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: June 9, 2009 09:00 AM Tuesday; Rod Welch

Millie meeting at UCSF assess recovery radiation side effects.

1...Summary/Objective


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SUBJECTS
White Blood Cell Condition Blood Test Shows Too Low Doctor Johnson A

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 71 0000. ref SDS 46 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - As planned in Millie's letter to the medical team on 090608 1346,
040902 - ref SDS 76 OM4F, Doctor Hsu examined the bleeding sore in a vertical
040903 - line slightly to the right of Millie's breastbone and described as
040904 - "adjacent to the inner right breast" in Millie's letter to the medical
040905 - team on Sunday night, 090607 2253, ref SDS 75 MU5T, and for the
040906 - purpose of requesting a meeting to get exigent treatment for
040907 - previously diagnosed "radiation side effects."
040908 -
040909 -        [On 090610 0043 Millie letter notifies medical team on results
040910 -        of meeting today. ref SDS 78 N630
040912 -  ..
040913 - The doctor feels today that the bleeding vertical line of tissue in
040914 - Millie's breastbone area is severe progression of IBC, rather than
040915 - reaction to radiation, as previously diagnosed, and so Doctor Hsu did
040916 - not prescribe Vitamin E Plus Pentoxifylline, which was the purpose of
040917 - meeting today, requested in Millie's letter on 090607 2253.
040918 - ref SDS 75 MU6P
040920 -  ..
040921 - Earlier, Millie reported to the medical team in a letter on 090310
040922 - 1551 being disappointed because IBC in the breastbone area looked
040923 - worse, after 3 weeks of radiation and hyperthermia treatment.
040924 - ref SDS 42 O56X  A few days later on 090312 0800, Doctor Hsu examined
040925 - all of the radiation zones, which were layed out for Millie's
040926 - treatment, and shown in the report submitted to Millie on 090226 1342.
040927 - ref SDS 39 D452  He advised that Millie's report of IBC getting worse
040928 - in the breastbone area was incorrect, because at that time on 090312
040929 - the doctor attributed all of the open sores to radiation side effects,
040930 - which nominally indicated strong recovery from IBC. ref SDS 46 UL5L
040932 -  ..
040933 - About 10 days after radiation and hyperthermia treatment ended on
040934 - 090317, Millie sent a letter on 090328 requesting an emergency meeting
040935 - to get relief from open sores in treated areas that were becoming more
040936 - painful. ref SDS 57 4S9W  A few days later, Doctor Hsu examined Millie
040937 - at UCSF on 090330 1200 and suggested increasing Silvadine Cream to
040938 - reduce pain from rising open sores on Millie's chest. ref SDS 58 9A66
040939 - The doctor could not distinguish IBC infection from large open sores
040940 - caused by radiation side effects, and explained previously on 090312
040941 - 0800, ref SDS 46 F893, as showing Millie had a favorable response to
040942 - treatment. ref SDS 46 F84U
040944 -  ..
040945 - At that time on 090330 1200 consideration of MRI technology to
040946 - identify IBC infection that may have escaped treatment with radiation
040947 - and hyperthermia was rejected as unnecessary because visual
040948 - observation has been effective at UCSF, and impracticle because MRI
040949 - applied at UCSF cannot distinguish IBC from radiation side effects.
040950 - ref SDS 58 RP4F
040952 -  ..
040953 - Millie's letter later that day on 090330 2310 to the medical team
040954 - cited continuing concerns about IBC disease being hidden by rising
040955 - radiation symptoms in the breastbone area. ref SDS 59 6F5U  Millie
040956 - further cited Doctor Johnson's warning that Millie's cancer has
040957 - mutated into a more aggressive disease which requies proactive urgency
040958 - for early treatment. ref SDS 59 6F6T
040960 -  ..
040961 - The next day on 090331 Millie notified the medical team of sudden
040962 - light rash on the lower left arm, and asked if this might be
040963 - Cellulitis, which has occurred on this arm many times in the past?
040964 - ref SDS 60 Q69V
040966 -  ..
040967 - Doctor Hsu responded in a letter received the next day on 090401 0032
040968 - that new rash on the lower left arm was likely IBC. ref SDS 61 R24X
040969 - This startling new progression of cancer could have signaled severe,
040970 - untreated IBC was driving disease to occur in entirely new areas never
040971 - previously infected.
040973 -  ..
040974 - Millie reported in a letter on 090412 that new IBC diagnosed on the
040975 - lower left arm had worsened, and so she requested immediate treatment,
040976 - because her last systemic treatment was on 090122. ref SDS 64 9S9V
040978 -  ..
040979 - On 090415 0949 Millie notified the medical team IBC was spreading; she
040980 - asked for timely treatment again, and cited rise in cancer marker from
040981 - recent lab on 090413. ref SDS 66 KG8Q
040983 -  ..
040984 - On 090420 2352 Millie's letter submitting the agenda to the medical
040985 - team for meeting at UCSF on 090423 reported skin was clearing of
040986 - radiation side effects, and that besides new IBC on lower left arm,
040987 - there was then visible a vertical line in the breastbone area of
040988 - possible IBC or continuing reaction to radiation. ref SDS 70 MS4X
040989 - Millie expressed hope to start treatment planning in the meeting on
040990 - 090423. ref SDS 70 MS6S
040992 -  ..
040993 - In the meeting at UCSF on 090423 Tara was very pleased to see strong
040994 - recovery from radiation side effects, and that IBC seemed
040995 - substantially degraded in treated areas.  Tara noticed that besides
040996 - new IBC on the lower left arm, recovery in the breastbone area seemed
040997 - slower. ref SDS 71 QR3M  She planned to call Doctor Hsu after the
040998 - meeting to discuss her examination and findings in the breastbone
040999 - area, and for the purpose of guidance when the doctor performed his
041000 - examination later in the day at 1300. ref SDS 71 R15K
041002 -  ..
041003 - Doctor Hsu examined Millie on 090423 1315. ref SDS 71 4H5G  He
041004 - concurred with Tara that examination shows favorable response to
041005 - treatment. ref SDS 71 5G4G  Doctor Hsu indicated that the few nodules
041006 - in a vertical line just right of the breastbone area was reaction to
041007 - radiation, and even if these nodules were IBC, radiation treatment
041008 - that ended on 090317 would continue to cure this condition.
041009 - ref SDS 71 EX4I  Millie asked about doing a biopsy to evaluate
041010 - nodules in the breastbone area, and the doctor said this was
041011 - unnecessary because nothing can grow in Millie's skin treated with the
041012 - amount of radiation she received in February and March. ref SDS 71
041013 - 456H
041015 -  ..
041016 - Doctor further explained that IBC on the lower left arm and at other
041017 - new isolated areas outside treatment zones for radiation and
041018 - hyperthermia were in beginning stages of disease, and so while very
041019 - serious, could await treatment scheduled to begin on 090514 when
041020 - Doctor Rugo was scheduled to begin treating Millie's cancer as a
041021 - chronic disease, as prescribed by Kaiser.
041023 -  ..
041024 - Understandings from meetings at UCSF were confirmed in Millie's letter
041025 - to the medical team later on 090423 2337. ref SDS 72 GJ3O, including
041026 - Tara's plan to discuss with Doctor Hsu findings from examining nodules
041027 - in the breastbone area, ref SDS 72 ZL7V, and that the doctor was
041028 - confident Millie would be okay because nothing can grow in areas
041029 - treated with radiation and hyperthermia. ref SDS 72 ZL9S
041031 -  ..
041032 - Today, Doctor Hsu explained that UCSF made a mistake laying out
041033 - radiation zones to treat IBC on Millie's chest; or, molds built to
041034 - guide radiation were defective due to mismanufacture. possibly
041035 - materials were substandard -- something went wrong.  This caused
041036 - cancer in Millie's breastbone between the left and right treatment
041037 - zones to "fall through the cracks" so to speak.  As a result, despite
041038 - numerous notices from Millie that there was a problem in the
041039 - breastbone area, per above, ref SDS 0 IK4N, cancer was not treated
041040 - during the entire 4-week February-March radiation and hyperthermia
041041 - program performed on referral from Kaiser.  On 090205, Doctor Johnson
041042 - was concerned about Millie "falling through the cracks. ref SDS 29
041043 - 278T  Today, Doctor Hsu advised that untreated IBC is causing bleeding
041044 - and puss still flowing from the open wound,reported in Millie's
041045 - letters to the medical team on 090401, ref SDS 62 RE6Y, again on
041046 - 090420, ref SDS 70 MS5Q, and on 090510, ref SDS 73 LJ5T, and on 090607
041047 - requesting exigent examination today. ref SDS 75 MU5T  Doctor Hsu
041048 - further clarified today that this problem in the breastbone is not
041049 - caused by side effects of radiation, as represented by UCSF during the
041050 - meeting on 090423. ref SDS 71 EX4I
041051 -
041052 -        [On 090610 0043 Millie letter notifies medical team about
041053 -        Doctor Hsu's examnation finding untreated IBC, ref SDS 78 W65S,
041054 -        and this was causing Millie's breathing problems. ref SDS 78
041055 -        W66P
041057 -         ..
041058 -        [On 090610 0122 notified Paula in Kaisr Claims Resolution
041059 -        Department that UCSF medical mistakes require UCSF to provide
041060 -        treatment for Millie to recover. ref SDS 79 855G
041062 -         ..
041063 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
041064 -        for fixing medical mistakes performing radiation services
041065 -        for Millie on referral from Kaiser. ref SDS 80 855G
041067 -         ..
041068 -        [On 090611 1632 Doctor Rugo's coordinator for Millie's care at
041069 -        UCSF, sent a letter to Kaiser asking where to send a
041070 -        requisition to pay for lab work at Kaiser which was ordered for
041071 -        Millie's treatment at UCSF to recover from radiation medical
041072 -        mistakes. ref SDS 85 YU3N
041074 -         ..
041075 -        [On 090616 1240 during meeting at UCSF Doctor Rugo notified
041076 -        Millie that UCSF and Kaiser have agreed in a letter that
041077 -        everybody is on board to treat Millie's cancer as a chronic
041078 -        disease for recovering from medical mistakes treating Millie
041079 -        with radiation at UCSF, and that Millie's next treatment after
041080 -        MPA will be with PARP. ref SDS 86 KD6L
041082 -         ..
041083 -        [On 090616 1245 Doctor Rugo advised that Millie's treatment
041084 -        has been transferred from Kaiser to UCSF for Millie to
041085 -        recover from UCSF medical mistakes, and so Millie should
041086 -        now call the Triage nurse at UCSF rather than at Kaiser,
041087 -        ref SDS 86 EE70,
041089 -         ..
041090 -        [On 091112 0930 IBC has now spread significantly onto Millie's
041091 -        right side for the first time in 8 years of treatment, and
041092 -        caused by cancer untreated in the breastbone for 6 months, due
041093 -        to medical mistakes getting radiation treatments at UCSF on
041094 -        referral from Kaiser. ref SDS 97 8G6O
041096 -         ..
041097 -        [On 100527 0217 Millie files claim to recover from injuries
041098 -        caused by medical mistakes getting radiation treatments from
041099 -        UCSF on referral from Kaiser. ref SDS A1 IZ7N
041101 -  ..
041102 - When Millie reported on 090401 a messy wound in the breastbone area,
041103 - ref SDS 62 RE6Y, and asked for immediate treatment of evident cancer
041104 - recurrence, ref SDS 62 RE8P, Doctor Rugo advised the medical team that
041105 - Millie's treatment for cancer must be delayed until after the wound in
041106 - the breastbone healed, reported on 090401 0121, ref SDS 63 K56O,
041107 - because at that time the wound was diagnosed as "reaction to
041108 - radiation," which Doctor Hsu reports today was a mistake, in that the
041109 - breastbone area where the wound occurred was not in fact treated with
041110 - radiation, per above. ref SDS 0 W65W
041112 -  ..
041113 - Doctor Johnson made this same mistake in January 2003, that delayed
041114 - treating Millie's cancer for over a year.  On 030109, IBC symptoms
041115 - were diagnosed, as Cellulitis, and/or reaction to radiation treatments
041116 - 5 months earlier, ref SDS 1 KW5F, and despite a PET scan test that
041117 - found the 3 symptoms of IBC. ref SDS 1 GJ69  On 040402, Doctor
041118 - Johnson diagnosed IBC as "reaction to radiation," again after delaying
041119 - Millie's treatment for cancer again, believing the rash was
041120 - Cellulitis. ref SDS 3 IM6J
041122 -  ..
041123 - When the mistake was finally discovered a month later on 040504,
041124 - showing Millie's cancer was untreated for 18 months, Doctor Johnson
041125 - said Kaiser would do everything possible to fix it. ref SDS 4 WI8F
041126 -
041127 -        [On 091125 1030 IBC spreading across the right chest caused by
041128 -        untreated IBC in breastbone area. ref SDS 98 8047
041130 -         ..
041131 -        [On 100112 0047 Millie reported recovery of IBC after 2nd cycle
041132 -        of Navelbine, except breastbone area, where IBC missed by UCSF
041133 -        radiation treatments is a bloody mess again. ref SDS A0 IS5P
041135 -  ..
041136 - Doctor Hsu advised that this IBC tumor in Millie's breastbone area has
041137 - been untreated since 090122 and so causes cancer to spread.  Doctor
041138 - Hsu said he is awfully sorry, but UCSF will try fit it.  He feels UCSF
041139 - files should be checked to figure how this occurred.  Was the layout
041140 - wrong?  Were molds mismanufactured, were wrong materials used;
041141 - defective materials; typo error in purchasing materials; did somebody
041142 - cut corners on accuracy to save time and money by avoiding
041143 - verification -- could be anything.  It is important to analyze the
041144 - whole process for quality improvement to reduce risk of future
041145 - problems.
041146 -
041147 -        [On 090616 1245 Doctor Rugo advised that everybody at Kaiser
041148 -        and UCSF is now "on board" for UCSF to treat Millie's cancer as
041149 -        a chronic disease in order to recover from medical mistakes
041150 -        caused by UCSF performing radiation treatments during February
041151 -        and March. ref SDS 86 KD6L
041153 -         ..
041154 -        [On 090616 1245 Doctor Rugo requested Kaiser's radiology
041155 -        report for Millie's CT test on 090612 in order to check for
041156 -        progression of ground glass opacities in the lungs,
041157 -        ref SDS 86 YS4J, which reflect Doctor Hsu's concern on
041158 -        090609 that medical mistakes performing radiation in
041159 -        Feb-Mar failing to treat IBC in the breastbone area could
041160 -        be causing problems in Millie's lungs evidenced by recent
041161 -        breathing and cough problems. ref SDS 0 W65W
041163 -         ..
041164 -        [On 090617 1954 Millie's letter asks medical team if
041165 -        "ground glass opacities" causing breathing problems will be
041166 -        treated as cancer with MPA, or presents a new problem that
041167 -        requires separate treatment? ref SDS 88 7J4Q
041169 -         ..
041170 -        [On 090618 1743 Millie's letter asks medical team for
041171 -        further tests, examination, and treatment to recover from
041172 -        breathing problems. ref SDS 89 TG3X
041174 -         ..
041175 -        [On 091125 1030 oxygen vitals seems improved starting 2nd
041176 -        treatment with Navelbine, and aligns with clinical improvement
041177 -        in breathing. ref SDS 98 MS7O
041179 -  ..
041180 - Cancer has begun to appear in entirely new areas on the left arm,
041181 - first noticed on 090331, and which seemed unexplainable until today.
041182 - ref SDS 60 Q69V
041184 -  ..
041185 - Doctor Hsu feels today Millie's recent breathing problems while hiking
041186 - the past few weeks, and recently climbing stairs at home, reported to
041187 - the medical team in Millie's letter on 090510, ref SDS 73 LJ6T, may be
041188 - due to cancer spreading to her lungs caused by untreated IBC tumor in
041189 - the breastbone area.  He seemed to indicate buildup in the lungs
041190 - creates diminished breathing capacity, which Millie is suffering.
041191 -
041192 -        [On 090610 0043 Millie letter notifies medical team about
041193 -        Doctor Hsu's examnation finding untreated IBC causing breathing
041194 -        problems. ref SDS 78 W66P
041196 -         ..
041197 -        [On 090610 0122 notified Paula in Claims Resolution
041198 -        Department that UCSF medical mistakes require UCSF to
041199 -        provide treatment for Millie to recover. ref SDS 79 855G
041201 -         ..
041202 -        [On 090610 0930 Paula advised that UCSF is liable to Kaiser
041203 -        for fixing medical mistakes performing radiation services
041204 -        for Millie on referral from Kaiser. ref SDS 80 855G
041206 -         ..
041207 -        [On 090610 2213 Millie notifies medical team that medical
041208 -        mistake which failed to treat IBC in breastbone area may have
041209 -        caused cancer spread into internal organs, which will be a new
041210 -        strategic inflection point for Millie's care. ref SDS 84 TA5O
041212 -         ..
041213 -        [On 090616 1245 Doctor Rugo asks for Kaiser's report on the CT
041214 -        test performed 090612 to evaluate progression of "ground glass
041215 -        opacities" caused by radiation treatments at UCSF in Feb -
041216 -        Mar, and which can increase after radiation ends, causing
041217 -        breathing problems.
041219 -         ..
041220 -        [On 090616 1245 Doctor Rugo advised that Millie's treatment
041221 -        has been transferred from Kaiser to UCSF for Millie to
041222 -        recover from UCSF medical mistakes, and so Millie should
041223 -        now call the Triage nurse at UCSF rather than at Kaiser.
041224 -        ref SDS 86 EE70
041226 -         ..
041227 -        [On 090617 0112 Millie notifies medical team that MPA treatment
041228 -        was started to recover from 8th relapse of cancer. ref SDS 87
041229 -        VS7R
041231 -         ..
041232 -        [On 090617 1954 Millie's letter asks medical team if "ground
041233 -        glass opacities" causing breathing problems will be treated as
041234 -        cancer with MPA, or presents a new problem that requires
041235 -        separate treatment? ref SDS 88 7J4Q
041237 -         ..
041238 -        [On 091125 1030 IBC spreading across the right chest caused by
041239 -        untreated IBC in breastbone area. ref SDS 98 8047
041241 -  ..
041242 - Doctor Hsu further explained that Millie may also be suffering
041243 - progressive radiation injury to her lungs from treatments at UCSF in
041244 - February and March.  Somehow precautions to avoid over-radiation to
041245 - Millie's lungs and discussed during the meeting at UCSF on 090205
041246 - 0830, ref SDS 28 PN8H, were not effective after starting radiation on
041247 - 090219 and ending on 090317 0915. ref SDS 50 9L7K  Radiation 4 times
041248 - per week for 4 weeks has increased injury to the lungs from previous
041249 - radiation treatments in 2002.  Doctor Hsu's diagnosis today of
041250 - radiation injury causing symptoms of breathing difficulties, aligns
041251 - with findings of increased ground glass opacities in the lungs
041252 - reported for Millie's CT test at Kaiser on 090413, reviewed on 090415.
041253 - ref SDS 68 RV78
041255 -  ..
041256 - On 090514 Doctor Rugo also diagnosed Millie's breathing problems are
041257 - caused by ground glass opacities found by the CT test on 090413, and
041258 - resulted from radiation injury to the lungs getting treatment at UCSF.
041259 - ref SDS 74 NL9I
041260 -
041261 -            [On 090702 0301 Mike, Coordinator for Doctor Rugo, reported
041262 -            that UCSF Radiology Department has not completed review of
041263 -            Millie's CT tests on 090423 and 090612 ordered by Doctor
041264 -            Rugo to develop UCSF work plan for Millie to recover from
041265 -            medical mistakes that caused radiation injury to Millie's
041266 -            lungs. ref SDS 93 LA6G
041268 -  ..
041269 - Millie has worked very hard to overcome these new infirmities.  She
041270 - hiked 4-times in a row last week, but has increasing difficulty with
041271 - heavy chest, shortness of breath, and cough.  She has loss of breath
041272 - climbing stairs at home when done twice in a row, e.g., going
041273 - downstairs, and upon returning, realizing something else is needed.
041274 - The second ascent of stairs creates similar loss of breath and
041275 - fatigue, as climbing the big hills at Lafayette Reservoir.  These new
041276 - symptoms are similar to experience in July, August, and September
041277 - 2004, when Kaiser failed to diagnose pulmonary embolism, because then,
041278 - as now, CT tests did not show anything specific to explain symptoms,
041279 - shown by case study on 060722, ref SDS 6 SV3I, and until Millie got a
041280 - 2nd opinion at UCSF on 041018, and Doctor Benz recommended further
041281 - investigation.
041282 -
041283 -            [On 090626 0301 Doctor Johnson's medical chart at Kaiser
041284 -            incorrectly reports Millie is still hiking at Lafayette
041285 -            Reservoir. ref SDS 91 U75J
041287 -             ..
041288 -            [On 090701 0301 Millie notifies medical team she is
041289 -            planning to try hiking at Lafayette Reservoir to evaluate
041290 -            recovery from breathing problems. ref SDS 92 UP3U
041292 -             ..
041293 -            [On 090702 2241 Millie notifies medical team she is
041294 -            frightened about having to think about breathing.
041295 -            ref SDS 94 D14S
041297 -  ..
041298 - Previously, on 041103 Kaiser CT test diagnosed Millie's breathing
041299 - problems in July - October 2004 were caused by treatment with
041300 - bevacizumab on clinical trial, which was widely reported in public
041301 - news media as causing deaths from pulmonary embolism.  Millie was
041302 - removed from the clinical trial, and a few months later her breathing
041303 - problems were resolved, as her lungs recovered.
041305 -  ..
041306 - Today, Millie needs a similar remedy.
041308 -  ..
041309 - Doctor Hsu was asked to submit a written work plan for review by
041310 - Millie's primary care physician at Kaiser, Doctor Johnson, showing
041311 - treatments for Millie to recover from UCSF medical mistakes?
041312 -
041313 -            [On 090610 1032 Millie notified Kaiser that UCSF is
041314 -            performing in good faith to provide medical services for
041315 -            Millie to recover from UCSF medical mistakes; and requests
041316 -            a copy of UCSF work plan submitted to Kaiser. ref SDS 81
041317 -            VQ5Q
041319 -             ..
041320 -            [On 090611 1632 UCSF performing work plan to correct
041321 -            medical mistakes providing radiation services on referral;
041322 -            Mike in Breast Care Clinic orders lab work services from
041323 -            Kaiser for Millie to start MPA treatment ordered by Doctor
041324 -            Hsu, and asks if Kaiser needs requisition. ref SDS 85 MH5O
041326 -  ..
041327 - Doctor Hsu explained that the medical team needs to work fast in order
041328 - for Millie to overcome these new problems.
041330 -  ..
041331 - First, he wants Millie to get a CT test and lab at Kaiser to evaluate
041332 - the scope of the problem.
041333 -
041334 -            [On 090609 1427 Doctor Johnson ordered CT test for Millie
041335 -            on 090614 1700, ref SDS 77 PPVY; this was later advanced to
041336 -            090612 1120 which helps expedite care for Millie's
041337 -            worsening patient profile. ref SDS 78 W67P
041339 -             ..
041340 -            [On 090610 0043 Millie notified medical team that CT test
041341 -            requested by Doctor Hsu to plan Millie's treatment
041342 -            recovering from medical mistakes performing radiation
041343 -            treatments at UCSF has been ordered by Doctor Johnson at
041344 -            Kaiser, and that Loretta in the CT Department scheduled the
041345 -            test at Kaiser in Walnut Creek for 090612 1120. ref SDS 78
041346 -            W67P
041348 -             ..
041349 -            [On 090610 1438 Mike called and advised that Doctor Rugo
041350 -            wants the files for the CT test on 090612 delivered to UCSF
041351 -            that expedites thorough review by UCSF radiologists in
041352 -            order to develop a comprehensive treatment plan.
041353 -            ref SDS 82 S537
041355 -             ..
041356 -            [On 090611 1632 UCSF performing on work plan to correct
041357 -            mistakes providing radiation services on referral; Mike in
041358 -            Breast Care Clinic orders lab work services from Kaiser for
041359 -            Millie to start MPA treatment ordered by Doctor Hsu, and
041360 -            asks Kaiser if they needs a UCSF requisition to pay the
041361 -            cost of lab work to fix UCSF medical mistakes. ref SDS 85
041362 -            MH5O
041364 -             ..
041365 -            [On 090616 1245 Doctor Rugo requested Kaiser's radiology
041366 -            report for Millie's CT test on 090612 in order to check
041367 -            for progression of ground glass opacities in the lungs
041368 -            which contributes to evaluating Doctor Hsu's concern on
041369 -            090609 that medical mistakes performing radiation in
041370 -            Feb-Mar failing to treat IBC in the breastbone area
041371 -            could be causing problems in Millie's lungs that explain
041372 -            recent loss of breathing capacity, and excessive
041373 -            coughing. ref SDS 86 D644
041375 -             ..
041376 -            [On 090706 0301 Millie received a letter from Mike
041377 -            saying nobody at UCSF ordered review of Millie's CT test
041378 -            scan files, ref SDS 95 1L6N, which were same-day hand-
041379 -            delivered to UCSF per Mike's request today, for timely
041380 -            review by UCSF. ref SDS 82 S537
041382 -  ..
041383 - Doctor Hsu seemed to indicate treatment should be multi-modal, because
041384 - success treating Millie for 8-relapses of cancer has exhausted
041385 - standard single-agent protocols.  Therefore, innovation is needed to
041386 - recover from the radiation mistake that caused Millie's cancer to
041387 - progress so quickly into areas that have never previously been
041388 - infected, and caused severe breathing problems.
041390 -  ..
041391 - The doctor feels initial efforts to treat severe IBC in the breastbone
041392 - area should be with systemic agents starting with the MPA clinical
041393 - trial in consultation with Doctor Rugo, as recommended to Kaiser on
041394 - 090514. ref SDS 74 A13N  Doctor Hsu advised that cancer untreated for
041395 - 6 months, per above, ref SDS 0 W66P, naturally gets worse and spreads.
041396 - outside the radiation zones. including the lungs, per his diagnosis
041397 - above. ref SDS 0 R24G
041399 -  ..
041400 - After MPA systemic treatment, then the Radiation Oncology Department
041401 - can radiate the breastbone area that was missed in the prior work.
041402 - This will require careful layout of radiation angles and amount to
041403 - avoid further damage to the lungs, based on Doctor Hsu's origial plan
041404 - received on 090226 1342. ref SDS 39 D452  CT testing requested today
041405 - is the next critical step for developing the best treatment plan, per
041406 - above. ref SDS 0 1P3K
041408 -  ..
041409 - Millie thanked Doctor Hsu for seeing her today, getting started right
041410 - away to take corrective action.  She recalled that when this mistake
041411 - occurred at Kaiser in January, 2003, and was not discovered until
041412 - April of 2004,  Doctor Johnson said he was very sorry, and that Kaiser
041413 - would do everything possible for Millie to recover. ref SDS 4 WI8F
041415 -  ..
041416 - Millie expressed appreciation that the medical team today is taking
041417 - timely action again.  She will hope for the best.
041419 -             ..
041420 -            [On 090610 0043 Millie letter notifies medical team that in
041421 -            the meeting today at UCSF on 090609 0900 Doctor Hsu
041422 -            diagnosed bleeding wound in breastbone area is caused by
041423 -            progression of IBC due to medical mistake omitting
041424 -            radiation treatment to this area during Feb - Mar referral
041425 -            care to recover from IBC, ref SDS 78 N630; Doctor Hsu
041426 -            prescribed systemic treatment with MPA for Millie to
041427 -            recover from medical mistake. ref SDS 78 W66W
041429 -             ..
041430 -            [On 090610 1443 Doctor Hsu's letter confirm's UCSF request
041431 -            for CT test for plan to start with MPA treatment to correct
041432 -            problems caused by mistake providing radiation treatments
041433 -            in February and March. ref SDS 83 G63H
041435 -             ..
041436 -            [On 090611 1632 UCSF performing on work plan to correct
041437 -            mistakes providing radiation services on referral; Mike in
041438 -            Breast Care Clinic orders lab work services from Kaiser for
041439 -            Millie to start MPA treatment ordered by Doctor Hsu, and
041440 -            asks Kaiser if they needs a UCSF requisition to pay the
041441 -            cost of lab work to fix UCSF medical mistakes. ref SDS 85
041442 -            MH5O
041444 -             ..
041445 -            [On 090616 1240 during meeting at UCSF Doctor Rugo notifies
041446 -            Millie that UCSF and Kaiser have agreed everybody is on
041447 -            board that Millie's therapy after MPA will be with PARP to
041448 -            treat Millie's cancer as a chronic disease for recovering
041449 -            from UCSF medical mistakes. ref SDS 86 KD6L
041451 -             ..
041452 -            [On 090616 1240 during meeting at UCSF Doctor Rugo provides
041453 -            MPA treatment, ref SDS 86 D647, prescribed by Doctor Hsu
041454 -            for Millie recover from medical mistakes at UCSF providing
041455 -            radiation treatments in Feb and Mar. ref SDS 0 W66W
041457 -             ..
041458 -            [On 090616 1245 Doctor Rugo advised that Millie's care to
041459 -            recover from radiation medical mistakes has been
041460 -            transferred from Kaiser to UCSF, and so Millie should now
041461 -            call the Triage nurse at UCSF rather than at Kaiser.
041462 -            ref SDS 86 EE70
041464 -             ..
041465 -            [On 090617 0112 Millie notifies medical team that MPA
041466 -            treatment was started to recover from 8th relapse of cancer
041467 -            and breathing problems caused by mistakes providing
041468 -            radiation medical services at UCSF during Fef and Mar.
041469 -            ref SDS 87 VS7R
041471 -             ..
041472 -            [On 090626 0301 Millie submits agenda to medical team for
041473 -            meeting at Kaiser to review Millie's progresss recovering
041474 -            from UCSF medical mistakes providing radiation treatment
041475 -            that caused cancer to spread, ref SDS 90 0E9V; untreated
041476 -            IBC has become so severe that Millie hates looking at
041477 -            herself in the mirror. ref SDS 90 0E9Y
041479 -             ..
041480 -            [On 090626 1140 Doctor Johnson prescribes MPA in the
041481 -            medical chart for Kaiser's approval of UCSF's treatment
041482 -            plan for Millie to recover from medical mistakes from UCSF
041483 -            providing radiation medical services. ref SDS 91 837H
041485 -             ..
041486 -            [On 090716 2106 Millie notifies medical team that UCSF
041487 -            delayed starting Millie's treatment with PARP until
041488 -            September, because Millie suffered painful breathing that
041489 -            might be caused by MPA so this treatment ended before PARP
041490 -            protocol was ready in September. ref SDS 96 EE6P
041492 -             ..
041493 -            [On 100108 1618 UCSF notifies Kaiser that Millie cannot get
041494 -            treatment for cancer with PARP that includes a protocol for
041495 -            Carboplatin, because Millie's was previously treated with
041496 -            Carboplatin chemotherapy, and UCSF fails to compare
041497 -            trade-offs exercising discretion to balance Millie's
041498 -            medical necessity for life-saving treatment with PARP,
041499 -            which UCSF and Kaiser indicated on 090616 was the best
041500 -            choice for Millie to recover from life-threatening medical
041501 -            mistakes made by UCSF. ref SDS 99 FM5I
041502 -
041503 -
041504 -
041505 -
041506 -
041507 -
0416 -