CONTACTS 

SUBJECTS
Breathing Difficulty Pain Radiation Injury Medical Mistake Radiation

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 53 0000. ref SDS 52 0000.
130502 -
130503 -
130504 -
130505 -
130507 -  ..
1306 -
1307 - Background
130801 -  ..
130802 - Fever Temperature 101.1 Rising from 99.7 Kaiser Says Go to ER
130803 -
130804 - Follow up ref SDS 53 DQ5O, ref SDS 52 DQ5O.
130805 -
130806 - On Thursday, Millie had a fever with temperature 101.4, reported on
130807 - 090917 1403. ref SDS 52 UE4P  With Tylenol and drinking cold liquids,
130808 - this dropped to 100.3, then to 99, and finally to normal. 090917 1403,
130809 - ref SDS 52 0Q58
130811 -  ..
130812 - Yesterday on Friday, similar experience, but temperature never got
130813 - above 100, reported 090918 0530. ref SDS 53 UE4P
130814 -
130815 -
130817 -  ..
1309 -
1310 -
1311 - 0742
1312 -
131201 - Breathing difficulty again, and temperature this morning 101.1.
131202 -
131203 - Millie took a Tylenol to reduce the temperature, but with consistent
131204 - problems will likely go to ER, pursuant to Kaiser guidance for cancer
131205 - patients on chemotherapy get treatment in the ER when temperature
131206 - reaches 100.5, reported on 041202 0605, ref SDS 11 IX9N, and cited a
131207 - few days ago on 090917 1403, when Millie's temperature was 101.4.
131208 - ref SDS 52 DQ5O
131209 -
131211 -  ..
1313 -
1314 -
1315 - 0812
1316 -
131601 - Millie has not been eating the past few days.  Just a nibble here and
131602 - there at meal times.
131604 -  ..
131605 - She looks like her weight has fallen.  Millie has not felt well for
131606 - the past week, reported yesterday. 090918 0530, ref SDS 53 XZ33
131608 -  ..
131609 - IBC continues to "look" improved, so assume current problems are
131610 - caused by Gemzar side effects and/or progression of radiation injury
131611 - to the lungs causing rising breathing problems, since treatment in the
131612 - ER on 090720 1437. ref SDS 49 GE5H
131614 -  ..
131615 - Notify medical team, and submit planning for treatment start 3rd
131616 - cycle of Gemzar next week.
131617 -
131619 -  ..
131620 - Millie takes a shower.
131621 -
131622 -
131624 -  ..
1317 -
1318 -
1319 - 0853
1320 -
132001 - Emergency Department Admission Breathing Problems High Fever
132002 -
132003 - Follow up ref SDS 49 PQ4U
132004 -
132005 - Arrived at Kaiser ER in Walnut Creek, and check in posted as 0909 in
132006 - Kaiser's records.
132008 -  ..
132009 - Reported difficulty breathing and fever from temperature 101.1 for a
132010 - cancer patient on chemotherapy, per above. ref SDS 0 UE4P
132012 -  ..
132013 - The receptionist asked for Millie's Kaiser member number.
132015 -  ..
132016 - When Millie gave the number, the attendant recognized Millie was
132017 - having breathing problems just from talking.  She called a colleague
132018 - to come immediately and get Millie for treatment and cited in the call
132019 - Millie's difficulty breathing while talking.
132021 -  ..
132022 - Efficiency getting care in ER today aligns with improvements reported
132023 - on 090720 1437. ref SDS 49 PQ4U
132025 -  ..
132026 - Nurse Michelle S came and accompanied Millie to an ER acute crisis
132027 - unit in the ER.
132029 -  ..
132030 - This is a change in prior treatment for breathing problems.  On 090720
132031 - Millie was treated in a standard cubicle.  Today, she was in a larger
132032 - room with additional equipment.  About 3 or 4 people attended to
132033 - Millie, which was aided by the larger area in the room today.
132035 -  ..
132036 - Millie connected to diagnostics.
132038 -  ..
132039 - Millie's temperature seems to have already dropped to normal from the
132040 - Tylenol treatment this morning, per above. ref SDS 0 UE4P
132042 -  ..
132043 - Shelby is the lead nurse.
132045 -  ..
132046 - Doctor Lilenstein examined Millie.  He treated Millie previously in ER
132047 - on 090122, when Millie dislocated her shoulder. ref SDS 41 03AG  He
132048 - said that Doctor Roth is scheduled to take over in an hour, when there
132049 - is a shift change, so he is starting Millie's care.
132051 -  ..
132052 - The doctor ordered an xray to evaluate lungs, and extensive lab work.
132054 -  ..
132055 - Doctor Lilenstein also indicated Millie will likely need a CT test,
132056 - but this will be confirmed by Doctor Roth when he takes over.
132057 -
132058 -        [...below Doctor Roth orders CT test to evaluate Millie's
132059 -        breathing problems. ref SDS 0 EA3I
132061 -  ..
132062 - Michelle took patient history, including medications.  She used
132063 - Kaiser's computer to ask about medications Millie is actually taking
132064 - compared to what has been prescribed listed in the computer.  For
132065 - example, oxychodone was prescribed on 090731 by Doctor Baitoo in Minor
132066 - Injury, ref SDS 51 QR59, to help Millie avoid severe pain from the
132067 - fall she suffered on 090728. ref SDS 50 RB5J
132069 -  ..
132070 - Shelby did an EKG.  Results were negative for heart problems.
132071 -
132073 -  ..
1321 -
1322 -
1323 - 0911
1324 -
132401 - Linda inserted a Huber needle to draw blood and for Millie's CT test.
132403 -  ..
132404 - She asked for the specification on the needle needed for injecting
132405 - contrast medium to perform the CT test?
132407 -  ..
132408 - Reported patient history showing Kaiser and UCSF use a Lifeguard 1"
132409 - needle with high strength steel, reported most recently for Millie's
132410 - last CT test on 090612 1030, ref SDS 45 WU55, and citing prior work at
132411 - UCSF receiving the product specification for the Huber needle required
132412 - for CT tests presnted in the record on 080724 0900. ref SDS 35 MV7Y
132414 -  ..
132415 - Linda seemed to confirm that she used a Lifeguard 1" Huber needle with
132416 - high strength steel that supports injecting high pressure contrast
132417 - medium for CT tests.  This aligns with Paula's report on 081017 that
132418 - Kaiser purchased Lifeguard Huber needles with high strength steel for
132419 - pressure injecting contrast medium to perform CT tests, reported on
132420 - 081017 1415. ref SDS 37 045H
132422 -  ..
132423 - Shelby said the ER department recently received orientation and
132424 - training on using Huber needle and Power Port technology for injecting
132425 - contrast medium to perform CT tests, which replaces conventional IV
132426 - methods.
132428 -  ..
132429 - This significantly improved prior difficulty on 090720 when Millie was
132430 - treated for difficulty breathing.  At that time, the ER medical team
132431 - refused to support Millie's CT test using her Power Port for injecting
132432 - contrast medium, and as a result.  Millie and several nurses suffered
132433 - severely in physicial and emotional trauma, and lost time trying to
132434 - use a conventional IV, rather than Millie's Power Port, reported on
132435 - 090720 1437. ref SDS 49 TV8H
132436 -
132437 -            [On 100218 1000 Cassandra reports Kaiser CT Department has
132438 -            recently upgraded to develop protocol for using Power Port
132439 -            to inject contrast testing medium. ref SDS 57 M67K
132441 -  ..
132442 - Shelby draws blood using the Huber needle and Power Port, and marks
132443 - vials for lab tests ordered by Doctor Lilenstein.
132444 -
132445 -
132447 -  ..
1325 -
1326 -
1327 - 0938
1328 -
132801 - Portable xray equipment is wheeled into Millie's cubicle and the xray
132802 - is taken, without Millie having to be moved anywhere.
132803 -
132804 -
132806 -  ..
1329 -
1330 -
1331 - 0950
1332 -
133201 - Doctor Roth arrives.
133202 -
133203 - He has been reviewing Millie's medical history from Doctor Johnson's
133204 - notes in the medical chart reporting on the meeting at Kaiser on
133205 - 090828.  Doctor Roth feels Millie's patient profile is very complex,
133206 - and overwhelming.  The doctor indicated increased effort is needed
133207 - today on discovering the cause of breathing problems since this is the
133208 - second time treatment in ER for the same thing.
133210 -  ..
133211 - Update the doctor with recent history starting Gemzar treatment at
133212 - Kaiser on 090720 after getting treatment at UCSF on 090616 with MPA
133213 - and ending treatment on 090716 because the doctor feels Millie's
133214 - increasing problems breathing could be pulmonary embolism that is a
133215 - side effect of MPA.
133217 -  ..
133218 - Doctor Roth asked about inflammatory breast cancer?  He said IBC is
133219 - new to his practice, similar to Doctor Lozano on 090720. ref SDS 49
133220 - EQ6K
133222 -  ..
133223 - The doctor asked how long Millie has had breathing problems and high
133224 - temperature.
133226 -  ..
133227 - Breathing problems first reported in late March and April following
133228 - treatment with radiation treatment at UCSF in February and ending
133229 - March 17, and has gradually gotten worse, per background when Millie
133230 - was treated in the ER on 090720 for painful breathing. ref SDS 49 DQ5O
133231 - and ref SDS 49 1Z32
133233 -  ..
133234 - Millie said she has not felt well since about Tuesday, when she had
133235 - elevated temperature and took Tylenol.  On Thursday, 090917 her
133236 - temperature increased to 101.4, but was again controlled and reduced
133237 - to normal by the evening taking Tylenol, and so Millie did not seek
133238 - treatment in the ER. ref SDS 52 UE4P  Yesterday on 090918 temperature
133239 - elevated to 99.7. ref SDS 53 L66I  This morning fever occurs again
133240 - with temperature of 101.1, so Millie requested treatment in ER, per
133241 - above. ref SDS 0 UE4P
133243 -  ..
133244 - Doctor Roth orders a CT test to evalute Millie's breathing problems
133245 - today, per planning above. ref SDS 0 QY5P  This follows up CT test in
133246 - Emergency Department to evaluate painful breathing on 090720.
133247 - ref SDS 49 GA37
133248 -
133249 -        [...below Danial Linnen arrives to organize work for Millie's
133250 -        CT test. ref SDS 0 04G4
133252 -         ..
133253 -        [...below, problems performing CT test injecting contrast
133254 -        medium, mix up on using Power Port; Millie suffers severe pain
133255 -        from 4 attempts to set IV with needle puncture. ref SDS 0 MI8H
133256 -
133257 -
133258 -
133260 -  ..
1333 -
1334 -
1335 - 1005
1336 -
133601 - Millie is moved from the acute trauma ER cubicle to a standard ER
133602 - cubicle.
133603 -
133604 -
133605 -
133607 -  ..
1337 -
1338 -
1339 - 1010
1340 -
134001 - Now that Millie is stabelized went to the ER parking and drove the
134002 - car to the regular parking garage on the West side of the 3rd floor.
134003 -
134004 -
134006 -  ..
1341 -
1342 -
1343 - 1013
1344 -
134401 - Millie having problems breathing again.
134402 -
134403 - Discuss with Doctor Roth at his work station in the ER section control
134404 - center.
134406 -  ..
134407 - Doctor Roth said he will give Millie treatment to help her breathing.
134409 -  ..
134410 - The doctor feels Millie's breathing problems could be caused by...
134411 -
134412 -        1.  Pulmonary embolism discussed at UCSF on 090716 as side
134413 -            effect of MPA; the doctor cited Millie's susceptibility
134414 -            from 2 prior PEs.
134415 -
134416 -        2.  Radiation injury progressing in lungs aligns with long
134417 -            period of rising breathing problems for past 3 months.
134419 -             ..
134420 -        3.  Cancer metastasis in the lining of the lungs from untreated
134421 -            IBC on breastbone since 090122, could be possible despite
134422 -            negative findings from several recent CT tests, and the
134423 -            xray test last week.
134425 -             ..
134426 -            Lymphangetic spread may be related to cancer in Millie's
134427 -            lungs, which is mentioned in Doctor Johnson's medical chart
134428 -            based on possible communication from Doctor Rugo at UCSF.
134430 -             ..
134431 -        4.  Gemzar chemotherapy side effects that weaken immune system
134432 -            causing infection.
134433 -
134434 -
134435 -
134436 -
134438 -  ..
1345 -
1346 -
1347 - 1023
1348 -
134801 - Doctor Roth gives Millie treatment with...
134802 -
134803 -             1.  Atrovent
134804 -                 Ipratropium Bromide............ 0.5 mg vial
134806 -                  ..
134807 -             2.  Albuterol Sulfate.............. 2.5 mg 0.5 mL
134809 -  ..
134810 - This is delivered with an inhaler configured with an air pressure tube
134811 - connected to a wall valve, so there is continuous treatment delivered
134812 - to the patient.
134814 -  ..
134815 - Albuterol Sulfate is one of the treatments Millie takes at home, but
134816 - only a single puff.
134817 -
134818 -
134820 -  ..
1349 -
1350 -
1351 - 1049
1352 -
135201 - John introduced himself as taking over for Millie's nurse while
135202 - Sherrille goes to lunch.
135203 -
135205 -  ..
1353 -
1354 -
1355 - 1054
1356 -
135601 - Millie's breathing equipment suddenly starts making a loud noise. and
135602 - is no longer working correctly.
135604 -  ..
135605 - Went and found John in the next cubicle helping another patient.
135607 -  ..
135608 - Advise that Millie's breating equipment is making a loud noise and is
135609 - not working properly.
135611 -  ..
135612 - John says that happens sometimes.  He will check on Millie in a few
135613 - minutes when he gets a chance from helping his current patient.
135614 -
135615 -
135617 -  ..
1357 -
1358 -
1359 - 1103
1360 -
136001 - Danial Linnen visits to explain problems getting CT test organized,
136002 - ordered by Doctor Roth, per above. ref SDS 0 EA3I
136004 -  ..
136005 - Kaiser has done a lot of orientation for the ER staff to do CT tests
136006 - using Millie's Power Port, but the IR Department that normally sends
136007 - someone to observe the test and connecting the contrast medium
136008 - injection is closed on Saturday.
136010 -  ..
136011 - Danial said there is only one nurse in the entire hospital today on
136012 - the weekend who is qualified to support injecting contrast medium for
136013 - CT tests.  He is worried that person will not agree to take
136014 - responsibility for Millie's CT test.
136016 -  ..
136017 - We reviewed Millie's patient history getting many CT tests using her
136018 - Power Port begining on 080718. ref SDS 33 0001
136020 -  ..
136021 - Typically, Millie's port is accessed in the Chemotherapy Infusion
136022 - Clinic, and after the test, she returns and the nurse removes the
136023 - Huber needle, and flushes the port.
136025 -  ..
136026 - Danial said the Chemotherapy Infusion Clinic in the Oncology
136027 - Department is closed on the weekend, so there is nobody there who can
136028 - support Millie's CT test today.
136030 -  ..
136031 - Explained that the Oncology Department is staffed in the Chemotherapy
136032 - Infusion Clinic changed there schedule.  Beginning last year, Millie
136033 - has been betting Neupogen treatments in the clinic on Saturdays.
136035 -  ..
136036 - Danial will call the Chemotherapy Infusion Clinic and ask if one of
136037 - the nurses will support Millie's CT test today by going to the CT
136038 - Department and observe injection of contrast medium.
136039 -
136040 -
136042 -  ..
1361 -
1362 -
1363 - 1113
1364 -
136401 - Doctor Lilienstein stops in and asks how Millie is doing.
136402 -
136403 - Explain loud noise from Millie's inhaler and it seems not to be
136404 - working.
136406 -  ..
136407 - Doctor inspects and finds the tube has somehow become disonnected from
136408 - the pressure air feed at the wall valve.  The doctor connects the tube
136409 - to the wall valve, and sets the valve to the correct pressure.
136411 -  ..
136412 - Millie breathing better now.
136413 -
136415 -  ..
1365 -
1366 -
1367 - 1122
1368 -
136801 - Phone rings in Millie's room.  Did not expect anyone to call, because
136802 - there has not been enough time this morning to notify family that
136803 - Millie is in ER.
136805 -  ..
136806 - Answered the phone; Danial called to explain good news on scheduling
136807 - Millie's CT test.
136809 -  ..
136810 - Danial advised that, Debbie, a nurse in his department (ICU), has
136811 - agreed to support Millie's CT test.  He said asked that Millie tell
136812 - her nurse or doctor that ICU has coordinated to arrange for a nurse to
136813 - support the CT test Department, and for someone to let him know when
136814 - Debbie should go to the CT Department for Millie's test.
136816 -  ..
136817 - Upon discusson, Danial agreed to call the CT Department and let them
136818 - know Debbie will support Millie's test using the Power Port for
136819 - injecting contrast medium, and coordinate on setting the time for the
136820 - test.  Danial will then notify the ER Department on when Millie will
136821 - get the CT test.
136822 -
136823 -
136824 -
136826 -  ..
1369 -
1370 -
1371 - 1131
1372 -
137201 - John arrives and checks Millie's breathing support.
137202 -
137203 - Explain the doctor just found it was unplugged, and fixed that
137204 - problem.
137206 -  ..
137207 - John inspects the breathing inhaler and says it has a couple more
137208 - minutes of medication.  He will check again in about 10 minutes to
137209 - give Millie a new inhaler or charge the one she has.
137210 -
137211 -
137213 -  ..
1373 -
1374 -
1375 - 1137
1376 -
137601 - Danial returns to Millie's cubicle, following up the telecon 20
137602 - minutes ago. ref SDS 0 0556
137604 -  ..
137605 - The CT test is scheduled for 1200.  Someone from the CT Department
137606 - will come and get Millie for the test.  Debbie will meet the team in
137607 - the CT Department at 1200.
137609 -  ..
137610 - Danial walked to the Control Center and told John that Millie's CT
137611 - test is scheduled for 1200.
137613 -  ..
137614 - Thanked Danial for excellent work.
137615 -
137616 -
137618 -  ..
1377 -
1378 -
1379 - 1139
1380 -
138001 - Breathing equipment no longer helping Millie.
138002 -
138003 - John walks by.
138005 -  ..
138006 - He feels the breathing equipment needs to be recharged or replaced.
138008 -  ..
138009 - John said he will do this in a few minutes, and leaves to work on
138010 - something else.
138011 -
138013 -  ..
1381 -
1382 -
1383 - 1141
1384 -
138401 - John returns.
138402 -
138403 - Millie says she feels better, because at least she is not coughing.
138404 - So, the breathing support has been a big help.
138406 -  ..
138407 - John checks Millie's lungs with a stethoscope.
138409 -  ..
138410 - He feels the lungs sound "good," there is a little crackling sound,
138411 - but nothing severe.
138413 -  ..
138414 - John takes vitals...
138415 -
138416 -               Temp.................. 97.8
138417 -               BP.................... 131 60
138418 -               Pulse................. 85
138419 -               S02................... 97
138421 -  ..
138422 - He leaves the cubicle without charging the breathing equipment.
138424 -  ..
138425 - So, Millie is no longer getting breathing support.
138427 -  ..
138428 - Millie feels okay at this time.
138429 -
138430 -
138432 -  ..
1385 -
1386 -
1387 - 1156
1388 -
138801 - Called Pam to explain Millie's situation.
138802 -
138803 - Pam talked to Millie briefly.
138805 -  ..
138806 - Millie discussed coordinating entertaining Millie's cousin Jannet who
138807 - is coming to San Francisco from Chicago for a visit next Tuesday.
138808 -
138810 -  ..
1389 -
1390 -
1391 - 1204
1392 -
139201 - Millie sleeping waiting for CT test.
139202 -
139204 -  ..
1393 -
1394 -
1395 - 1217
1396 -
139601 - Sherril comes to Millie's cubicle.  Plans to check vitals.
139602 -
139603 - Reviewed John's work at 1141 taking vitals.  Sherrille said she did
139604 - not see the results entered in the computer.
139606 -  ..
139607 - She checked the monitoring and found the report for vitals John took
139608 - at 1145, per above.
139610 -  ..
139611 - Sherril takes vitals...
139612 -
139613 -               Temp.................. 97.8
139614 -               BP.................... 116 71
139615 -               Pulse................. 85
139616 -               S02................... 92
139618 -  ..
139619 - Sherrille explains SO2 does not measure well when the patients hands
139620 - are cold.  She checked and said Millie's left hand is cold, so she
139621 - put the diagnostic connection on Millie's right hand.  She had to
139622 - peel back the compresson glove on the left hand that controls
139623 - swelling from lymphedema.
139625 -  ..
139626 - SO2 still reading between 95 and drops to 90, so say 92.
139628 -  ..
139629 - Review concern about Millie getting support for breathing because the
139630 - reason for coming to ER today was to recover from breathing problems.
139632 -  ..
139633 - Sherrille said Millie should get 3 breathing treatments.  Not clear
139634 - why John did not set up another breathing treatment when the first one
139635 - ended, per above. ref SDS 0 MN3G
139636 -
139638 -  ..
1397 -
1398 -
1399 - 1227
1400 -
140001 - Sherrille starts Millie on 2nd treatment with...
140002 -
140003 -             1.  Atrovent
140004 -                 Ipratropium Bromide............ 0.5 mg vial
140006 -                  ..
140007 -             2.  Albuterol Sulfate.............. 2.5 mg 0.5 mL
140008 -
140009 -
140011 -  ..
1401 -
1402 -
1403 - 1231
1404 -
140401 - Millie feeling chilled.
140402 -
140403 - Sherrill is busy with another patient.  She asks Mike to get another
140404 - blanket for Millie, still waiting to do the CT test.
140405 -
140407 -  ..
1405 -
1406 -
1407 - 1242
1408 -
140801 - Mike arrives with 2 extra blankets for Millie.
140802 -
140803 - Millie feels better now with continual breathing support and extra
140804 - blankets.
140806 -  ..
140807 - Her cough has subsided again.
140808 -
140809 -
140811 -  ..
1409 -
1410 -
1411 - 1251
1412 -
141201 - Sherrille checks to see progress with Millie's 2nd breathing
141202 - treatment.
141204 -  ..
141205 - She said there are few more minutes until this treatment is
141206 - completed, and then the 3rd and final treatment begins.
141208 -  ..
141209 - Asked about progress with the CT test that was scheduled for 1200, per
141210 - Danial, above. ref SDS 0 AC8E
141212 -  ..
141213 - Sherrill said the CT Department just called and said the nurse Danial
141214 - arranged has not arrived for Millie's test because an emergency
141215 - situation occurred in ICU.  Sherrill called ICU to get an update on
141216 - when the nurse can support Millie's CT test.  She could not talk to
141217 - Danial.  She thinks he may be tied up with the emergency also.
141219 -  ..
141220 - So, Millie is standing by waiting for the emergency in ICU to be
141221 - resolved so the nurse can support the test in the CT Department.
141222 -
141223 -
141225 -  ..
1413 -
1414 -
1415 - 1303
1416 -
141601 - Doctor Roth arrives and says there is a new plan.  Millie is in the
141602 - restroom.
141603 -
141604 -
141606 -  ..
1417 -
1418 -
1419 - 1309
1420 -
142001 - Doctor Roth returns and explains new plan for keeping Millie in the
142002 - hospital overnight for observation and to treat with antibiotics.
142004 -  ..
142005 - The lab shows bands are high which indicates infection, so a doctor
142006 - in the Internal Medicine Department wants to keep Millie in the
142007 - hospital to observe and treat the infection.
142008 -
142009 -
142010 -
142012 -  ..
1421 -
1422 -
1423 - 1315
1424 -
142401 - Sherrille returns to set up the 3rd breathing treatment.
142402 -
142403 -             1.  Atrovent
142404 -                 Ipratropium Bromide............ 0.5 mg vial
142406 -                  ..
142407 -             2.  Albuterol Sulfate.............. 2.5 mg 0.5 mL
142408 -
142409 -
142411 -  ..
1425 -
1426 -
1427 - 1332
1428 -
142801 - Doctor Chung Kung from Internal Medicine visits Millie.
142802 -
142803 - He asks about Coumadin treatments and eye drops.
142805 -  ..
142806 - Asks about patient history of fever and coughing.
142808 -  ..
142809 - Uses stethoscope to test lungs.
142811 -  ..
142812 - Millie starting to cough.
142814 -  ..
142815 - Doctor Kung feels that since this is the second time Millie has been
142816 - treated in ER for breathing problems in 2 months, Kaiser should
142817 - investigate more closely this time.
142819 -  ..
142820 - The doctor confirms that Millie will be checked into the hospital for
142821 - treatment with antibiotics.
142823 -  ..
142824 - Doctor Kung asks what antibiotics Millie has had previously, and when
142825 - she was last treated?
142827 -  ..
142828 - Millie was treated with Keflex in the ER to recover from Cellulitis
142829 - and lymphedema beginning on 080409.
142831 -  ..
142832 - Doctor Kung asked why Kaiser prescribed Oxychodone?
142834 -  ..
142835 - We reviewed the record on 090728 when Millie fell and hurt her back.
142836 - ref SDS 50 RB5J  A few days later, the back was still hurting so
142837 - Doctor Baitoo in Minor Injury Clinic prescribed oxychodone, reported
142838 - on 090731 1330, ref SDS 51 QR59
142840 -  ..
142841 - Millie said she only took it once, and then stopped, because it caused
142842 - bad side effects, and did not seem as effective as Vicodin and
142843 - Tylenol.
142845 -  ..
142846 - Doctor Kung said he removed this from Millie's list of prescribed
142847 - medications.
142848 -
142849 -
142850 -
142851 -
142853 -  ..
1429 -
1430 -
1431 - 1412
1432 -
143201 - Sherrille visited Millie and said the CT test is now scheduled for
143202 - 1500.
143204 -  ..
143205 - Millie is tired.  She cannot eat until after the CT test.
143207 -  ..
143208 - Sherrille takes information to fill out the CT test consent form.
143210 -  ..
143211 - Millie signed the form.
143213 -  ..
143214 - Decided not to request the CT test of the neck, because Millie usually
143215 - palpates nodes in the neck, and she has not noticed any problems since
143216 - radiation treatment in March.  This avoids a battle getting a
143217 - professional report from the CT Department.
143219 -  ..
143220 - Millie wants to sleep until the CT test at 1500.
143222 -  ..
143223 - Drove home to take care of things.
143224 -
143226 -  ..
1433 -
1434 -
1435 - 1635
1436 -
143601 - Millie called.
143602 -
143603 - She still has not received the CT test.  There was a delay because the
143604 - time slot at 1500 was used for an emergency patient in ICU.
143606 -  ..
143607 - No one has told her when the CT test will be prformed.
143609 -  ..
143610 - She has been checked into the hospital in room #3050A.
143612 -  ..
143613 - While we talked someone came into Millie's room and said her test will
143614 - be in 10 minutes.
143615 -
143616 -
143617 -
1437 -

SUBJECTS
CT Test 090720 Kaiser Radiology Report Prescribed by Doctor Lazano K

2403 -
2404 - 1647
240501 -  ..
240502 - CT Test Problems Setting IV 4 Tries Painful Mistakes Using Power Port
240503 -
240504 - Follow up ref SDS 49 GA37.
240505 -
240506 - Person from CT Department arrives in Millie's room 3050A to take her
240507 - for the CT test, ordered by Doctor Roth, per above. ref SDS 0 EA3I
240508 -
240510 -  ..
2406 -
2407 -
2408 - 1656
2409 -
240901 - Millie arrives in CT Department.
240902 -
240903 - Danial Linnin, who coordinated the CT test and support for injecting
240904 - contrast medium using Millie's Power Port, per above, ref SDS 0 AC8E,
240905 - was on scene along with a nurse from ICU, who would observe the
240906 - connection of the equipment to the Huber needle.
240908 -  ..
240909 - Danial had evidently done research and noticed that manufacturer
240910 - requirements for the Power Port recommend using only Bard Huber
240911 - needles for injecting contrast medium to perform CT tests.  Daniel's
240912 - research aligns with product specifications for the Power Port
240913 - received on 080708 0630. ref SDS 32 JE7N
240915 -  ..
240916 - Danial determined that Linda had used a yellow Lifeguard Huber needle
240917 - per above, ref SDS 0 1K6M, rather than a purple Bard needle.  He
240918 - evidently advised the medical team of his research finding
240919 - manufacturer recommends using only Bard Huber needles with the Bard
240920 - Power Port.
240922 -  ..
240923 - No one on the scene was familiar with patient history showing that
240924 - Paula Vanicola in the Kaiser Oncology Chemotherapy Infusion Clinic
240925 - advised that Kaiser investigated and determined that Lifeguard Huber
240926 - needels are an acceptable alternative to Bard, reported on 081017
240927 - 1415. ref SDS 37 045H
240929 -  ..
240930 - No one could find a protocol saying Lifegard Huber needles are
240931 - acceptable.
240932 -
240933 -           [On 100218 1000 Cassandra reports Kaiser CT Department has
240934 -           recently upgraded to develop protocol for using Power Port
240935 -           to inject contrast testing medium. ref SDS 57 M67K
240937 -  ..
240938 - As a result, Millie's CT test was delayed for 15 minutes, while
240939 - Danial left and went to the ICU Department to find a purple Bard
240940 - Huber needle to replace the yellow Lifeguard Huber needle already
240941 - accessed by Linda for the CT test earlier this morning at 0911, per
240942 - above. ref SDS 0 1K6M
240944 -  ..
240945 - Danial returned to the CT Department and reported that there were no
240946 - Bard Huber needles in the ICU Department.
240948 -  ..
240949 - The team decided they could not use the yellow Lifeguard Huber needle
240950 - that was used successfully for three (3) prior tests in the Kaiser CT
240951 - Department, most recently on 090612 1120. ref SDS 46 026E
240953 -  ..
240954 - Millie was relieved Danial did not find a Bard Huber needle, because
240955 - this would have risked making the same mistakes setting the pressure
240956 - level that caused failure and bleeding problems with the CT test on
240957 - 080718, when people unfamiliar with using Huber needles and Power Port
240958 - for injecting contrast medium try to use a new procedure for the first
240959 - time reported on 080718 1030. ref SDS 33 2U8V
240961 -  ..
240962 - The trade-off was causing the nurse and/or technician to suffer
240963 - emotional trauma trying to set an adequate IV, and the patient suffer
240964 - severe pain from failure trying to find a vein in the right arm that
240965 - provides blood flow with conventional IV, as occurred on 090720 1437.
240966 - ref SDS 49 PQ4V
240968 -  ..
240969 - Millie decided that rather than present guidance for people under
240970 - stress, she would not explain advantages of using the Lifeguard Huber
240971 - needle already accessing her port, because this would cause strong
240972 - emotional resistance from people who believed in a set of paradigms
240973 - driving their actions.
240975 -  ..
240976 - Either a technician or the nurse from ICU then attempted to set up a
240977 - standard IV again, totally ignoring the investment Kaiser had already
240978 - made to surgically implant a Power Port, and already accessed.
240980 -  ..
240981 - This effort failed, causing pain and suffering for Millie, reported
240982 - previously on 080425 1509. ref SDS 30 FP6F  As occurred last July, the
240983 - person who failed to achieve the IV and was aware of causing Millie
240984 - severe pain was traumatized by failure, reported on 090720 1437.
240985 - ref SDS 49 PQ4V  The IV was prepared but could not produce sufficient
240986 - blood flow for injecting contrast medium.
240988 -  ..
240989 - The nurse tried another IV at another location.  This failed again,
240990 - causing the nurse to start crying.
240992 -  ..
240993 - The technician, who was observing and would normally set IV's for
240994 - other patients who do not use Power Ports, offered to try.  He told
240995 - Millie that if this failed, he would ask a nurse from the Chemotherapy
240996 - Infusion Department to look for a Bard Huber needle for using the
240997 - Power Port.  Millie agreed, because she wanted to complete the CT
240998 - test.
241000 -  ..
241001 - The technician failed again to set an IV with sufficient flow; but a
241002 - second try was finally successful.
241004 -  ..
241005 - The CT test was performed taking a total of about 90 minutes, instead
241006 - of 20 minutes needed for the test using the Lifeguard Huber needle,
241007 - reported on 090612 1120. ref SDS 46 026E
241008 -
241009 -           [On 100218 1000 Cassandra reports Kaiser CT Department has
241010 -           recently upgraded to develop protocol for using Power Port
241011 -           to inject contrast testing medium. ref SDS 57 M67K
241013 -  ..
241014 - The CT team decided to leave the IV in place for removal by the nurse
241015 - after Millie is returned to her room in the hospital.
241017 -  ..
241018 - The technician apologized for difficulty getting the test done, and
241019 - said Millie was a "trooper," for letting everybody poke her in the arm
241020 - so many times.  This aligns with Dennis' comments last year, when the
241021 - Kaiser CT Department in Walnut Creek had difficulty using the Power
241022 - Port for the first time, reported on 080718 1030. ref SDS 33 FM74
241024 -  ..
241025 - The technician advised that Power Ports are new technology for the CT
241026 - Department at Kaiser in Walnut Creek.  He has heard discussions about
241027 - it.
241029 -  ..
241030 - Millie explained she has been getting contrast medium injected for CT
241031 - tests using the Power Port for more than a year, most recently on
241032 - 090413 1500. ref SDS 42 QO4L  The technician indicated that there
241033 - should be a protocol on using Bard Power Ports and Huber needles so
241034 - that everybody is on the "same page" in the CT Department.
241036 -                ..
241037 -               [On 091223 0639 Paula, Chief Chemotherapy Infusion
241038 -               Clinic, disclosed that Kaiser has written a protocol for
241039 -               using Bard Power Ports with Lifeguard and Bard Huber
241040 -               needles; it is filed in Kaiser's system under a heading
241041 -               of some kind that begins wth "Nursing." ref SDS 56 057K
241042 -
241044 -  ..
241045 - Millie's last CT test was on 090720. ref SDS 49 GA37
241047 -         ..
241048 -        Test History No Evidence Distant Metastasis
241049 -        Distant Metastasis No Evidence 8 Years Imaging Tests
241050 -
241051 -        Follow up ref SDS 49 6I4G. ref SDS 47 GM3N.
241052 -
241053 -        CT test today on 090919 continues Millie's 8 year history of
241054 -        testing that finds no evidence of distant metastasis.
241056 -        ..
241057 -       Type    Date              Received              Source
241058 -    1.  CT     090919 reported on 090919.............. ref SDS 0 DA6Q
241059 -    2.  CT     090720 reported on 090720.............. ref SDS 49 DA6Q
241060 -    3.  CT     090612 reported on 090617.(neck)....... ref SDS 47 DA6Q
241061 -        CT     090612 reported on 090617.(1st part)... ref SDS 47 DA6Q
241062 -    4.  CT     090413 reported on 090415.............. ref SDS 43 DA6Q
241063 -    5.  CT     081230 reported on 090107.(neck)....... ref SDS 40 DA6Q
241064 -        CT     081230 reported on 090107.(1st part)... ref SDS 40 5O6N
241065 -    6.  CT     081107 reported on 081113 (neck)....... ref SDS 39 DA6Q
241066 -        CT     081107 reported on 081112 (1st part)... ref SDS 38 5O6N
241067 -    7.  CT     080911 reported on 080912.............. ref SDS 36 DA6Q
241068 -    8.  CT     080718 reported on 080723.............. ref SDS 34 DA6Q
241069 -    9.  CT     080425 reported on 080428.............. ref SDS 31 DA6Q
241070 -   10.  CT     080212 reported on 080215.............. ref SDS 28 DA6Q
241071 -   11.  CT     071210 reported on 071213.............. ref SDS 27 UG4L
241072 -   12.  CT     070930 reported on 071018.............. ref SDS 26 VK8L
241073 -   13.  CT     070723 reported on 070802.............. ref SDS 25 IM6M
241074 -   14.  CT     070520 reported on 070524.............. ref SDS 24 DA6Q
241075 -   15.  CT     070326 reported on 070329.............. ref SDS 23 DA6Q
241076 -   16.  CT     070131 reported on 070202.............. ref SDS 22 1Y8G
241077 -   17.  PET/CT 061227 reported on 070102.............. ref SDS 21 1Y8G
241078 -   18.  CT     060930 reported on 061012.............. ref SDS 20 284J
241079 -   19.  MRI    060708 reported on 060711.............. ref SDS 19 PT4K
241080 -   20.  Xray   060623 reported on 060711.............. ref SDS 19 WJ6G
241081 -   21.  CT     060505 reported on 060523.............. ref SDS 18 E355
241082 -   22.  PET    060414 reported on 060428.............. ref SDS 17 WJ6G
241083 -   23.  PET    060120 reported on 060126.............. ref SDS 16 WJ6G
241084 -   24.  PET/CT 051005 reported on 051007.............. ref SDS 15 WJ6G
241085 -   25.  CT     050530 reported on 050610.............. ref SDS 14 G75L
241086 -   26.  CT     050325 reported on 050422.............. ref SDS 13 G75L
241087 -   27.  CT     041217 reported on 041230.............. ref SDS 12 G75L
241088 -   28.  CT     041103 reported on 041104.............. ref SDS 10 WV7H
241089 -   29.  CT     040921 reported on 041005.............. ref SDS 9 NL4N
241090 -   30.  CT     040710 reported on 040811.............. ref SDS 8 H85S
241091 -   31.  CT     040410 reported on 040416.............. ref SDS 7 LK5L
241092 -   32.  CT     040307 reported on 040318.............. ref SDS 6 LK5L
241093 -   33.  CT     031031 reported on 031205.............. ref SDS 5 IG9K
241094 -   34.  CT     030626 reported on 030710.............. ref SDS 4 AL6N
241095 -   35.  CT     030428 reported on 030508.............. ref SDS 3 LK5L
241096 -   36.  PET    021218 reported on 030109.............. ref SDS 2 LK5L
241097 -   37.  PET    020529 reported on 020603.............. ref SDS 1 0001
241098 -
241100 -  ..
241101 - CT Test Results Negative
241102 -
241103 - The doctor would not submit results of the test today.
241105 -  ..
241106 - Doctor Johnson reported favorable results, when he met with Millie in
241107 - the hospital a few days later on 090921, while she is recovering from
241108 - breathing problems, and admitted by the Emergency Room Department
241109 - today, per above. ref SDS 0 Y67J
241111 -  ..
241112 - Doctor Johnson generally explained the test reported continuing ground
241113 - glass opacities in the lungs that explain breathing problems, and
241114 - align with findings from the CT test on 090720, ref SDS 49 GG6L, and
241115 - further correlates with detailed findings in test on 090612, reported
241116 - on 090617. ref SDS 47 RV78
241117 -
241118 -            [On 090822 0028 letter to medical team confirms
241119 -            understandings from Millie meeting with Doctor Johnson in
241120 -            her hospital room, and advising ground glass opacities are
241121 -            cited again in the CT test performed on Saturday, 090919,
241122 -            though without substantial increase since the prior test on
241123 -            090612 (this is hazy in the report, which also refers to
241124 -            the test "last month," since the "last test" was on 090720,
241125 -            possibly suggesting a mistake in the CT test report).
241126 -            ref SDS 54 NW3X
241128 -             ..
241129 -            [On 091112 0930, medical chart for meeting with Millie
241130 -            seems to have text from CT test today, on 090919, and
241131 -            reports finding no pulmonary embolism, and that some ground
241132 -            glass opacity nodules in the lungs have resolved, and new
241133 -            ones have appeared in other areas of the lungs. ref SDS 55
241134 -            RU6R
241135 -
241136 -
241137 -
241139 -  ..
2412 -
2413 -
2414 - 1857
2415 -
241501 - Visit Millie in her room 3050A.
241502 -
241503 - She was disappointed about the CT test issue.
241505 -  ..
241506 - Millie was very pleased though that IBC continues to improve.
241508 -  ..
241509 - She showed her left arm has significantly reduced lymphedema now.  The
241510 - skin is loose rather than swelled like a balloon.  The sore in the
241511 - breastbone has reduced from 3" to about .5 inches.
241513 -  ..
241514 - Millie's temperature has continued to rise.  The doctor prescribed
241515 - Tylenol suppositories.  Millie changed this to oral Tylenol.
241516 -
241517 -
241518 -
241519 -
241520 -
241521 -
241522 -
241523 -
241524 -
241525 -
241526 -
241527 -
2416 -