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0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 19 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Did not get a respnse from Doctor Mason in Kaiser's Outside Referrals,
040902 - to the call earlier this morning, on 090727 1119, ref SDS 19 BD5I, so
040903 - called Paula to get support from Claims Resolution Department, which
040904 - has jurisdiction for Millie's case, based on following work history...
040905 -
040906 -        1.  On 090520 1153, called Paula in Claims Resolution
040907 -            Department for assistance getting Kaiser to perform section
040908 -            2 of the insurance agreement that requires the doctor to
040909 -            provide standard of care for Millie's patient profile to
040910 -            recover from the 8th relapse of cancer, which evidence
040911 -            shows is treament with MPA treatment at UCSF. ref SDS 2
040912 -            4M9G
040914 -             ..
040915 -            Paula related Kaiser policy to rely on best evidence,
040916 -            reported on 090520 1153. ref SDS 2 HX3O
040918 -             ..
040919 -            Paula advised Millie to request that Kaiser's Expedited
040920 -            Claims Department make immediate review of her claim for
040921 -            treatment in a letter to Kaiser on 090515 1017. ref SDS 1
040922 -            6Q4Y   She provided a phone number to make this claim.
040923 -            reported on 090520 1153. ref SDS 2 T65H
040925 -             ..
040926 -        2.  On 090520 1203, Expedited Claims was called.  Claims
040927 -            representative, Pamela, refused to accept written statement
040928 -            of Millie's complex claim, despite the request that
040929 -            submitting the claim in writing would enhance case
040930 -            management and quality control with transparency and
040931 -            accuracy. reported on 090520 1203. ref SDS 3 PQ8P
040932 -            ref SDS 3 PQ8P  Millie's claim was therefore presented
040933 -            verbally, ref SDS 3 9595, and confirmed in a letter to the
040934 -            medical team, with a copy to Paula, shown on 090520 1710,
040935 -            ref SDS 4 ZF4T
040937 -             ..
040938 -        3.  On 090521 0902, Pamela called back and said Expedited
040939 -            Claims cannot rule on Millie's request for support, because
040940 -            Millie's case falls through the cracks; Expedited claims
040941 -            cannot deny Millie's request for the doctor to prescribe
040942 -            treatment, but does not want to issue an order for a doctor
040943 -            to prescribe care for a patient, and so Expedited Claims
040944 -            called Doctor Johnson to encourage resolution, and also
040945 -            submitted the case to Member Services Claims Resolution
040946 -            Department in Pleasanton. ref SDS 5 UD5H
040948 -             ..
040949 -        4.  On 090523 0148 Millie sent a letter to Paula with Kaiser
040950 -            Member Services Claims Resolution Department, ref SDS 6
040951 -            2P6J, requesting a determination of her claim to
040952 -            entitlement for medical services under EOC section 2 of the
040953 -            insurance agreement with Kaiser. ref SDS 6 DQ5S
040955 -             ..
040956 -            Millie claimed entitlement to a doctor's prescription for
040957 -            treatment of her cancer, and that evidence shows treatment
040958 -            at UCSF with MPA is the appropriate prescription.
040959 -            ref SDS 6 DQ9Q
040961 -             ..
040962 -        5.  On 090528 0803 Kaiser did not respond; called and talked to
040963 -            Paula; she sent the letter on 090523 addressed to Paula at
040964 -            Claims Resolution, demanding care for cancer, back to
040965 -            Kaiser's Expedited Claims Department, ref SDS 7 PP6Q,
040966 -            which has already reviewed the matter and advised that
040967 -            Expedited Claims sent Millie's case to Paula's Department
040968 -            in Kaiser Member Services Claims Resolution, reported on
040969 -            090521 0902. ref SDS 5 RW82
040971 -             ..
040972 -        6.  On 090528 1228 Millie's letter to Kaiser notifies Paula in
040973 -            Member Services Claims Resolution that Millie objects to
040974 -            delaying treatment caused by errors referring treatment
040975 -            back and forth between departments. ref SDS 8 4M6Y
040977 -             ..
040978 -            Millie corrected Kaiser's mistake processing her claim as
040979 -            requesting treatment in a clinical trial, and stated she
040980 -            requests standard of care of Millie's patient profile,
040981 -            ref SDS 8 4N3R, as required in Section 2 of the insurance
040982 -            agreement with Kaiser. ref SDS 8 4N3X
040984 -             ..
040985 -            Paula asked Millie to sign another form on authorizing Rod
040986 -            to represent Millie's claim for care; Paula sent a form via
040987 -            fax. ref SDS 8 4N7U
040989 -             ..
040990 -            Kaiser has many treatments to prescribe that are targeted
040991 -            to Millie's patient profile, ref SDS 8 4N5U, including
040992 -            radiation, and clinical trials. ref SDS 8 4N6Q
040994 -             ..
040995 -            Millie notified Kaiser that her disease was progressing and
040996 -            needed immediate care. ref SDS 8 4N8X
040998 -             ..
040999 -            If Kaiser fails to perform on the insurance agreement, then
041000 -            Millie will have the work done at UCSF and bill Kaiser.
041001 -            ref SDS 8 4N9Q
041003 -             ..
041004 -            Kaiser's success treating Millie to survive beyond disease
041005 -            trajectory causes confusion, delay, and resistance in
041006 -            Oncology, Outside Referrals, Member Services, Expedited
041007 -            Claims, and Claims Resolution.  Since Millie has survived
041008 -            with all of the cancer treatments Kaiser normally
041009 -            prescribes, demands to prescribe additional treatments
041010 -            overwhelms case management by conflicting with daily work,
041011 -            policy and procedures. ref SDS 8 4N4S
041013 -             ..
041014 -        7.  On 090531, since Millie's cancer was getting worse, Doctor
041015 -            Johnson and Doctor Rugo said she needs immediate treatment,
041016 -            and since Kaiser defaulted on obliations to prescribe
041017 -            treatment, Millie sent a letter to Doctor Rugo ordering
041018 -            treatment from UCSF. ref SDS 9 2E4K
041020 -             ..
041021 -        8.  090601 0818 at 1132, Brad in Kaiser Oncology Pharmacy
041022 -            called and advised that Doctor Johnson issued a
041023 -            Chemotherapy Order for Millie to be treated with Gemzar,
041024 -            ref SDS 10 PQ7V; but, treatment could not be scheduled
041025 -            because the doctor did not sign the order, and he went home
041026 -            with a headache. ref SDS 10 PQ4F
041028 -             ..
041029 -            Brad said that Gemzar is not appropriate for Millie's
041030 -            patient profile, because it presents significant risks of
041031 -            infection and death. ref SDS 10 8J8L
041033 -             ..
041034 -        9.  On 090601 0818 at 1412 woman from Expedited Claims called
041035 -            and said Kaiser does not understand Millie's claim for
041036 -            standard of care to treat Millie's 8th relapse of cancer in
041037 -            time to be effective. ref SDS 10 TG5G
041039 -             ..
041040 -            Advised the caller from Expedited Claims, who would not
041041 -            give her name nor address for confirming the record, that
041042 -            this matter was reviwed by Pamela in Expedited Claims, and
041043 -            on 090521, Pamela sent the case to the Claims Resolution
041044 -            Department. ref SDS 10 MD3L
041046 -             ..
041047 -            Kaiser's claims adjuster then maintained that regardless of
041048 -            how Millie presents her claim, Kaiser interprets all claims
041049 -            as requests for clinical trials, and the policy is to deny
041050 -            the requests. ref SDS 10 TD6J
041052 -             ..
041053 -            Kaiser's claims adjuster maintained that Kaiser was not
041054 -            required to issue a denial of claim because Millie's doctor
041055 -            issued an unsigned chemotherapy order for treatment which
041056 -            the Oncology Pharmacy reported is not appropriate for
041057 -            Millie's patient profile. ref SDS 0 GZ9L
041059 -             ..
041060 -       10.  On 090610 0122 notified Paula in Claims Resolution
041061 -            Department that UCSF medical mistakes caused Millie's
041062 -            cancer to be untreated for 6 months, and so UCSF has
041063 -            ordered treatment for Millie to recover. ref SDS 11 855G
041065 -             ..
041066 -       11.  On 090610 0930 called Paula and she advised that UCSF is
041067 -            liable to Kaiser for fixing medical mistakes performing
041068 -            radiation services for Millie on referral from Kaiser.
041069 -            Paula is coordinating with Outside Referrals, who issued
041070 -            the referral, for case management. ref SDS 12 855G
041072 -             ..
041073 -       12.  On 090610 1032 notified Kaiser Outside referrals that Paula
041074 -            in Claims Resolution Department coordinating Kaiser
041075 -            response for Millie to recover from medical mistakes UCSF
041076 -            reported yesterday that occurred from UCSF providing
041077 -            radiation treatments on referral from Kaiser. ref SDS 14
041078 -            1Q7J
041080 -             ..
041081 -       13.  On 090611 1632 Doctor Rugo's coordinator for Millie's care
041082 -            at UCSF, sent a letter to Kaiser asking where to send a
041083 -            requisition to pay for Millie's lab work at Kaiser ordered
041084 -            for her treatment at UCSF to recover from radiation medical
041085 -            mistakes. ref SDS 15 YU3N
041087 -             ..
041088 -       14.  On 090616 1240 during meeting at UCSF Doctor Rugo notified
041089 -            Millie that UCSF and Kaiser have agreed in a letter that
041090 -            everybody is on board to treat Millie's cancer as a chronic
041091 -            disease for recovering from medical mistakes treating
041092 -            Millie with radiation at UCSF, and that Millie's next
041093 -            treatment after MPA will be with PARP. ref SDS 16 KD6L
041095 -             ..
041096 -       15.  On 090616 1245 Doctor Rugo advised that Millie's treatment
041097 -            has been transferred from Kaiser to UCSF for Millie to
041098 -            recover from UCSF medical mistakes, and so Millie should
041099 -            now call the Triage nurse at UCSF rather than at Kaiser,
041100 -            ref SDS 16 EE70,
041102 -             ..
041103 -       16.  On 090716 2106 Millie's letter to the medical team reports
041104 -            Tara called for Doctor Rugo and said the doctor stopped
041105 -            Millie's treatment with MPA because Millie's difficult
041106 -            breathing, observed during examination at UCSF in the
041107 -            morning, could be pulmonary embolism, which is a rare side
041108 -            effect of MPA.  PARP treatment, planned for Millie's next
041109 -            therapy after MPA, will not be ready at UCSF until
041110 -            September, so Doctor Rugo sent a letter to Doctor Johnson
041111 -            asking Kaiser to treat Millie with Gemzar, because UCSF
041112 -            feels it is cheaper for UCSF to pay Kaiser to treat Millie
041113 -            with Gemzar than to provide the treatment directly.
041114 -            ref SDS 17 EE6P
041116 -             ..
041117 -       17.  On 090725 2017 Millie reports to medical team on meeting at
041118 -            Kaiser to "fill-the-gap," ref SDS 18 R25J, with Gemzar
041119 -            chemotherapy, until PARP, that is a therapy targeted to my
041120 -            patient profile, begins at UCSF in September, as agreed
041121 -            between Kaiser and UCSF. ref SDS 18 T49Q  Doctor Johnson
041122 -            warned that prospects for favorable results with Gemzar
041123 -            were low because Millie's cancer has mutated to aggressive
041124 -            cells that can now "outsmart" chemotherapy. ref SDS 18 T45X
041126 -             ..
041127 -            Doctor Johnson explained evidence-based medical practice at
041128 -            Kaiser, ref SDS 18 T55W, reported previously by Paula on
041129 -            090520 1153. ref SDS 2 HX3O
041131 -             ..
041132 -            Doctor Johnson cited "yeoman's work" in SDS creating a
041133 -            well-ordered record of Millie's complex patient history
041134 -            aids the medical team performing case management.  Timely,
041135 -            comprehensive care has extended Millie's survival far
041136 -            beyond disease trajectory. ref SDS 18 T58R
041138 -             ..
041139 -            Research was presented that evidence-based medical practice
041140 -            charge doctors with fiduciary responsibility to provide
041141 -            evidence for patients comparing trade-offs determining
041142 -            treatments with the best outcome and least cost in terms of
041143 -            suffering, time, and money. ref SDS 18 T58U
041145 -             ..
041146 -            Case study shows Millie has requested trade-offs 7 times in
041147 -            order for the medical team to be prepared to make a smooth
041148 -            transition changing treatments, required to treat Millie's
041149 -            cancer as a chronic disease. ref SDS 18 X66O
041151 -             ..
041152 -            Longevity surviving cancer beyond disease trajectory
041153 -            creates a dilemma of compounding complexity which defeats
041154 -            case management. ref SDS 18 T55S
041156 -             ..
041157 -            Doctor Johnson reported he did not receive Doctor Rugo's
041158 -            letter, ref SDS 18 T64P, promised in Tara's call a week
041159 -            earlier on 090716, per above. ref SDS 0 447H
041161 -             ..
041162 -            Millie asserted her rights to recover from injuries caused
041163 -            by mistakes getting radiation treatment at UCSF on referral
041164 -            from Kaiser, and that the agreement Doctor Rugo reported
041165 -            between Kaiser and UCSF that everybody was on board to
041166 -            provide standard of care requires the medical team to
041167 -            submit analysis comparing trade-offs on determining
041168 -            treatments that yield the best results and least cost in
041169 -            terms of suffering, time, and money. ref SDS 18 T64X
041171 -             ..
041172 -       18.  On 090727 2012 Millie's letter to Paula in Claims
041173 -            Resolution Department advances her cliam for standard of
041174 -            care. ref SDS 20 3S4I
041176 -  ..
041177 - Paula has read Millie's letter to the medical team on 090725 2017.
041178 - ref SDS 18 R25J, confirming understandings meeting with Doctor Johnson
041179 - at Kaiser earlier in the day on 090725, and as summarized above.
041180 - ref SDS 0 448M
041182 -  ..
041183 - We discussed the meeting at UCSF on 090616, when Doctor Rugo reported
041184 - that "everybody is on board" for treating Millie at UCSF to recover
041185 - from medical mistakes getting radiation at UCSF on referral from
041186 - Kaiser, ref SDS 16 D647, and as set out in Millie's letter to the
041187 - medical team on 090725 2017. ref SDS 18 T49Q
041189 -  ..
041190 - Paula feels the UCSF letter Doctor Rugo mentioned on 090616, showing
041191 - agreement with Kaiser for UCSF to treat Millie's cancer as a chronic
041192 - disease, and that the next treatment after MPA will be with PARP,
041193 - ref SDS 16 KD6L, can help her review in the Claims Resolution
041194 - Department.
041196 -  ..
041197 - Paula will make inquires to get the letter, and call back later today
041198 - on how to get Kaier to exercise rights to demand performance by UCSF.
041199 -
041200 -
041202 -  ..
0413 -
0414 -
0415 - 1940
0416 -
041601 - Paula did not call back.
041602 -
041603 -     [On 090727 2012 sent letter to Paula explaining Millie's
041604 -     entitlement to recover damages including expanded treatment to
041605 -     recover from UCSF's medical mistake. ref SDS 20 3S4I
041607 -      ..
041608 -     [On 090730 1129 Paula in Kaiser Claims Resolution
041609 -     Department corridinating to get relief at Kaiser for
041610 -     Millie's injuries caused by UCSF medical mistakes providing
041611 -     radiation treatment on referral from Kaiser. ref SDS 21
041612 -     BD5I
041613 -
041614 -
041615 -
041616 -
041617 -
041618 -
0417 -