CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Doctor Johnson called about results of Millie's meeting at UCSF this
040902 - morning with Doctor Hsu, ref SDS 12 02HF, and following telecon with
040903 - Arlette this morning 090609 1130, asking her to facilitate a telecon
040904 - with Doctor Johnson. ref SDS 13 MW5H
040906 -  ..
040907 - The doctor was disappointed hearing that UCSF found a medical mistake
040908 - today that caused Millie's cancer to spread, and injured Millie's
040909 - breathing, all because radiation treatment zones UCSF layed out
040910 - somehow failed to include cancer in Millie's breastbone area.  So this
040911 - area, which has Millie's most intense cancer, observed by Doctor Hsu
040912 - during examination on 090205, to plan Millie's radiation treatments at
040913 - UCSF, ref SDS 5 PR5K, was entirely untreated during February-March,
040914 - when Millie received radiation treatment on referral from Kaiser.
040915 - ref SDS 12 W65W
040917 -  ..
040918 - Asked Doctor Johnson to approve the UCSF proposal on treating Millie
040919 - with MPA to recover from the UCSF medical mistake, as prescribed by
040920 - Doctor Hsu earlier this morning, reported on 090609 0900. ref SDS 12
040921 - 1P42
040923 -  ..
040924 - Doctor Johnson refused to support Millie's treatment to recover from
040925 - UCSF medical mistake that occurred performing radiation medical
040926 - services on referral from Kaiser.  Rather than demand UCSF correct the
040927 - mistake, Doctor Johnson said Millie would have to make her own
040928 - arrangements for UCSF to provide care.  The doctor insisted on
040929 - treating Millie at Kaiser with Gemzar, despite Kaiser guidance that
040930 - Gemzar conflicts with Millie's patient profile, reported last Friday
040931 - on 090605 1447. ref SDS 10 V34K
040933 -  ..
040934 - Doctor Johnson indicated that Millie should not worry about getting
040935 - treatment he has prescribed with Gemzar that conflicts with Kaiser's
040936 - published guidance for patients with Millie's medical history.  He
040937 - said this guidance has to be very conservative and overstated in order
040938 - to protect Kaiser against lawsuits.  He believes Gemzar is safe for
040939 - Millie because he has treated patients for pancreatic cancer with
040940 - Gemzar after they received radiation, and they survived.  The doctor
040941 - maintained in the call today that Millie should therefore ignore
040942 - Kaiser's published guidance that indicates Gemzar is not safe for
040943 - Millie's patient profile.
040945 -  ..
040946 - Since the doctor was in a hurry we did not review his comments on
040947 - 090213 that Millie has a unique patient profile from having survived 8
040948 - relapses of cancer and has been treated for cancer for 8 years while
040949 - the survival for her disease trajectory is 2 - 3 years.  Therefore
040950 - Kaiser guidance to use "extreme caution" giving Gemzar to Millie
040951 - because she just received radiation may be quite valid for Millie's
040952 - medical profile.
040954 -  ..
040955 - Doctor Johnson further said that his treatment plan for Millie is not
040956 - to pause Gemzar if her blood counts fall below safe levels for getting
040957 - chemotherapy, as he has done previously, shown in case study on
040958 - 060810. ref SDS 1 HV45  He plans instead to give her blood
040959 - transfusions and use other measures that will enable her to get the
040960 - full treatment with Gemzar, despite Kaiser's published guidance that
040961 - says Gemzar is dangerous for Millie's patient profile, reported on
040962 - 090605. ref SDS 10 V37O
040964 -  ..
040965 - On 090601 Brad in Kaiser's Oncology Pharmacy warned that Gemzar would
040966 - be very difficult for Millie's patient profile to tolerate, having
040967 - relapsed 8 times over the past 8 years. ref SDS 9 8J8L
040969 -  ..
040970 - Doctor Johnson mentioned today that blood tranfusions can maintain
040971 - Millie's platelets, and other CBC counts.  This was previously a
040972 - concern discussed by Doctor Rugo in a letter on 081205. ref SDS 3 GF8Q
040973 - On 081219 Doctor Johnson diagnosed Millie was already suffering
040974 - severely low blood counts with cytopenia and pancytopenia, that risks
040975 - infection from fatal diseases. ref SDS 4 LS6K
040977 -  ..
040978 - The doctor assured that blood transfusions will solve this problem,
040979 - despite never having proposed this method in 8 years of care.  Always
040980 - in the past, Kaiser and UCSF have paused treatments, and changed
040981 - treatments to avoid risks of low blood counts.
040983 -  ..
040984 - We did not take time today to discuss risks of blood transfussions.
040986 -  ..
040987 - Requested that the doctor send a letter telling Millie she can ignore
040988 - Kaiser's published guidance that indicates Gemzar is not safe for her
040989 - patient profile, reported on 090605 1447. ref SDS 10 V34K, and as
040990 - requested in the letter to Kaiser also on 090605 2215. ref SDS 11 LF7S
040992 -  ..
040993 - Doctor Johnson said that it is unnecessary for him to send a letter to
040994 - Millie confirming verbal representations today in a telephone call
040995 - that Gemzar is safe and effective for Millie's patient profile, and so
040996 - Kaiser's published guidance for Gemzar can be ignored for treating
040997 - Millie, per above. ref SDS 0 VV75
040999 -  ..
041000 - Reluctance to confirm verbal guidance in writing conflicts with Doctor
041001 - Davidson's practice in the Radiology Department.  On 090409, the
041002 - doctor sent a letter confirming that Kaiser made a mistake publishing
041003 - results of CT tests in multiple reports, because this causes confusion
041004 - in the record.  He issued orders for the Radiology Department to
041005 - correct the problem so that risk of medical mistakes is reduced.
041006 - ref SDS 6 XZ6U  Similarly, if Doctor Johnson feels Kaiser published
041007 - guidance that indicates Gemzar is dangerous for Millie, as set out in
041008 - the letter to Kaiser on 090605 2314, ref SDS 11 L57S, then he can send
041009 - a letter explaining the grounds for ignoring the guidance.  Otherwise,
041010 - why send it to the patient, as occurred on 090605? ref SDS 10 V37O
041012 -  ..
041013 - Doctor Johnson further said today that Millie should consider ending
041014 - treatment to recover from UCSF medical mistakes, and instead go into
041015 - the Kaiser Hospice program for palliation to tolerate suffering from
041016 - her cancer and breathing problems, while she declines into death.
041017 - This repeats advice on 090213, and more recently in the doctor's
041018 - letter on 090528 (approximately, verify...)
041020 -  ..
041021 - We reviewed Doctor Johnson's recent examination at Kaiser on 090515
041022 - that reported in the medical chart that Millie is ECOG performance
041023 - "0," indicating she is fully functioning as well as the doctor, so
041024 - long as Kaiser directs UCSF to provide timely treatment for her cancer
041025 - and breathing problems. ref SDS 8 YF9L
041027 -  ..
041028 - We reviewed advantages of MPA treatment proposed in Doctor Rugo's
041029 - letter to Doctor Johnson on 090514 0830, ref SDS 7 DI63  This is
041030 - inexpensive, likely effective based on "targeted" design to treat
041031 - Millie's ER- status, and will not require blood transfusions to
041032 - maintain blood counts, and has no danger from prior radiation
041033 - treatments.
041035 -  ..
041036 - Doctor Johnson said he has sent Doctor Mason emails, and talked to
041037 - Doctor Mason on the telephone explaining Millie needs MPA treatment to
041038 - recover from cancer, as discussed during the meeting at Kaiser on
041039 - 090515 1140. ref SDS 8 H56M  Doctor Johnson further said that Doctor
041040 - Mason has told Doctor Johnson that he (Doctor Mason) won't approve
041041 - referral for Millie to get treatment at UCSF, despite Kaiser having
041042 - approved similar treatment 4 times previously.  As a result of being
041043 - told the Outside Referral Department won't authorize referral, Doctor
041044 - Johnson said he refuses to exercise responsibility to issue a referral
041045 - for Millie's treatment prescribed by Doctor Hsu for Millie to recover
041046 - from medical mistakes by UCSF providing medical services on referral
041047 - from Kaiser.
041049 -  ..
041050 - During the call today, we reviewed the record showing Doctor Mason
041051 - does not have responsibility to prescribe treatment for Millie, based
041052 - on best evidence.  Millie's doctor has that responsiblity under EOC
041053 - section 2, reviewed on 070927 1311. ref SDS 2 WS6M  Doctor Johnson
041054 - has treated the patient for 8 years.  Doctor Mason has never seen
041055 - Millie nor reviewed her medical history.  Doctor Johnson has the sole
041056 - responsibility to order treatment Millie needs.  Doctor Johnson has
041057 - previously made referrals similar to the current MPA treatment, and
041058 - Doctor Mason has issued referrals to UCSF.  Rather than rely on
041059 - conversation, Doctor Johnson should issue the referral as in the past,
041060 - and then permit Doctor Mason to take responsibility to deny treatment
041061 - ordered by Millie's doctor.
041063 -  ..
041064 - Doctor Johnson said that Pam Vardanian in Doctor Mason's office told
041065 - him in a telephone call that Millie does not need a referral from her
041066 - doctor at Kaiser in order to get treatment with MPA.
041068 -  ..
041069 - We agreed that Millie can buy any treatment she wants from another
041070 - provider.  She has purchased insurance for Kaiser to provide health
041071 - care, and Kaiser therefore has a responsibility to perform on that
041072 - agreement.  Kaiser has at all times prescribed care, similar to the
041073 - MPA protocol in this case, and so to refuse arbitrarily now has no
041074 - justification in the record.
041076 -  ..
041077 - We further discussed Kaiser's duty to provide medical services for
041078 - Millie to recover from medical mistakes caused by UCSF on referral
041079 - from Kaiser, and that UCSF has proposed treatment with MPA as the most
041080 - cost effective way for Millie to recover.  Since UCSF made the
041081 - mistake, neither Kaiser nor Medicare have any cost exposure.  Kaiser
041082 - has a duty to Millie to demand performance from UCSF.
041083 -
041084 -        [On 090610 0122 notified Kaiser Claims Department that Millie
041085 -        demands Kaiser provide care for her to recover from cancer and
041086 -        breathing problems caused by medical mistakes made by UCSF on
041087 -        referral from Kaiser. ref SDS 16 RR7T
041089 -  ..
041090 - Doctor Johnson feels his hands are tied by guidance he has received
041091 - from telephone calls with Pam and Doctor Mason in Outside Referrals,
041092 - who have refused to coordinate Millie's treatment at UCSF to recover
041093 - from medical mistakes caused by UCSF providing radiation treatment on
041094 - referral from Kaiser.
041096 -  ..
041097 - Doctor Johnson agreed to order the CT test requested by Doctor Hsu to
041098 - prepare a treatment plan for Millie to recover from radiation
041099 - treatment mistakes caused by UCSF. ref SDS 12 W66T
041101 -  ..
041102 - During the call he described using Kaiser's computer to order the CT
041103 - test.
041105 -  ..
041106 - Doctor Johnson was in a hurry, so he scheduled the CT test on Sunday,
041107 - 090614 1720, because that seemed like the quickest way for him to get
041108 - Millie into the computer system scheduling CT tests.  He asked Rod to
041109 - coordinate with the CT Department to revise the date of the test for
041110 - the earliest date when Millie can get the Power Port accessed with a
041111 - Huber needle in the Chemotherapy Infusion Clinic, and also when
041112 - Interventional Radiology Services (IS) can support the test, since
041113 - neither organization is operational on Sunday, and so if the CT test
041114 - were on Sunday these units would have schedule overtime.
041116 -  ..
041117 - Discussed including in the order for Millie's CT test that findings be
041118 - consolidated to avoid prior problems of multiple reports being issued
041119 - for a single test, and causing confusion and error applying test
041120 - results.
041122 -  ..
041123 - Doctor Johnson recalled that Doctor Davidson issued a letter saying
041124 - that findings would be consolidated for future tests, reported on
041125 - 090409 2018. ref SDS 6 XZ6U   Doctor Johnson indicated that, since
041126 - Doctor Davidson is Chief of Radiology, and has ordered findings
041127 - consolidated, it is unnecessary overkill to specify this requirement
041128 - in the order for Millie's next CT test.  As a result, Doctor Johnson
041129 - refused to specify consolidated findings in the order for Millie's
041130 - next CT test.
041132 -         ..
041133 -        [On 090609 1514 called Loretta in the CT Department and changed
041134 -        the CT test from 090614 to 090612 1120. ref SDS 14 UD5H
041136 -         ..
041137 -        [On 090609 1514 called Arlette to schedule the Oncology
041138 -        Chemotherapy Infusion Clinic accessing Millie's Power Port for
041139 -        the CT test on 090612; Arlette tranferred the call to the
041140 -        Clinic and no one answere, so left message requesting the
041141 -        Clinic schedule the work. ref SDS 14 LA57
041143 -         ..
041144 -        [On 090610 0043 Millie notified medical team that CT test
041145 -        requested by Doctor Hsu to plan Millie's treatment recovering
041146 -        from medical mistakes performing radiation treatments at UCSF
041147 -        has been ordered by Doctor Johnson at Kaiser, and that Loretta
041148 -        in the CT Department scheduled the test at Kaiser in Walnut
041149 -        Creek for 090612 1120. ref SDS 15 W67P
041151 -         ..
041152 -        [On 090617 1737 Kaiser Radiology Department failed to
041153 -        consolidate findings for Millie's CT test on 090612.
041154 -        ref SDS 17 SQ8M
041156 -  ..
041157 - Explained Doctor Hsu's findings of rising lymphedema in Millie's left
041158 - arm from rising IBC.  The doctor recommended Millie have physical
041159 - therapy to treat lymphedema in the left arm.
041161 -  ..
041162 - Doctor Johnson said he did not have time during the call to make the
041163 - referral for Millie to get treatment with physicial therapy, but would
041164 - do this later.
041165 -
041166 -        [On 090609 1514 called Kaiser about scheduling accessing
041167 -        Millie's Power Port to get the CT test on Friday; Arlette,
041168 -        advised that the doctor ordered physical therapy for Millie. on
041169 -        090611 1145. ref SDS 14 LA4J
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0412 -