CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 87 0000. ref SDS 86 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 -    1.  On 090121 1041 Glenna called and said that progression of
040902 -        Millie's cancer, most notably in the breastbone area requires
040903 -        UCSF to change treatments, as ordered by Doctor Johnson at
040904 -        Kaiser on 081219.  Doctor Rugo needs a list of treatments from
040905 -        Millie's records which UCSF has planned to treat Millie's
040906 -        cancer as a chronic disease, ref SDS 24 Y67L, further ordered
040907 -        by Doctor Johnson at Kaiser on 081219. ref SDS 23 V93O
040909 -         ..
040910 -    2.  On 090123 1326 Doctor Johnson confirms prior guidance that
040911 -        multiple (7) relapses have mutated Millie's cancer into a very
040912 -        aggressive disease that requires immediate change in treatment
040913 -        in order for Millie to recover. ref SDS 26 RK6O
040915 -         ..
040916 -    3.  On 090129 0800 UCSF delayed Millie's treatment 1 week due to
040917 -        problems of missed communication between Oncology and Infusion,
040918 -        reported on 090130 1722. ref SDS 27 AY8Q
040920 -         ..
040921 -    4.  On 090129 1036 Doctor Rugo at UCSF notified Kaiser that Millie
040922 -        needs immediate treatment to recover from 7th relapse of
040923 -        cancer, which is worse in the breastbone area, and proposes
040924 -        treatment in UCSF Radiation Oncology Department with
040925 -        hyperthermia and Doxil, reported on 090130 1722. ref SDS 27
040926 -        TZ6H
040928 -         ..
040929 -    5.  On 090201 2017 UCSF delayed treatment for Millie's 7th relapse
040930 -        of cancer, because the Radiation Oncology Department needed
040931 -        more time to schedule the work. ref SDS 28 GV4M
040933 -         ..
040934 -    6.  On 090202 1047 Kaiser delayed authorization for Millie's
040935 -        treatment because the doctor did not fill out a form correctly
040936 -        referring Millie's treatment to UCSF. ref SDS 29 9Y5I
040938 -         ..
040939 -    7.  On 090202 1353 UCSF delayed treatment again for 6 weeks to
040940 -        maintain an orderly schedule. ref SDS 30 SP6H
040942 -         ..
040943 -    8.  On 090202 1932 Doctor Rugo at UCSF Oncology Department notified
040944 -        the medical team that Millie needs urgent treatment quickly in
040945 -        time to be effective. ref SDS 31 Y15J
040947 -         ..
040948 -    9.  On 090203 1438 UCSF Radiation Oncology Department advances
040949 -        Millie's treatment 4 weeks to begin in time to be effective.
040950 -        ref SDS 32 XX5I
040952 -         ..
040953 -   10.  On 090204 0219 Millie's letter asks Doctor Rugo to submit
040954 -        proactive planning for follow on treatment after hyperthermia
040955 -        and Doxil for Millie's 6th relapse of IBC. ref SDS 33 278T
040957 -         ..
040958 -   11.  On 090204 1914 Doctor Rugo defers teamwork for practice synergy
040959 -        and proactive management to plan for alternate scenarios that
040960 -        optimize coprehensive care is prevented because Millie's case
040961 -        is very complicated. ref SDS 34 063I
040963 -         ..
040964 -   12.  On 090205 0830 Doctor Hsu examination in UCSF Radiation
040965 -        Oncology Department finds Millie's cancer has progressed
040966 -        significantly due to delays starting treatment; changes
040967 -        treatment protocol from hyperthermia and Doxil to radiation and
040968 -        hyperthermia. ref SDS 35 EY5F
040970 -         ..
040971 -   13.  On 090213 1140 Doctor Johnson notifies Millie that she has less
040972 -        than 1 year to live, ref SDS 37 646L, unless she gets effective
040973 -        treatment quickly for cancer that has mutated into aggressive
040974 -        disease that will cascade out of control. ref SDS 37 ES7I
040976 -         ..
040977 -   14.  On 090218 1205 Millie notifies Doctor Rugo again that Doctor
040978 -        Johnson has authorized UCSF Cancer Center to begin planning
040979 -        Millie's next treatment after radiation and hyperthremia,
040980 -        because she has a narrow margin for delay getting treatment to
040981 -        survive. ref SDS 38 TH6U
040983 -         ..
040984 -   15.  On 090219 1315 UCSF begins treatment 4-weeks late on referral
040985 -        from Kaiser for Millie to recover from 7th relapse of cancer.
040986 -        ref SDS 39 E57G
040988 -         ..
040989 -   16.  On 090310 0351 after 3-weeks treatment with radiation and
040990 -        hyperthermia Millie notifies medical team that cancer in the
040991 -        breastbone area seems worse. ref SDS 41 O56X
040993 -         ..
040994 -   17.  On 090331 2947 Millie notified medical team of possible IBC
040995 -        progression on lower left arm, and asked about starting
040996 -        treatment to recover from 8th relapse of cancer. ref SDS 45
040997 -        Q64R
040999 -         ..
041000 -   18.  On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower
041001 -        left arm as progression of IBC. ref SDS 46 R24X
041003 -         ..
041004 -   19.  On 090401 0046 Millie asks about getting treatment of IBC
041005 -        spreading to lower left arm, which establishes the 8th relapse
041006 -        of cancer diagnosed by Doctor Hsu. ref SDS 47 RE8P
041008 -         ..
041009 -   20.  On 090401 0121 Doctor Rugo reports Millie's wound in breastbone
041010 -        area diagnosed as reaction to 4-weeks of radiation that ended
041011 -        on 090317 must heal before starting treatment for IBC relapse,
041012 -        and so defers the meeting scheduled on 090402 0800; Doctor Rugo
041013 -        expects full recovery from IBC in areas treated with radiation
041014 -        and hyperthermia because this regimen to be very effective.
041015 -        ref SDS 48 K56O
041017 -         ..
041018 -   21.  On 090412 2241 Millie reports again to the medical team that
041019 -        IBC on lower left arm is getting worse, and requests immediate
041020 -        treatment in order to prevent problems cited by Doctor Johnson
041021 -        that delay risks losing control and death. ref SDS 49 9S8Y
041023 -         ..
041024 -   22.  On 090510 1220 Millie reports wound in the breastbone diagnosed
041025 -        as reaction to radiation looks worse; asks if this might be IBC
041026 -        because of a mistake in performing radiation treatments?
041027 -        Millie further asked about doing a biopsy to test for cancer,
041028 -        so that treatment can begin immediately under Doctor Johnson's
041029 -        warning that immediate treatment is essential for recovery.
041030 -        ref SDS 52 LJ5T
041032 -         ..
041033 -   23.  On 090514 0830 Doctor Rugo prescribes treatment with MPA,
041034 -        ref SDS 54 D647, and submits a letter to Kaiser submitting the
041035 -        protocol, ref SDS 54 DI63, as previously requested by Doctor
041036 -        Johnson on 081219 1140. ref SDS 23 V93O
041038 -         ..
041039 -   24.  On 090515 0800 Doctor Rugo notifies medical team that Kaiser
041040 -        failed to perform requirements for referral to pay for Millie's
041041 -        treatment recommended by UCSF Cancer Center as the best
041042 -        evidence of care that has the best chance for Millie to
041043 -        recover, which Kaiser is required to provide under section 2 of
041044 -        EOC. ref SDS 55 WP6S
041046 -         ..
041047 -   25.  On 090515 1017 Millie notified medical team that Doctor Rugo's
041048 -        letter was received; that Kaiser is responsible for Millie's
041049 -        care, and Millie will meet with the primary care doctor at
041050 -        Kaiser on 090515 1140 and request that Kaiser prescribe care
041051 -        for Millie's 8th relapse of cancer based on the best evidence,
041052 -        ref SDS 56 6Q8W, as shown in Doctor Rugo's letter to Kaiser on
041053 -        090514 0830. ref SDS 54 DI63
041055 -         ..
041056 -   26.  On 090515 1518 Doctor Rugo responds wishing Millie "good luck."
041057 -        ref SDS 58 PW7H
041059 -         ..
041060 -   27.  On 090515 1140 Millie met with Doctor Johnson at Kaiser and the
041061 -        doctor said that he was told by Doctor Mason that the primary
041062 -        care physician, Doctor Johnson, cannot prescribe standard of
041063 -        care treatment for Millie in a clinical trial, despite patient
041064 -        history having prescribed prior clinical trials 4 times
041065 -        previously for standard of care in oncology, and as a result,
041066 -        Doctor Johnson requested a draft to assist him preparing an
041067 -        appeal to file with Member Services so that Kaiser can expedite
041068 -        Millie's recovery from the 8th relapse of cancer. ref SDS 57
041069 -        655R
041071 -         ..
041072 -   28.  On 090516 0858 Millie notified Doctor Rugo that Doctor Johnson
041073 -        is filing an appeal for Kaiser to treat Millie with MPA
041074 -        protocol recommended by UCSF to recover from the 8th relapse of
041075 -        cancer. ref SDS 59 SY4J
041077 -         ..
041078 -   29.  On 090518 0017 Millie submits letter to Doctor Johnson with
041079 -        copy to Doctor Rugo at UCSF, and transmitting a draft to assist
041080 -        Doctor Johnson filing his appeal with Member Services to
041081 -        assisting Kaiser implement Doctor Johnson's strategy to treat
041082 -        Millie's cancer as a chronic disease in time for Millie to
041083 -        recover from the 8th relapse of cancer. ref SDS 60 R16I
041085 -         ..
041086 -   30.  On 090519 1536 Doctor Johnson changed his mind; he sent the
041087 -        draft appeal to Doctor Mason, and tells Millie to file an
041088 -        appeal with Member Services, which is incorrect since at this
041089 -        time Millie has not been denied medical services; and the
041090 -        doctor further says he is suddenly relieved of responsibility
041091 -        performed continuously the past 8 years to prescribe treatment
041092 -        for Millie to recover from cancer, because Kaiser's Outside
041093 -        Referrals Department has a better understanding of Medicare.
041094 -        ref SDS 61 5K7H
041096 -         ..
041097 -   31.  On 090519 1613 Millie responded, ref SDS 62 8V8H, to the
041098 -        Doctor's letter earlier yesterday afternoon on 090519 1536,
041099 -        ref SDS 61 5K7H; and, Millie asks the doctor to prescribe
041100 -        treatment so she can recover from cancer, as done previously in
041101 -        patient history, ref SDS 62 TY3X, and further as planned by the
041102 -        doctor during the meeting on 090515 1140. ref SDS 57 655R
041103 -        Millie also asked the doctor to call on expediting treatment in
041104 -        time to be effective, see again on 090520 1613, ref SDS 62
041105 -        TY4W; and Millie asks Doctor Rugo for a "drop dead" date on how
041106 -        soon treatment must start in order to be effective, also,
041107 -        reported on 090519 1613. ref SDS 62 TX4W
041109 -         ..
041110 -   32.  Since Kaiser has delayed ordering treatment, reported on 090520
041111 -        1710. ref SDS 69 ZF4Q, then on 090521 0211 Millie's letter to
041112 -        Doctor Rugo at UCSF with copy to Doctor Hsu asks about getting
041113 -        treatment with hyperthermia and Doxil, while Kaiser resolves
041114 -        delays ordering MPA prescribed by Doctor Rugo for Millie to
041115 -        recover from 8th relapse of cancer, which Millie reports is
041116 -        getting worse every day, ref SDS 70 FM7Q, and since Kaiser has
041117 -        previosuly authorized treatment with hyperthermia and Doxil,
041118 -        which Doctor Rugo recommended earlier on 090129 for Millie to
041119 -        recover from the 7th relapse. ref SDS 70 6M4F
041121 -         ..
041122 -   33.  On 090521 2006, Millie received a letter from Doctor Johnson
041123 -        responding to Millie's letter to the medical team on 090520
041124 -        1710, and requesting that Kaiser prescribe treatment suitable
041125 -        for Millie's patient profile for recovering from 8th relapse of
041126 -        cancer. ref SDS 69 P65H   Doctor Johnson's letter was sent
041127 -        through Kaiser's Knowledge Management System and so was not
041128 -        disclosed to the medical team, and it did transmit the Doctor
041129 -        Johnson's medical chart for the meeting on 090515, ref SDS 57
041130 -        YT5N, and said that Millie could "choose" any treatment she
041131 -        wants, and no treatment is superior for Millie's patient
041132 -        profile, 090521 2006, ref SDS 72 9Q9H; the doctor noted
041133 -        Millie's cancer is progressing and so she needs to start
041134 -        treatment by the end of the week, which was in just 12 hours,
041135 -        which means today, ref SDS 72 HC8O, and the doctor told Millie
041136 -        to call Medicare for prescribing treatment to recover from the
041137 -        8th relapse of cancer. ref SDS 72 HC93
041139 -         ..
041140 -   34.  On 090522 0813 Millie responded to Doctor Johnson's letter on
041141 -        090521 2006 and submitted copies to the medical team to
041142 -        maintain collaboration that has been effective treating Millie
041143 -        the past 8 years.  Millie also sent a copy to Jullian Kwok to
041144 -        notify Medicare that Kaiser is refusing treatment. ref SDS 73
041145 -        RX6L  Millie asked Kaiser to prepare a workup and Tumor Board
041146 -        to evaluate Millie's next treatment, including trade-offs
041147 -        comparing all of the treatments available for Millie.
041148 -        ref SDS 73 7Z5Y  Millie reports having called Kaiser numerous
041149 -        times to speak with the doctor on prescribing treatment.
041150 -        ref SDS 73 7Z9Y  Millie notifies medical team she chooses
041151 -        hyperthermia and radiation, Doxil, or other agent suitable for
041152 -        Millie's patient profile. ref SDS 73 715V
041154 -         ..
041155 -   35.  On 090522 1247 Millie received a response from Doctor Johnson
041156 -        to Millie's letter on 090522 0813. ref SDS 73 RX6L who sent
041157 -        copies to the medical team, and saying Kaiser has performed
041158 -        workups, but does not submit any workups, and says Millie's
041159 -        patient profile is too complex for Tumor Board to evaluate best
041160 -        course of treatment, and that Millie's patient profile resists
041161 -        single agent treatments like Gemzar and Navelbine, and that
041162 -        Millie can choose Hospice instead of treatment with drugs which
041163 -        her patient profile now resists. ref SDS 74 XO5O
041165 -         ..
041166 -   36.  On 090522 1351 Millie responded to Kaiser's letter submitted by
041167 -        Doctor Johnson on 090522 1247, ref SDS 74 XO5O, confirming
041168 -        Millie needs urgent treatment to start quickly, reported on
041169 -        090522 1351, ref SDS 75 7R7J; Millie asks if treatment with
041170 -        Gemzar, Navelbine, and possibly CTP, ref SDS 75 2T9W and
041171 -        ref SDS 75 2T4P, will be weeks of agony then progression of
041172 -        cancer that requires another treatment "targeted" to treat
041173 -        Millie's patient profile. ref SDS 75 2T4S  Millie requested
041174 -        advice on treatment with a clinical trial at Kaiser, based on
041175 -        patient history, ref SDS 75 2T4V, and further requested
041176 -        trade-offs getting more hyperthermia and radiation and Doxil or
041177 -        other appropriate agent, including vaccines. ref SDS 75 2T4Y
041178 -
041180 -         ..
041181 -        Millie Over-treated Cannot Estimate Time to Progression
041182 -        May Not Work at All Millie Over-treated Patient Profile Resists Chemo
041183 -        Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
041184 -        Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
041185 -
041186 -        Follow up ref SDS 87 NM6J, ref SDS 86 NM6J.
041187 -
041188 -   37.  On 090522 1953 Millie received a letter from Doctor Johnson
041189 -        responding to Millie's letter to the medical team at Kaiser and
041190 -        UCSF this afternoon, reported on 090522 1351. ref SDS 75 7R7J
041191 -        For some reason, the doctor he did not submit copies to the
041192 -        medical team, demonstrating uneven case management for
041193 -        coordination and collaboration; the doctor confirms that
041194 -        treatment with single-agent chemotherapies presented as the
041195 -        only choices for care may not work at all for Millie to recover
041196 -        from 8th relapse of cancer. ref SDS 76 NV4L
041197 -
041198 -
041200 -         ..
041201 -        Demand for Treatment Standard of Care Millie's Patient Profile
041202 -
041203 -        Follow up ref SDS 87 ON8G, ref SDS 86 ON8G.
041204 -
041205 -   38.  On 090523 0148 Millie sent a letter to Paula in the Kaiser
041206 -        Claims Resolution Department with copy to medical team
041207 -        demanding treatment to recover from 8th relapse applying
041208 -        standard of care for Millie's patient profile. ref SDS 77 2P6J
041210 -         ..
041211 -   39.  On 090528 0803 called Paula for progress processing Millie's
041212 -        claim for treatment with standard of care for Millie's patient
041213 -        profile. ref SDS 79 T04L
041215 -         ..
041216 -   40.  On 090528 1228 Millie sent a letter to Paula confirming claim
041217 -        demanding timely treatment for 8th relapse of cancer.
041218 -        ref SDS 80 UD5H and saying that she will get treatment through
041219 -        another provider and bill Kaiser, because her doctor at Kaiser
041220 -        says Millie needs immediate treatment, and Kaiser has failed to
041221 -        perform. 090528 1228, ref SDS 80 4N8X
041223 -         ..
041224 -        Kaiser Defaults Insurance Contract Millie Orders Work from Others
041225 -        UCSF Prescribes Gemcitabine Treatment for Millie at Kaiser
041226 -        Millie Requests Prescription and Comparison of Treatment Choices
041227 -
041228 -        Follow up ref SDS 87 UD5H, ref SDS 86 UD5H.
041229 -
041230 -   41.  On 090528 1334 Millie sent a letter to Doctor Rugo and Doctor
041231 -        Hsu at UCSF requesting treatment, and sent a copy to notify the
041232 -        medical team she has been forced to get treatment from another
041233 -        provider to mitigate damages from Kaiser's failure to provide
041234 -        care. ref SDS 81 UD5H
041236 -         ..
041237 -   42.  On 090528 1613 Doctor Rugo responds to Millie's letter on
041238 -        090528 1334, requesting prescription for treatment because
041239 -        Kaiser has defaulted on insurance contract, ref SDS 81 2L7P;
041240 -        UCSF prescribes treatment with gemcitabine starting next week.
041241 -        ref SDS 82 XZ4M
041243 -         ..
041244 -   43.  On 090528 1652 Millie letter to medical team thanks Doctor Rugo
041245 -        for her letter today suggesting a new treatment, ref SDS 82
041246 -        XZ4M, and asks for comparison with other treatments to recover
041247 -        from 8th relapse of cancer. ref SDS 83 MZ7N
041249 -         ..
041250 -   44.  On 090529 1109 since Kaiser has failed to order treatment,
041251 -        Millie requests treatment date and time from UCSF, ref SDS 84
041252 -        448K, and to compare advantages and costs of treatment options.
041253 -
041255 -         ..
041256 -        Complex Patient History Causes Confusion Mistakes Conflict
041257 -        Misleading Correspondence Kaiser Complains Against Patient
041258 -
041259 -        Follow up ref SDS 87 SZ9J, ref SDS 86 SZ9J.
041260 -
041261 -   45.  On 090529 1751 Doctor Johnson responds to Millie's letter
041262 -        earlier in the day, ref SDS 84 448K; Kaiser complains that
041263 -        patient correspondence is confusing and misleading, and
041264 -        proposes treating Millie with Gemzar and Navelbine starting
041265 -        next week. ref SDS 85 SZ9J
041267 -         ..
041268 -   46.  On 090531 1544 Millie notifies the medical team responding to
041269 -        Doctor Johnson's letter on 090529 1751. ref SDS 85 SZ9J, and
041270 -        reports cancer is getting worse so she needs urgent treatment,
041271 -        and asks Kaiser to provide treatment based on standard of care
041272 -        for Millie's patient profile. ref SDS 86 LD4O
041273 -
041275 -         ..
041276 -        Millie Requests Treatment from UCSF to Replace Kaiser
041277 -
041278 -        Follow up ref SDS 87 2E4K.
041279 -
041280 -   47.  On 090531 2227 Millie requests treatment from UCSF because
041281 -        Kaiser has failed to provide treatment for Mille's 8th relapse
041282 -        of cancer. ref SDS 87 2E4K
041284 -         ..
041285 -   48.  On 090601 0818 Millie files authorization for representation to
041286 -        provide patient assistance helping Kaiser implement
041287 -        requirements of insurance agreement in EOC Section 2.
041288 -        ref SDS 88 UD5H
041290 -         ..
041291 -   49.  On 090601 0818 at 0820 called UCSF to make arrangmenets for
041292 -        Millie to start treatment of her patient profile for recovering
041293 -        from 8th relapse of cancer. ref SDS 88 VT8M
041295 -         ..
041296 -   50.  On 090601 0818 at 0830 submitted letter to UCSF with copy to
041297 -        Kaiser confirming arrangements for Millie to get treatment
041298 -        based on her patient profile. ref SDS 88 1P8M
041300 -         ..
041301 -   51.  On 090601 0818 at 0910 called counsel for support assisting
041302 -        Kaiser implement insurance requirements. ref SDS 88 0154
041304 -         ..
041305 -   52.  On 090601 0818 at 1051 called Mike at UCSF to coordinate work
041306 -        plan for starting treatment at UCSF; Mike advises that Millie
041307 -        needs another CT test to set baseline for starting treatment.
041308 -        ref SDS 88 PP6U
041310 -         ..
041311 -   53.  On 090601 0818 at 1111 called Kaiser to coordinate schedule for
041312 -        CT test required by treatment protocol at UCSF. ref SDS 88 0285
041314 -         ..
041315 -   54.  On 090601 0818 at 1132 Brad called from the Kaiser Oncology
041316 -        Pharmacy and advised that Doctor Johnson has issued a
041317 -        chemotherapy order to treat Millie with Gemzar, ref SDS 88
041318 -        PQ7V, implementing Doctor Rugo's letter on 090528 1613.
041319 -        ref SDS 82 4T6K  Treatment was scheduled for later in the week,
041320 -        based on Millie passing a blood test later in the day on 090601
041321 -        0818. ref SDS 88 5K94
041323 -         ..
041324 -   55.  On 090601 0818 at 1153 Sheree called in the Kaiser Chemotherapy
041325 -        Infusion Clinic and advised that Millie cannot get a blood test
041326 -        today for starting treatment later in the week, because the
041327 -        doctor did not sign the Chemotherapy Order, and the doctor went
041328 -        home with a headache after delivering an unsigned order for
041329 -        treating Millie with Gemzar which the doctor expects to get in
041330 -        trouble for prescribing a treatment that conflicts with
041331 -        Millie's patient profile, and the order cannot be signed until
041332 -        the doctor recovers and returns to work. ref SDS 88 PQ5Q
041334 -         ..
041335 -   56.  On 090601 0818 1227 Millie received letter from UCSF confirming
041336 -        arrangements for treatment to recover from Kaiser's failure to
041337 -        perform. ref SDS 88 SQ5G
041339 -         ..
041340 -   57.  On 090601 0818 at 1412 Kaiser Expedited Claims called and
041341 -        advised that Paula sent Millie case back to Expedited Claims
041342 -        after Kaiser Expedited Claims sent the case to Paula's office
041343 -        in Member Services Claims Resolution for resolution, and the
041344 -        woman said she does not understand Millie's claim for a
041345 -        treatment plan to recover from the 8th relapse of cancer.
041346 -        ref SDS 88 PR4S
041348 -         ..
041349 -   58.  On 090601 0818 at 1603 called UCSF and deferred treatment
041350 -        pending Kaiser's progress on treating Millie wtih Gemzar, as
041351 -        recommended by Doctor Rugo. ref SDS 88 H14T
041352 -
041354 -  ..
0414 -
0415 -
0416 - Progress
0417 -
041701 -        Work Plan Implement Kaiser's Order for Gemzar Treatment
041702 -        Kaiser Pays 300% to 400% More For Patient Care than Necessary
041703 -
041704 -        On 090601 1847 notified medical team of Kaiser's work plan for
041705 -        treating Millie with Gemzar to recover from 8th relapse of
041706 -        cancer. ref SDS 0 9M6F
041707 -
041708 -    1.  Subject: Gemzar Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041709 -        Date: Mon, 01 Jun 2009 20:02:56 -0700
041721 -         ..
041722 -    2.  Brad in the Kaiser Pharmacy called at 1140a and said you have
041723 -        prescribed Gemzar. 090601 0818, ref SDS 88 PQ7V  Looks like
041724 -        this will cost Kaiser 300% to 400% more than the MPA plan.
041725 -        Hopefully, cost containment can be a factor for the 9th
041726 -        relapse.
041727 -
041728 -            [On 090602 1340 Doctor Johnson responds with "secure" mail
041729 -            which cannot be accessed, Millie requests resubmission.
041730 -            ref SDS 89 H56W
041732 -         ..
041733 -    3.  For Doctor Rugo, you can stop reading; Mike can brief you on
041734 -        the details, since the rest involves mainly Kaiser for now.
041736 -         ..
041737 -    4.  Thanks very much for moving forward with care requested in a
041738 -        letter to the medical team yesterday on 090531 [1544,
041739 -        ref SDS 86 IH6S].
041741 -         ..
041742 -    5.  Brad advised that you reduced the Gemzar dose because my blood
041743 -        counts are already too low (ANC 1320), in the most recent test
041744 -        on 090512. ref SDS 88 5K9F  Brad planned to order a blood test
041745 -        today, so we can start treatment this week. ref SDS 88 5K94  He
041746 -        initially proposed starting in 10 days to 2 weeks.  He feels
041747 -        that since my last treatment with sunitinib was on 090122, time
041748 -        is of the essence, and so will try to schedule treatment this
041749 -        week.  I later decided it would be best to start next Monday if
041750 -        possible.
041752 -         ..
041753 -    6.  Brad indicated that if blood counts are too low (ANC then he
041754 -        would caution against my getting treatment with Gemzar.  We can
041755 -        try Neupogen, which has worked previously, but that takes time
041756 -        and is expensive. ref SDS 88 5K94
041757 -
041758 -            [On 090602 1518 Millie notifies medical team lab shows
041759 -            blood counts good to go for starting Gemzar chemotherapy at
041760 -            Kaiser. ref SDS 90 J47U
041762 -         ..
041763 -    7.  Brad further warned that even with reduced dose, side effects
041764 -        will be very severe for me because this is my 8th relapse of
041765 -        cancer.  He wanted to make sure I am okay with this.
041766 -        ref SDS 88 8J8L
041768 -         ..
041769 -    8.  I explained placing trust in my doctor, who has always stood by
041770 -        me.
041771 -
041772 -            [On 090605 Millie received documentation from Kaiser that
041773 -            says Gemzar has high risks for Millie's patient profile;
041774 -            requires extreme caution given after getting treatment with
041775 -            radiation, which Millie received for 4 weeks in February and
041776 -            March, and contiues to suffer side effects; Kaiser further
041777 -            says treatment with Gemzar requires avoiding blood thinners,
041778 -            and Millie is required to take blood thinners every day to
041779 -            prevent death from pulmonary embolism; Gemzar can cause low
041780 -            blood counts that leads to infection and death, Millie has a
041781 -            history of low blood counts. ref SDS 95 V34K
041783 -         ..
041784 -    9.  About 20 minutes later, I got a call from Sheree in the
041785 -        Infusion Clinic.  She said that this morning you brought a
041786 -        Chemo Order into the Infusion Clinic for me to get Gemzar, but
041787 -        the order is not signed, and that you went home sick with a
041788 -        migraine headache, so she cannot get it signed today [reported
041789 -        on 090601 0818. ref SDS 88 PQ4F].
041791 -         ..
041792 -   10.  Sheree said that, since the chemo order has not been signed, I
041793 -        cannot get a blood draw today, as planned with Brad.
041795 -         ..
041796 -   11.  Reviewed background that you have a standing order for a blood
041797 -        draw. ref SDS 88 HX63
041799 -         ..
041800 -   12.  Sheree was terrific.  She found your standing order on the
041801 -        computer for my monthly labs.  She said I still cannot get the
041802 -        blood test today to see if my counts are high enough for
041803 -        Gemzar, because the Oncology Infusion Clinic is short-handed
041804 -        both today and tomorrow.  Apparently, several nurses called in
041805 -        sick for 2 days. ref SDS 88 HX6S  She said that with Gemzar, I
041806 -        will need weekly tests to assess ability to get weekly
041807 -        treatments.
041809 -         ..
041810 -   13.  Sheree ordered a blood draw for me at Kaiser in Martinez
041811 -        tomorrow at 1130 in order to assess counts to get Gemzar this
041812 -        week, ref SDS 88 LS7F, so if counts are too low, and I cannot
041813 -        get treatment at Kaiser, per Brad, then I can get treatment at
041814 -        UCSF where blood counts don't matter, because of the different
041815 -        type of drug.
041817 -         ..
041818 -   14.  Upon consideration, I am willing to forgo the test tomorrow in
041819 -        Martinez, and wait to do the lab the same day as the Gemzar
041820 -        treatment, so we don't double up on lab costs unnecessarily.
041821 -        As seen in the treatment plan, below, I would like to do Gemzar
041822 -        on Mondays, so there is time to recover by the weekend.
041824 -         ..
041825 -   15.  Earlier this morning before Brad's call, since I had no
041826 -        appointment for treatment, I asked Rod to call UCSF about
041827 -        getting treatment with MPA, recommended to Kaiser by Doctor
041828 -        Rugo on 090514, as appropriate for my patient profile [reported
041829 -        on 090601 0818. ref SDS 88 VT8M].
041831 -         ..
041832 -   16.  Rod talked to Mike, coordinating the MPA study for Doctor Rugo,
041833 -        and requested on my behalf an appointment to start treatment
041834 -        with MPA.  Arrangements were made for me to come in and sign
041835 -        the consent documents today, because I need another CT test
041836 -        under the treatment protocol.  Mike said the date of the CT
041837 -        test must occur after the date signing the consent. ref SDS 88
041838 -        PP6U
041840 -         ..
041841 -   17.  I think Kaiser is better positioned to prescribe MPA, because
041842 -        it is targeted and will have less impact on blood counts.  As
041843 -        noted, it less expensive than Gemzar by orders of magnitude
041844 -        [see above, ref SDS 0 9M6F), does not require weekly labs, has
041845 -        a better chance of being effective, and, it does not cause
041846 -        congestion in the Infusion Clinic cited by Sheree, as delaying
041847 -        treatment today at Kaiser. ref SDS 0 0C8R  Getting treatment
041848 -        off-site in pill-form, significantly reduces stress on the
041849 -        system, accomplishing health care cost containment
041850 -        requirements.
041852 -         ..
041853 -   18.  For now, guess we need to defer the CT test needed to start MPA
041854 -        in the event my blood counts are too low to start Gemzar.  Rod
041855 -        called the CT Department before Brad's call saying Kaiser
041856 -        prescribed Gemzar, and Chris said the CT Department has test
041857 -        slots available today, tomorrow, and Wednesday.  I was hoping
041858 -        to start MPA on Thursday in order to stop progression of
041859 -        disease.
041861 -         ..
041862 -   19.  That is why I asked in the letter yesterday, if Gemzar doesn't
041863 -        work out, what will be prescribed to treat my cancer [reported
041864 -        on 090531 1544. ref SDS 86 IH9S].
041866 -         ..
041867 -   20.  This afternoon, Rod called Mike back at UCSF.  Mike had already
041868 -        sent an email to Doctor Rugo this morning explaining plans for
041869 -        me to come in today and sign the consent document, so I can
041870 -        start treatment one way or the other this week, as recommended
041871 -        by you and Doctor Rugo.
041873 -         ..
041874 -   21.  We decided under the circumstances to try Gemzar and hope for
041875 -        the best, since that is what the doctor ordered.
041877 -         ..
041878 -   22.  Here is the treatment plan for the 8th relapse of cancer.  Keep
041879 -        in mind Eisenhower observed "plans are nothing, planning is
041880 -        everything" so this gets the ball rolling...
041882 -         ..
041883 -        Work Plan Gemzar Recover 8th Relapse of Cancer
041884 -
041885 -        1.  Get a blood draw on 090602 1130.
041887 -             ..
041888 -            I am willing to defer this test, and wait for step 2;
041889 -            apparently the Gemzar protocol is to do labs the day of
041890 -            treatment.  I am fine with that.
041892 -             ..
041893 -        2.  If blood counts are high enough will get Gemzar treatment,
041894 -            as prescribed.
041896 -             ..
041897 -            Note:  I would prefer to get treatments with Gemzar on
041898 -            Monday, if possible, so that I have the week to recover
041899 -            from side effects, and can have a better chance for an
041900 -            active weekend.
041902 -             ..
041903 -        3.  If we can at least start Gemzar, then I ask Kaiser to
041904 -            submit a plan for follow on treatments to be prepared for
041905 -            failure, based on your letter sent 090522 saying that
041906 -            Gemzar may not work at all, because my disease is resistant
041907 -            to Gemzar-type agents.
041909 -             ..
041910 -        4.  If blood counts are too low in the test tomorrow, and/or if
041911 -            the Chemo Order is not signed, then Kaiser can prescribe
041912 -            the MPA treatment, more hyperthermia with a support
041913 -            modality like radiation, Doxil, or another agent.
041915 -             ..
041916 -        5.  If blood counts are too low, and/or if the Chemo Order is
041917 -            not signed, and further if Kaiser does not prescribe
041918 -            treatment, then I will get the MPA treatment based on best
041919 -            evidence of Doctor Rugo's recommendation to Kaiser, and
041920 -            Kaiser having implemented all prior UCSF recommendations
041921 -            since 2004, and I will seek recovery of costs based on
041922 -            pattern and practice for the past 4 clinical trials, and in
041923 -            order to maintain the chain of responsibility for my care
041924 -            with Kaiser.
041926 -             ..
041927 -        6.  If we are lucky, and blood counts hold, and if I tolerate
041928 -            Gemzar reasonably well, and further if there is response to
041929 -            treatment, then as usual we continue to progression.
041931 -             ..
041932 -        7.  Do we need examination to set a baseline for current IBC
041933 -            infection to assess progression?  Tara has a detailed
041934 -            history of IBC sites and measurements in the UCSF medical
041935 -            chart, beginning on 070201, and up until 090423.  She has
041936 -            always done excellent work supporting Doctor Rugo.  Should
041937 -            collaboration be continued for continuity of care?
041939 -             ..
041940 -            Additionally, weekly labs can track CA 15-3.  What criteria
041941 -            will signal progression?  We hope for decline, but if CA
041942 -            15-3 increases the first week 10 points, 30 points, 100...
041943 -            what will be the criteria to say it is time to switch
041944 -            treatments after 1 week, 2 weeks, or possibly 10 or more,
041945 -            so that transformation can be accomplished in time to be
041946 -            effective treating my cancer as a chronic disease, as you
041947 -            have discussed?
041948 -
041949 -               [On 090603 1128 Millie asks medical team again for work
041950 -               plan with criteria to evaluate progression of her cancer
041951 -               getting Gemzar chemotherapy, and with a list of
041952 -               additional treatments targeted to Millie's patient
041953 -               profile after Gemzar fails, which is expected not to
041954 -               work at all. ref SDS 91 028X
041956 -                ..
041957 -               [On 090603 1412 Doctor Johnson's reply letter to Millie
041958 -               did not respond with criteria for evaluating progression
041959 -               of disease, and when treatment must be changed. 090603
041960 -               1507, ref SDS 92 07AD
041962 -                ..
041963 -               [On 090603 1524 Queenie called from Kaiser Pharmacy and
041964 -               Millie asks for criteria Kaiser will use to evaluate
041965 -               progressio of disease that signals requirement to change
041966 -               treatments; Queenie will discuss with the doctor and
041967 -               send a letter confirming understandings on Kaiser's work
041968 -               plan, including serious side effects of Gemzar.
041969 -               ref SDS 93 7J4I
041971 -                ..
041972 -               [On 090604 1021 Millie's letter to medical team requests
041973 -               treatment plan on criteria for evaluating when treatment
041974 -               needs to be changed, and what treatments can continue
041975 -               Millie's recovery from the 8th relapse of cancer as a
041976 -               chronic disease. ref SDS 94 VM3T
041978 -             ..
041979 -        8.  If steps 3 or 4 occur, then I will go to UCSF on Wednesday
041980 -            to sign the consent for MPA.  Assume that if blood counts
041981 -            are too low, tomorrow then a plan "b" is needed.
041983 -             ..
041984 -        9.  We need Doctor Johnson to order the CT test, and request an
041985 -            expedited scan, for later this week after I sign the
041986 -            consent docs on Wednesday.
041988 -             ..
041989 -       10.  Since MPA only involves taking Pills, this seems like I can
041990 -            start right away, which best advice says is essential in my
041991 -            case.
041993 -         ..
041994 -   23.  Thanks to everyone planning treatment for my 8th relapse.
041995 -        Doctor Johnson explained on 090325 that we are exploring new
041996 -        territory treating cancer as a chronic disease.  Doctor Rugo
041997 -        indicated on 090514 that pioneering a new path presents new
041998 -        challenges.  I am grateful and lucky to have a great team.
041999 -
042006 -
042007 -
042008 -
042009 -
042010 -
0421 -