asked for an email address to submit Millie's claim again, along with
046201 - the record confirming understandings from this call.
046203 -  ..
046204 - The woman said her department does not work with email from patients.
046205 - She can only take a verbal explanation by telephone, along with the
046206 - patient's story proving entitlement.
046208 -  ..
046209 - Advised there has been some new movement in the past hour or so.
046211 -  ..
046212 - Explained call from Brad saying that Doctor Johnson has prescribed
046213 - treatment with Gemzar for Millie, per above, saying Doctor Johnson has
046214 - prescribed Gemzar, ref SDS 0 PQ7V, and warning that Gemzar is not
046215 - appropriate for Millie's patient profile. ref SDS 0 8J8L
046217 -  ..
046218 - The claims woman then said that obviously Millie's claim is now
046219 - resolved by Brad's call.  She feels Millie does not have a claim, and
046220 - so the Expedited Claims Department does not have to issue a
046221 - determination.
046223 -  ..
046224 - Explained the matter is more complex.  It turns out the doctor has not
046225 - signed the Chemotherapy Order. ref SDS 0 PQ4F  Even if the order is
046226 - signed, and Millie gets treatment, this is not a "plan" that meets
046227 - requirements for Millie's patient profile, which is Millie's claim at
046228 - this time against Kaiser.
046229 -
046230 -        [On 090605 Millie received documentation from Kaiser that
046231 -        says Gemzar has high risks for Millie's patient profile;
046232 -        requires extreme caution given after getting treatment with
046233 -        radiation, which Millie received for 4 weeks in February and
046234 -        March, and contiues to suffer side effects; Kaiser further
046235 -        says treatment with Gemzar requires avoiding blood thinners,
046236 -        and Millie is required to take blood thinners every day to
046237 -        prevent death from pulmonary embolism; Gemzar can cause low
046238 -        blood counts that leads to infection and death, Millie has a
046239 -        history of low blood counts. ref SDS 37 V34K
046241 -  ..
046242 - The claims woman disagreed.
046244 -  ..
046245 - Asked the claims woman to issue a denial letter, so this issue can
046246 - proceed to timely resolution for Millie.
046248 -  ..
046249 - The claims woman seemed to say that it is unncessary, because the
046250 - doctor has prescribed treatment.
046252 -  ..
046253 - Asked the woman for the spelling of her name, and an email address to
046254 - confirm these understandings, and include her in distribution to the
046255 - team.
046257 -  ..
046258 - She hung up.
046259 -
046260 -        [On 090610 0122 notified Paula in Claims Resolution
046261 -        Department that UCSF medical mistakes require UCSF to
046262 -        provide treatment for Millie to recover. ref SDS 39 855G
046264 -         ..
046265 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
046266 -        for fixing medical mistakes performing radiation services
046267 -        for Millie on referral from Kaiser. ref SDS 40 855G
046268 -
046269 -
046270 -
046272 -  ..
0463 -
0464 -
0465 - 1506
0466 -
046601 - Millie arrived howe from errands.
046602 -
046603 - She found the copy of the fax sent this morning to Kaiser authorizing
046604 - her represenation.
046606 -  ..
046607 - Millie called the number on the document, and left a message on the
046608 - answering machine advising that the authorization was faxed this
046609 - morning.
046610 -
046611 -
047021 -
047023 -  ..
0471 -
0472 -
0473 - 1603
0474 -
047401 - UCSF Treatment Deferred Pending Kaiser Progress on Promise to Perform
047402 -
047403 - Called Mike at UCSF to follow up telecon this morning, per above.
047404 - ref SDS 0 PP6U
047406 -  ..
047407 - Mike advised that Doctor Rugo is off-site today.  He has sent her an
047408 - email to explain plans for starting treatment this week on Thursday.
047410 -  ..
047411 - Explained call from Kaiser this morning advising the primary care
047412 - physician has ordered Gemzar, ref SDS 0 PQ7V, but it turns out that
047413 - Doctor Johnson has not actually signed the work order, and that he
047414 - went home with a headache, ref SDS 0 PQ4F, so it is still not clear
047415 - that Kaiser will provide treatment for Millie, and if not then Millie
047416 - will need immediate treatment from UCSF.
047418 -  ..
047419 - We will get a blood draw tomorrow at Kaiser 1130; and if the counts
047420 - are adequate, and if Doctor Johnson signs the Chemotherapy Order,
047421 - then Millie will get treatment with Gemzar, and treatment with MPA
047422 - will be deferred, pending progression on Gemzar.
047423 -
047424 -            [On 090602 1518 sent copy to Mike of letter notifying
047425 -            medical team that lab shows blood counts have improved
047426 -            enough for starting Gemzar treatment at Kaiser, ordered by
047427 -            Doctor Johnson, and so treatment at UCSF is deferred
047428 -            pending Kaiser attempts to remedy default on insurance
047429 -            contract. ref SDS 33 J48Q
047431 -  ..
047432 - Further decided that treatment this week will be deferred at least
047433 - until next week, because Kaiser needs time to implement its work plan
047434 - with Gemzar.
047435 -
047436 -
047437 -
047438 -
047439 -
047440 -
047441 -
047442 -
0475 -