THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: November 12, 2009 07:52 AM Thursday;
Millie submits agenda for meeting at Kaiser to evaluate 9th relapse cancer.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS 13 0000.
040507 - ..
0408 - Progress
040901 - The cancer marker increased 50 points for the blood test 2 weeks ago.
040903 - IBC seems visibly worse now, including increased swelling of left that
040904 - has lymphedema from IBC.
040906 - ..
040907 - On 091019 0007 Millie notified the medical team that UCSF efforts to
040908 - treat Millie's cancer at Kaiser for Millie to recover from medical
040909 - mistakes performing radiaton at UCSF during Feb and Mar, now need to
040910 - end, ref SDS 13 WV63, and a new treatment is needed...
040912 - ..
040913 - On 091019 0007 Millie submits agenda for meeting at Kaiser on 091020
040914 - to evaluate 9th relapse of cancer. ref SDS 13 WV63
040916 - ..
040917 - On 091027 0830 Millie meeting with primary care physician, Doctor
040918 - Johnson, with Pam observing; the doctor reported significant drop on
040919 - cancer marker CA 15-3 299 from 350 a few weeks earlier, and indicating
040920 - possible continuing response to treatment. ref SDS 14 DR6M The Doctor
040921 - Johnson reported examination shows stable cancer, ref SDS 14 GN7W, and
040922 - so orders another cycle of Gemzar rather than switch to a treatment
040923 - targeted to Millie's patient profile. ref SDS 14 BK9M
040925 - ..
040926 - This morning, Millie submitted the following letter to the medical
040927 - team presenting the agenda for meeting at Kaiser to evaluate 9th
040928 - relapse, and progress finding a "targeted" treatment for Millie's
040929 - patient profile...
040931 - 1. Subject: Agenda Meeting Kaiser Nov 12 0930 Treatment Plan 9th Relapse Cancer and Breathing Problems Caused by Medical Mistakes at UCSF
040932 - Date: Thu, 12 Nov 2009 08:33:14 -0800
040949 - ..
040950 - 3. The letter to the team on 091019 reported continuing problems
040951 - using the Power Port for infusion treatments, blood draws, CT
040952 - tests. etc. ref SDS 13 0Z9P These problems occur because Power
040953 - Ports are relatively new technology. They significantly reduce
040954 - costs performing the work, and eliminate a lot of discomfort I
040955 - otherwise suffer using conventional IV methods. However,
040956 - specific details for use, though fast and easy to perform, are
040957 - either not known or forgotten due to infrequent use by various
040958 - department staff. I proposed solving the problem by writing a
040959 - protocol, which can be cited in your referrals for my care, and
040960 - checked for procedures at the time services are performed.
040962 - ..
040963 - 4. During the meeting today, I would like to get a copy of the
040964 - protocol which I can cite to assist providers when needed, or
040965 - hear how Kaiser proposes to solve the problem without a
040966 - protocol.
040968 - [On 091112 0930 Doctor Johnson sent an internal electronic
040969 - letter to Paula notifying the Chemotherapy Infusion Clinic
040970 - that the doctor prescribes blood draws and chemotherapy
040971 - infusion treaments using Millie's Power Port with a 1"
040972 - high-strength Huber Needle in order to avoid the high risk
040973 - of compounding Millie's cancer and lymphedema from using
040974 - conventional needle penetrations in her arms. ref SDS 15
040975 - UN8F
040977 - ..
040978 - 5. Confirming understandings from the meeting in your office on
040979 - 091027, when my daughter Pam attended, and we teleconferenced
040980 - with Rod at the VA, you indicated that due to limited time you
040981 - and Doctor Mason had not collaborated with Doctor Rugo and
040982 - Doctor Hsu on UCSF's treatment plan for me to recover from
040983 - medical mistakes at UCSF performing radiation treatments on
040984 - referral from Kaiser, and cited by Doctor Hsu on 090609. As
040985 - you recall, I requested the UCSF treatment plan, and notified
040986 - the medical team on 090610 that UCSF proposed MPA. You
040987 - approved this plan, and Doctor Rugo took control of my case on
040988 - 090616 to mitigate damages I suffer from UCSF medical mistakes.
040989 - This included transferring Triage support from Kaiser to UCSF.
040990 - ref SDS 7 EE70
040992 - [On 091112 0930 Kaiser's medical chart, which was not
040993 - received until months later, ref SDS 15 655J, represents
040994 - incorectly that the doctor presented potential risks (side
040995 - effects and complications) and benefits of the recommended
040996 - and alternative oncologic treatment(s). I have answered
040997 - the patient's questions. I believe the patient is
040998 - competent and can understand the recommendations that I
040999 - have made. The patient agrees with these recommendations -
041000 - none of this occurred - the doctor prescribed Abraxane for
041001 - Millie's next relapse, and did not compare trade-offs with
041002 - other oncology treatments, ref SDS 15 PUGK, contrary the
041003 - request in Millie's letter today transmitting the agenda,
041004 - per above, ref SDS 0 LE3R, and further requested also
041005 - below. ref SDS 0 LE3R
041007 - ..
041008 - 6. A month later on 090716, Tara Lacy advised during a meeting at
041009 - UCSF that my advancing injuries from UCSF mistakes that caused
041010 - breathing problems required ending treatment with MPA, due to
041011 - concerns about possible PE side effects. ref SDS 9 EE9X Tara
041012 - called later that night on 090716 and said that Doctor Rugo was
041013 - out of town, and had not had time to line up an effective
041014 - replacement treatment. She explained that your strategy to
041015 - hold "gold standard" [chemotherapy] treatments in reserve could
041016 - be used on an interim basis with Gemzar, while the [team] finds
041017 - another "targeted" treatment suitable to my patient profile [as
041018 - listed on 090213, ref SDS 3 ES7I].
041020 - ..
041021 - 7. Doctor Rugo planned on 090616 to start me on PARP "targeted"
041022 - treatments to replicate the experience with cetuximab that
041023 - provided care without side effects for nearly 2 years.
041024 - ref SDS 7 KD6L
041026 - ..
041027 - 8. Recall at that time in 2007 - 2008 I was hiking 3 - 8 miles per
041028 - day 4 - 5 times per week, reflecting your strategy to treat my
041029 - cancer as a chronic disease with "targeted" drugs that maintain
041030 - quality of life.
041032 - ..
041033 - 9. In the call on 090716, Tara further related Doctor Rugo's
041034 - request that I get the Gemzar treatment at Kaiser, because UCSF
041035 - believed Kaiser could deliver the treatment at less cost than
041036 - at UCSF [... and which the Kaiser Oncology Pharmacist advised
041037 - on 090601, was not appropriate for my patient profile,
041038 - ref SDS 6 8J8L, risking loss of energy, agony, infection, and
041039 - death, ref SDS 6 FR8L ...] To mitigate damages, I agreed to
041040 - this request. While my cancer has been held somewhat in check
041041 - under Brigid's rule that "stable is good" [diagnosed by Doctor
041042 - Johnson on 091027 0830, ref SDS 14 DR6M], I can barely function
041043 - due to onerous side effects of Gemzar treating cancer spread
041044 - due to mistakes at UCSF, and from breathing problems also
041045 - caused by radiation injury at UCSF. I cannot hike one lap at
041046 - Lafayette. I can barely walk from the parking lot to meet with
041047 - you today at Kaiser due to side effects of Gemzar.
041049 - [On 091112 0930 medical chart incorrectly reports "energy
041050 - level stable still able to walk Lafayette reservoir,"
041051 - ref SDS 15 RT94, conflicts with letter submitting agenda
041052 - for the meeting, ref SDS 0 L65W, and which was read to
041053 - start the meeting. ref SDS 15 4W8K
041055 - ..
041056 - 10. At all times, I have tried to be a good partner. However, at
041057 - no time have I waived my right to recover damages from Kaiser
041058 - and UCSF for failure to recover from medical mistakes at UCSF
041059 - on referral from Kaiser. My claim has been filed and forwarded
041060 - to Paula pending performance by the medical team. I realize
041061 - that treating a stage V cancer patient presents challenges. I
041062 - will continue to work constructively to assist the team in
041063 - mitigating damages, which primarily entails finding another
041064 - "cetuximab" solution for extending my life in a manner that is
041065 - worth living.
041067 - [On 091112 1412 notified Paula in Kaiser's Claims
041068 - Resolution Department to process Millie's claim for
041069 - recovery from medical mistakes getting radiation
041070 - treatment from UCSF on referral from Kaiser, ref SDS 16
041071 - KJ6F; Paula indicated that Kaiser refuses to demand
041072 - performance from UCSF, and to charge UCSF for necessary
041073 - and reasonable costs of Millie's recovery, because
041074 - Kaiser has a good business relationship with UCSF, and
041075 - Kaiser fears that holding UCSF accountable for medical
041076 - mistakes would harm Kaiser's good business relationship.
041077 - ref SDS 16 A593
041079 - ..
041080 - [On 100528 0322 Millie requested Medicare support for
041081 - quality care, and conformance with entitlement to
041082 - recover from medical mistakes getting radiation treation
041083 - on referral from Kaiser, ref SDS 17 QQ6N; asked Medicare
041084 - to hold Kaiser accountable for Millie's care because
041085 - desire to have good business relationship with UCSF does
041086 - not excuse failure to provide effective care.
041087 - ref SDS 17 QZ5U
041089 - ..
041090 - 11. I fully appreciate we may fail to find another "cetuximab"
041091 - solution. I only ask for reasonable efforts to try, to
041092 - investigate, to review and determine my next treatment based on
041093 - best evidence [of "trade-offs" as discussed during the prior
041094 - meeting and confirmed in my letter later that day on 090725
041095 - 2017, ref SDS 11 T58U].
041097 - ..
041098 - 12. You further indicated [during the meeting at Kaiser] on 091027
041099 - that since my cancer marker CA 15-3 299 dropped about 50
041100 - points, this indicated my condition remained "stable", and so
041101 - it was not necessary to switch immediately to another
041102 - treatment. ref SDS 14 DR6M You scheduled follow up today to
041103 - consider if we can reasonably squeeze another cycle of Gemzar
041104 - or must change treatments in order for me to survive.
041106 - ..
041107 - 13. I believe there has been a subsequent CA 15-3 299 reading for
041108 - last week, which may suggest "stability" that justifies another
041109 - cycle with Gemzar, or it could indicate this is the end of
041110 - Gemzar effectiveness, and we must immediately change
041111 - treatments. The meeting today can verify the record to
041112 - accurately assess this issue, as much as possible.
041114 - ..
041115 - 14. Today, we need to review the 20 or so treatments submitted
041116 - previously to the team, including Doctor Rugo's PARP treatments
041117 - discussed on 090616. ref SDS 7 KD6L
041119 - [On 091112 0930 Kaiser's medical chart, which was not
041120 - received until months later, ref SDS 15 655J, represents
041121 - incorectly that the doctor presented potential risks (side
041122 - effects and complications) and benefits of the recommended
041123 - and alternative oncologic treatment(s). I have answered
041124 - the patient's questions. I believe the patient is
041125 - competent and can understand the recommendations that I
041126 - have made. The patient agrees with these recommendations -
041127 - none of this occurred - the doctor prescribed Abraxane for
041128 - Millie's next relapse, and did not compare trade-offs with
041129 - other oncology treatments, ref SDS 15 PUGK, contrary the
041130 - request in Millie's letter today transmitting the agend,
041131 - per above, ref SDS 0 LE3R, and further requested also
041132 - above. ref SDS 0 L64X