CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 28 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 091027 Millie and Pam met with Doctor Johnson in the Oncology
040902 - Department at Kaiser in Walnut Creek. ref SDS 28 GN5I
040903 -
040904 -
040905 -
040907 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - The doctor was about 20 minutes late, after completing examination
041302 - and consultation for another patient.
041304 - ..
041305 - Doctor Johnson advised that he did not have enough time to review the
041306 - letter with the agenda for the meeting this morning, and which was
041307 - submitted earlier today on 091112 0752. ref SDS 29 IL8L He therefore
041308 - left the examination room, and returned to his office to read the
041309 - letter.
041311 - ..
041312 - About 20 minutes later, the doctor returned to the examination room.
041314 - ..
041315 - Doctor Johnson commented that Millie's medical care at Kaiser and UCSF
041316 - benefits from thorough case management, illustrated by the letter
041317 - submitted through email to the medical team this morning, and which
041318 - analyses all communications for alignment with the record of
041319 - objectives, requirements, and commitments, reported on 091112 0752.
041320 - ref SDS 29 IL8L
041321 -
041322 - [...below, after being unable to find an email which the doctor
041323 - recalled showed Doctor Rugo approves Kaiser treating Millie
041324 - with chemotherapy, and which conflicts with Millie's patient
041325 - profile, Doctor Johnson relates being told today that HIPAA
041326 - regulations deny patients access to communications on their
041327 - health care, and which as well is in fact the opposite of the
041328 - Federal rule which grants patients access. ref SDS 0 QN5G
041330 - ..
041331 - Previously, on 090213 Doctor Johnson advised that other patients do
041332 - not have this support, which has enabled Millie to exceed survival for
041333 - disease trajectory. This aligns with Doctor Rugo's comment that
041334 - Millie's records on patient history provide comprehensive case
041335 - management that supports Doctor Rugo's personal practice for tracking
041336 - critical details carefully, reported on 090514 0830. ref SDS 17 LS5M
041338 - ..
041339 - During the meeting, Doctor Johnson sent a letter, using Kaiser's
041340 - internal Knowledge Management email system, to Paula Vannicola, who
041341 - manages the Chemotherapy Infusion Clinic. The doctor's letter today
041342 - prescribes using Millie's Power Port with 1" high strength Lifeguard
041343 - Huber needles to perform blood draws and chemotherapy treatments as
041344 - standard of care for Millie's patient profile to recover from cancer.
041345 - Using the Power Port avoids the high risk of complications from
041346 - conventional needle penetrations that compound cancer and lymphedema
041347 - which now infect both of Millie's arms, and further avoids pain and
041348 - suffering which Millie and the nurses experience from difficulty
041349 - locating a vein that requires multiple penetrations, because Millie's
041350 - veins in the arms have been scarred by excessive needle penetrations
041351 - for prior care, reported on
041353 - ..
041354 - The doctor's letter to Paula implements the agenda for the meeting
041355 - today, which was listed in Millie's letter to the medical team earlier
041356 - this morning on 091112. ref SDS 29 IL8L
041357 -
041358 - [On 100104 1216 Chemotherapy Infusion Clinic at Kaiser in
041359 - Walnut Creek refused to perform emergency blood draw ordered by
041360 - Doctor Zhang to evaluate diagnosis of severe shingles,
041361 - ref SDS 33 4W56, and using Millie's Power Port with a 1" Huber
041362 - needle to prevent trauma from needle penetrations into Millie's
041363 - arms infected with IBC and lymphedema, ordered by Doctor
041364 - Johnson during the meeting at Kaiser on 091112 0930,
041365 - ref SDS 0 UN8F; as a result, blood draw was performed in the
041366 - Lab with conventional needle penetration contrary to the
041367 - doctor's order. ref SDS 33 4Q40
041369 - ..
041370 - [On 100119 0830 Mary Beth in the Infusion Clinic at Kaiser in
041371 - Martinez, CA reported a new policy to avoid using port catheter
041372 - technology for blood draws because some may patients may have a
041373 - small risk of complications caused by using Heperin to maintain
041374 - the port catheter, ref SDS 35 X56L; Millie cited the record of
041375 - having zero (0) risk since she never suffered complications
041376 - from the medical team using Heperin to maintain her Power Port
041377 - for hundreds of procedures over an 8-year period, and further
041378 - explained Doctor Johnson's order for Kaiser to use Millie's
041379 - Power Port for blood draws and infusion procedures in order to
041380 - avoid the high risk of compounding Millie's cancer and
041381 - lymphedema which now infect both arms, ref SDS 35 QR72; as a
041382 - result, Kaiser's Infusion Clinic in Martinez used Millie's
041383 - Power Port to perform blood draws to minimize the risk of
041384 - complications. ref SDS 35 QR8G
041386 - ..
041387 - [On 100203 1410 Arlette called and advised she received
041388 - Millie's letter notifying the medical team that Gloria ordered
041389 - an interim blood draw to test INR on Friday, 100205, and in
041390 - order to make timely adjustment to Millie's Coumadin
041391 - prescription on Friday to reduce the risk of pulmonary
041392 - embolism, ref SDS 36 QJ85; Arlette reported that Chemotherapy
041393 - Infusion Clinic in Walnut Creek refuses to perform the doctor's
041394 - order to use Millie's Power Port for blood draws, because of
041395 - new general policy to reduce the risk of complications which
041396 - some patients have from using Heperin to maintain port
041397 - catheters. ref SDS 36 124J
041399 - ..
041400 - [On 100204 1325 Millie's letter to the medical team asks
041401 - the primary care physician to enter in Millie's medical
041402 - chart and notify the Chemotherapy Infusion Clinic that
041403 - Millie's patient profile requires drawing blood from
041404 - Millie's Power Port rather than use IV needle penetration
041405 - balancing very low risks of Heprin contamination in the
041406 - Power Port which has never occurred in Millie's case over 8
041407 - years, against lymphedema recently diagnosed in the right
041408 - arm which, has prevented IV needle penetrations in the left
041409 - arm for 8 years. ref SDS 37 SB6S
041411 - ..
041412 - [On 100205 0938 Doctor Johnson did not have time to align
041413 - Kaiser practices for Millie's blood draws, with Millie's
041414 - patient profile, so Millie was forced to get the blood draw
041415 - with an IV in her right arm despite rising IBC and lymphedema;
041416 - fortunately, the lab was successful on the first needle
041417 - penetration, ref SDS 38 IS6R, and the lab reported the test
041418 - shows INR 3.2, significant improvement after pausing Coumadin
041419 - for 2 days; Millie asks Gloria for guidance from Coagulation
041420 - Control Clinic on adjusting Coumadin medicattion. ref SDS 38
041421 - IS7Q
041423 - ..
041424 - [On 100427 0830 Doctor Johnson entered in medical chart
041425 - another order for blood draws to be performed using only
041426 - Millie's Power Port because both arms are infected with
041427 - cancer, and needle punctures cause cancer to spread.
041428 - ref SDS 42 X74Q
041430 - ..
041431 - [On 100529 0930 blood draw went smoothly correcting past
041432 - problems, because nurse relied on instructions in
041433 - medical chart on 100427, directing use of Millie's Power
041434 - Port for blood draws, ref SDS 42 X74Q, and restating
041435 - directions in the doctor's letter to the Kaiser Walnut
041436 - Creek Infusion Clinic on 091112, ref SDS 30 UN8F, and so
041437 - in Millie's case overrules the new policy change a few
041438 - months ago that prevented nurses from drawing blood
041439 - using Millie's port, thereby forcing Millie to get blood
041440 - drawn from her arms infected with cancer, causing her
041441 - cancer to spread, e.g., on 100104, ref SDS 33 4Q30, and
041442 - which conflicted with the doctor's order to avoid blood
041443 - draws and blood pressure procedures on Millie's arms
041444 - infected with cancer. ref SDS 44 SK8M
041446 - ..
041447 - Doctor Johnson said that even though he is Millie's primary care
041448 - physician, he cannot direct the work to implement orders for Millie's
041449 - care at Kaiser, by asking the Radiology Department to prepare a
041450 - protocol for using Huber needles to inject contrast medium for CT
041451 - tests, because he does not have political standing as a member of a
041452 - different department, i.e., he works in Oncology. The doctor related
041453 - having talked informally to Doctor Davidson, former Chief of Radiology
041454 - about this issue. He feels that Doctor Davidson is "on Millie's side"
041455 - with respect to publishing a protocol to avoid more mistakes, but
041456 - further feels that assisting the new Chief, Doctor Mates, would
041457 - undermine relations between Oncology and the Radiology Department, and
041458 - be regarded as "interference," rather than alerting Doctor Mates with
041459 - timely notice of critical requirements for Millie's care.
041461 - ..
041462 - Doctor Johnson summarized the feeling by recalling that, when he was
041463 - Chief of Oncology for Kaiser's Diablo Service Region, he did not want
041464 - interference from outsiders telling him how to run his Department. He
041465 - feels human nature resists improvement to save lives, time, and money.
041467 - ..
041468 - This reminds of the line in the 1992 movie, "A Few Good Men." The
041469 - Comanding Officer at the Marine base in Guantanamo, Cuba objected to
041470 - "interference" from Navy headquarters ordering all commanders to end
041471 - the practice of "code red" extrajudicial punishment for perceived
041472 - minor offenses. The commander at Guantanamo Bay said (in the
041473 - movie)...
041474 - ..
041475 - I run my unit how I run my unit!
041477 - ..
041478 - Avoiding conflict in bureaucracy, rather than notify people to perform
041479 - requirements in time to be effective saving lives, time, and money was
041480 - reported at the VA on 060505 0830. ref SDS 2 P58H
041482 - ..
041483 - Deferring to bureaucratic perogatives are helpful to maintain friendly
041484 - relations, but should not deny Millie the benefit of her bargain for
041485 - the primary care physician to direct the work for her care. Referral
041486 - orders must be implemented with deferrance to doctor discretion.
041487 - Where a conflict is preceived with local policy, then the doctor
041488 - should be notified for verification that the local policy was intended
041489 - to be set aside.
041491 - ..
041492 - Doctor Johnson examined Millie.
041494 - ..
041495 - He advised that examination shows progression of IBC as reported in
041496 - Millie's letter to the medical team on 091019, ref SDS 26 0Z9S, and
041497 - discussed during the meeting at Kaiser the following week on 091027.
041498 - ref SDS 28 DR6M
041500 - ..
041501 - Bad news is new, strong evident IBC lesions on the right breast and
041502 - upper chest. Until now, and for the past 4 years, Millie's right
041503 - breast only had a very small area of skin infected from time to time
041504 - with IBC rash, extending about .5 inches from intense IBC in the
041505 - breastbone area onto the right breast. This was originally observed
041506 - on 061204, ref SDS 4 I93X, and has never progressed until now due to
041507 - rising cancer in Millie's breastbone that was untreated for 6 months
041508 - because of medical mistakes getting radiation treatments at UCSF on
041509 - referral from Kaiesr, reported by Doctor Hsu on 090609. ref SDS 19
041510 - W65W
041511 - [...below, medical chart reports cancer spread to righ side.
041512 - ref SDS 0 EZ4R
041514 - ..
041515 - [On 091203 1017 Millie's letter confirms progression of IBC
041516 - onto the entire right side, caused by untreated cancer in the
041517 - breastbone area due medical mistakes getting radiation from
041518 - UCSF. ref SDS 32 A98Y
041520 - ..
041521 - Doctor Johnson further advised that he and Doctor Rugo have not had
041522 - time to review treatments for Millie submitted to the medical team on
041523 - 090326 0058. ref SDS 14 DW5S, and cited again for reminder in a follow
041524 - up letter later that morning on 090326 0947, ref SDS 15 QM3V, similar
041525 - to Doctor Rugo's report on 090716 submitted by Tara Lacey at that time
041526 - on 090716. As a result, the only treatment Doctor Johnson can
041527 - prescribe today is Navelbine, which he previously reported on 090515,
041528 - would not likely be effective for Millie's patient profile.
041529 -
041530 - [...below the doctor recalls there has been collaboration with
041531 - UCSF through email correspondence, and that Doctor Rugo
041532 - approves Kaiser treating Millie with chemotherapy. ref SDS 0
041533 - QN5G; today, the doctor cannot find a record of any
041534 - correspondence with Doctor Rugo on Millie's care. ref SDS 0
041535 - LQ5N
041537 - ..
041538 - The doctor orders Navelbine treatment to start with the next cycle on
041539 - 091118.
041541 - ..
041542 - Doctor Johnson advised that Navelbine treatments are every week for 4
041543 - weeks, then start a new 4 week cycle. The patient does not get a week
041544 - of rest between cycles.
041545 -
041546 - [On 091118 0730 Barbara the nurse for Millie's 1st
041547 - treatment of the 1st cycle with Navelbine clarified that
041548 - cycles are only for 3 weeks with Navelbine, and then the
041549 - patient has a week of rest. ref SDS 31 6263
041551 - ..
041552 - Doctor Johnson today said that, if Doctor Rugo suffers further delays
041553 - starting Millie on PARP for "targeted" treatemnt planned on 090616,
041554 - and confirmed in the letter on 090716, ref SDS 22 EE5W, then Kaiser
041555 - will provide chemotherapy treatments until PARP is ready at UCSF for
041556 - Millie's 10th relapse, after Navelbine, and with...
041557 -
041558 - a. Abraxane
041559 - b. Ixempra
041560 -
041561 - [...below, medical chart lists Abraxane and Ixempra for
041562 - consideration in Doctor Johnson's work plan. ref SDS 0
041563 - RV60
041565 - ..
041566 - Ixempra was not discussed during the meeting today. After the
041567 - meeting, research shows...
041568 -
041569 - Medical News Today
041570 -
041571 - Breast Cancer News
041573 - ..
041574 - Significant Improvement In Progression-Free Survival For
041575 - Triple Negative Metastatic Breast Cancer Patients Treated
041576 - With IXEMPRAT Plus Capecitabi
041577 -
041578 - http://www.medicalnewstoday.com/articles/133039.php
041580 - ..
041581 - Article Date: 15 Dec 2008 - 4:00 PDT
041583 - ..
041584 - Bristol-Myers Squibb Company (NYSE:BMY) today announced new
041585 - data from studies of IXEMPRAT (ixabepilone) plus
041586 - capecitabine compared to capectabine alone, including a
041587 - pre-specified sub set analysis demonstrating a significant
041588 - increase in progression free survival (PFS) in patients
041589 - with triple negative breast cancer.
041591 - ..
041592 - The study results - which are from a pooled analysis of
041593 - approximately 2,000 patients enrolled in two Phase III
041594 - clinical trials of IXEMPRA (046 and 048) - were presented
041595 - today at the 2008 San Antonio Breast Cancer Symposium
041596 - (SABCS). Patients studied were either resistant to or
041597 - pretreated with anthracyclines and taxanes. In the pooled
041598 - analysis of the subset of 443 patients with triple
041599 - negative breast cancer, data show that IXEMPRA plus
041600 - capecitabine (n = 191 patients) is the first combination
041601 - regimen to demonstrate statistically significant
041602 - (p<0.0001) PFS compared to capecitabine (n = 208 patients)
041603 - alone.
041604 -
041605 - "Patients with advanced, triple negative breast cancer
041606 - have limited treatment options and a poor prognosis," said
041607 - Hope S. Rugo, M.D., Clinical Professor of Medicine and
041608 - Director, Breast Oncology Clinical Trials Program,
041609 - University of California San Francisco Helen Diller Family
041610 - Comprehensive Cancer Center. "For this reason, it is
041611 - important to explore the potential of other current and
041612 - developmental therapies to discover more and effective
041613 - treatment options for patients with this specific type of
041614 - breast cancer."
041616 - ..
041617 - Abraxane was presented during the meeting based on treatments listed
041618 - in the record on 090121. ref SDS 10 EV53 Previously, Kaiser maintained
041619 - they had no additional treatments for Millie, and so Millie should ask
041620 - Doctor Rugo to do the research to identify agents for treating
041621 - Millie's cancer as a chronic disease, see case study on 090213.
041622 - ref SDS 11 PT3N
041624 - ..
041625 - UCSF 2nd opinion received on 060929 lists Abraxane with lapitinib,
041626 - ref SDS 3 UI9K, but also says that Millie is not likely to benefit
041627 - from Abraxane, because of prior treatment with taxanes. ref SDS 3
041628 - SX3J
041629 -
041630 - [On 100218 1000 Doctor Johnson disgnosed relapse with
041631 - Navelbine, and prescribed Abraxane for 10th relapse.
041632 - ref SDS 39 MD4H
041634 - ..
041635 - [On 100303 0730 Millie at Kaiser for 1st treatment of 1st
041636 - cycle with Abraxane to recover from 10th relapse of cancer.
041637 - ref SDS 41 625I
041639 - ..
041640 - [On 100501 1037 Millie notifies the medical team that
041641 - treatment with Abraxane seems to have failed after 2
041642 - cycles. ref SDS 43 U44U
041644 - ..
041645 - Doctor Johnson seemed to indicate today that Abraxane is a stronger
041646 - form of Carboplatin chemotherapy, which Millie received with cetuximab
041647 - at UCSF during 2008, and beginning on 080313, ref SDS 8 TZ8I, and
041648 - which would therefore seem to preclude using again, following
041649 - progression and ending treatment with Carboplatin on 081016.
041650 - ref SDS 9 J34U
041652 - ..
041653 - After the meeting research indicates Abraxane is prescribed to treat
041654 - patients in combination with Carboplatin; typical reporting shows...
041655 -
041656 - CancerConsultants.com
041657 -
041658 - Developments in the Treatment of Non-Small Cell Lung
041659 - Cancer with Abraxane
041661 - ..
041662 - http://professional.cancerconsultants.com/conferencecoverage.aspx?id=38966
041664 - ..
041665 - Chandra Belani, MD, Co-Director, Lung and Thoracic
041666 - Malignancies Program, University of Pittsburgh Cancer
041667 - Institute
041669 - ..
041670 - Date: November 5-9, 2006
041671 - Location: New York, New York
041672 - Author: Chandra Belani, MD, Co-Director, Lung and Thoracic
041673 - Malignancies Program, University of Pittsburgh Cancer
041674 - Institute
041676 - ..
041677 - Combination Regimens
041679 - ..
041680 - Encouraged with the single agent activity of Abraxane, the
041681 - combination with carboplatin was then evaluated in NSCLC.
041682 - The efficacy of the combination of Abraxane and carboplatin
041683 - appears to be comparable to that reported for solvent-based
041684 - paclitaxel and carboplatin in patients with advanced
041685 - NSCLC.[8]
041687 - ..
041688 - Research indicates that Abraxane is is a stronger form of Taxol
041689 - chemotherapy...
041690 -
041691 - Paclitaxel
041692 -
041693 - From Wikipedia, the free encyclopedia
041695 - ..
041696 - http://en.wikipedia.org/wiki/Paclitaxel
041698 - ..
041699 - A newer formulation, in which paclitaxel [Taxol] is bound
041700 - to albumin, is sold under the trademark Abraxane.
041702 - ..
041703 - Millie also received Taxol previously with bevacizumab (Avastin) at
041704 - Kaiser to treat the first relapse of cancer, diagnosed as secondary
041705 - IBC, and beginning on 040420. ref SDS 1 9Z5J Millie had good success
041706 - with another taxane, Taxotere, except on the 3rd relapse her cancer
041707 - progressed and this treatment was ended, reported on 061208.
041708 - ref SDS 5 3B4N
041710 - ..
041711 - Doctor Johnson has previously reported chemotherapy is not effective
041712 - for Millie's patient profile, because Millie's cancer has mutated to
041713 - resist chemotherapy - see again case study on 090213. ref SDS 11 PT3N
041715 - ..
041716 - Doctor Johnson did not discuss the UCSF 2nd opinion prepared by Doctor
041717 - Benz, and received in the record on 060929, and which says in part...
041719 - ..
041720 - He feels today, that since the medical team has not had time to review
041721 - treatments targeted to Millie's cancer, then doctor discretion can
041722 - prescibe Abraxane for medical necessity, i.e., Abraxane is the best
041723 - treatment available at the moment, becasue nobody has had enough time
041724 - to compare trade-offs for the list of targeted treatments submitted to
041725 - the medical team on 090326. ref SDS 14 DW5S
041726 -
041727 - [...below CT test on 090919, shows no pulmonary embolism,
041728 - which indicates ending Millie's treatment with MPA, may not
041729 - have been necessary, and so resuming treatment may expand
041730 - her treatment options. ref SDS 0 RU68
041732 - ..
041733 - [On 100108 1618 UCSF notifies Kaiser that Millie cannot get
041734 - treatment for cancer with PARP that includes a protocol for
041735 - Carboplatin, because Millie's was previously treated with
041736 - Carboplatin chemotherapy, and UCSF fails to compare
041737 - trade-offs exercising discretion balancing Millie's medical
041738 - necessity for life-saving treatment with PARP, which UCSF
041739 - and Kaiser indicated on 090616 was the best choice for
041740 - Millie to recover from life-threatening medical mistakes
041741 - made by UCSF. ref SDS 34 FM5I
041743 - ..
041744 - Millie has had severe problems holding blood counts with chemotherapy
041745 - getting Taxotere, Taxol, capeticabine, Carboplatin. In 2008, UCSF
041746 - exercised discretion for medical necessity ordering Millie to miss
041747 - treatments, and the dose was ultimately reduced (evidently in error).
041748 - This combination of missing and reduced treatment dose caused Millie
041749 - to suffer progression with 5th relapse of cancer reported on 081016
041750 - 2342. ref SDS 9 J34U
041752 - ..
041753 - There is a question that if Abraxane is stronger form of chemotherapy
041754 - that caused reduced blood counts that prevented getting regular
041755 - treatments, will this occur with Abraxane as well?
041757 - ..
041758 - Doctor Johnson advised that he has collaborated with Doctor Rugo on
041759 - finding Millie's next treatment to mitigate damages caused by medical
041760 - mistakes UCSF made. Doctor Johnson related today that communication
041761 - with Doctor Rugo has occurred through email rather than telephone
041762 - calls, and that Doctor Rugo approves Kaiser treating Millie with
041763 - Navelbine and then Abraxane, discussed above, ref SDS 0 KB4F, if
041764 - necessary, and because Doctor Rugo has reported to Kaiser that
041765 - "targeted" treatment with PARP is still not ready for Millie at UCSF.
041767 - ..
041768 - This seems to clarify and revise initial understandings starting the
041769 - meeting, per above, ref SDS 0 A94I, aligns in part with the meeting at
041770 - Kaiser on 090909, when Doctor Johnson was worried that Millie's cancer
041771 - was worse, and she needed to change treatments. At that time, the
041772 - doctor reported his schedule had finally cleared after 6 months, so he
041773 - had time to collaborate with Doctor Rugo at UCSF on providing standard
041774 - of care comparing trade-offs on results and costs for the 20 or so
041775 - treatments submitted to the medical team, ref SDS 24 VF60, with
041776 - Millie's letter on 090326. ref SDS 14 DW5S
041778 - ..
041779 - Doctor Johnson was asked during the meeting today for a copy the
041780 - letter sent with email showing UCSF ordering or agreeing on Kaiser
041781 - treating Millie with Navelbine, pending starting treatment with PARP,
041782 - and for all other communications in email and otherwise with Doctor
041783 - Rugo and UCSF on Millie's case.
041785 - ..
041786 - The doctor left the meeting to check the files in his personal office
041787 - down the hall.
041789 - ..
041790 - Doctor Johnson returned about 15 minutes later, and said he cannot
041791 - find any communication with Doctor Rugo on Millie's case in Kaiser's
041792 - records. Sounded like he mainly checked email program on his office
041793 - computer. Aligns with initial understanding starting the meeting that
041794 - Kaiser and UCSF have not done anything to plan Millie's care with
041795 - targeted treatments, per above. ref SDS 0 A94I
041797 - ..
041798 - [On 091203 1017 Millie confirmed in a letter to the medical
041799 - team that Kaiser and UCSF owe a duty to provide standard of
041800 - care to evaluate treatments targeted to Millie's patient
041801 - profile, based on represnetation of intent to collaborate
041802 - through email on Millie's care, ref SDS 32 A99R, and Doctor
041803 - Johnson was unable to fined evidence of email showing
041804 - performance of collaboration and coordiantion between
041805 - Kaiser and UCSF. ref SDS 32 A99U
041807 - ..
041808 - Doctor Johnson further said that he was just told (didn't say by whom
041809 - -- a colleague, the boss, nurse, someone in the business office, Chief
041810 - of Oncology??) that HIPAA prohibits distribution of communications on
041811 - Millie's health care to Millie. He feels Kaiser and UCSF therefore
041812 - need not spend time submitting communications to Millie that pertain
041813 - to her care.
041815 - ..
041816 - The medical team has distributed communications the past 8 years, with
041817 - Millie facilitating collaboration between Kaiser and UCSF to
041818 - coordinate case management.
041820 - ..
041821 - Discussed review on 071009, showing HIPAA entitles patients to any
041822 - and all communications among health care provides, doctors, nurses,
041823 - administrators, managers, accountants, etc., that pertains to patient
041824 - care. ref SDS 7 TG3K Patient access to health records, including
041825 - communications among providers pertaining to patient care provides
041826 - transparency that encourages timely, accurate work that prevents small
041827 - mistakes from escalating into major catastrophies.
041829 - ..
041830 - Doctor Johnson reported this morning that Millie benefits with
041831 - extended survival and quality of life from Millie's access to
041832 - communications that enables effective support for case management,
041833 - citing Millie's letter today submitting the agenda for this meeting,
041834 - per above. ref SDS 0 4W8K
041836 - ..
041837 - This is the 3rd major correspondence affecting Millie's care that is
041838 - reported to have occurred, and cannot be produced, and was witheld
041839 - from Millie.
041841 - ..
041842 - Previously, on 090616, Doctor Rugo cited agreement between Kaiser and
041843 - UCSF in an email, and to treat Millie's cancer as a chronic disease
041844 - initially with MPA, and then with PARP. ref SDS 20 KD6L At that time,
041845 - Doctor Rugo said the letter could not be given to Millie, because it
041846 - also pertained to other patients. On 090716, Tara said Doctor Rugo
041847 - sent a letter to Doctor Johnson with email that amended the agreement
041848 - on 090616, to treat Millie with Gemzar until PARP was ready in
041849 - September. ref SDS 22 EE5W Millie has asked for the 090716 letter
041850 - numerous times, and it has never been produced.
041851 -
041852 -
041853 -
041854 -
0419 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Chart Received Weeks Later
050403 -
050404 - Doctor Johnson distributed the medical chart for the meeting today at
050405 - Kaiser, however, it was not received until weeks later due to a
050406 - combination of problems with Kaiser's electronic business system being
050407 - of -line and denying access at varous times, and that Rod was
050408 - recuperating from heart surgery on 091022. ref SDS 27 PQWU After
050409 - release from the hospital on 091104, support for case management on
050410 - Millie's care was slowed.
050412 - ..
050413 - [On 100301 0005 Millie's letter notified the medical team
050414 - that Doctor Johnson's medical chart for the meeting today
050415 - on 090912 was reviewed, and shows critical errors reporting
050416 - that during this meeting the doctor disucssed potential
050417 - risks (side effects and complications) and benefits of
050418 - recommended alternative oncologic treatment(s), and
050419 - answered the patient's question, and that the patient is
050420 - competent to understand recommendations, and agrees with
050421 - recommendations, in that this discussion did not occur, and
050422 - Millie asked Kaiser to submit what recommendations were
050423 - presented, what side effect risks and complications were
050424 - presented, and what questions were asked and what answeres
050425 - were given. ref SDS 40 OO9S
050427 - ..
050428 - Subject: Visit 11/12/09
050429 - Received: 11/12/09 11:00 AM
050430 - To: Mildred A Buck
050431 - From: ROBERT ALLSTON JOHNSON MD
050433 - ..
050434 - Patient presents with: RECHECK
050436 - ..
050437 - History of Present Illness:
050439 - ..
050440 - Mildred A Buck is a 73 Y female with a history of IBC of left
050441 - breast who was initially diagnosed 03/04/02. S/P AC x's 4 from
050442 - 04/23/02 through 07/01/02 followed by Taxotere ending 12/04/02.
050443 - She had recurrent disease noted initially in the cervical LN's
050444 - 03/03/04. On E2100 Study with Taxol/Avastin, but she had a PE
050445 - noted on CT 11/03/2004. Then, because of progression of
050446 - disease, the patient was started on Taxotere and Xeloda
050447 - 4/15/05. She had a total of 8 cycles ending 9/16/05. She had
050448 - a palliative left mastectomy performed 10/21/05. Then her left
050449 - chest lesions began expanding again. The patient started
050450 - Taxotere and Xeloda again 07/21/06 for 7 cycles. She was
050451 - started on a Clinical Trial 02/01/07 at UCSF and was randomized
050452 - to the Erbitux only (no Carbo) Arm. She had weekly Carboplatin
050453 - added 03/13/08 because of progression of disease. Her disease
050454 - progressed again and she began a Phase I/II Study of Sunitinib
050455 - (SU11248) at UCSF 11/14/08. Lengthy discussion about current
050456 - status and response to therapy. Because of cytopenia, MTX to be
050457 - D/C'd and Sutent and CTX held and then dose reduced. The
050458 - patient started hyperthermia/XRT at UCSF 02/19/09 and completed
050459 - it 03/17/09. She has started the MPA Clinical Trial at UCSF
050460 - 06/16/09 but this has been D/C'd.
050462 - ..
050463 - She started Gemzar 07/28/09 and started Cycle #4 11/05/09. She
050464 - is here for FU. She is concerned that there is continued
050465 - evidence of progression.
050467 - ..
050468 - Current medications:
050470 - ..
050471 - HYDROCODONE/ACETAMINOPH 5-5
050472 - WARFARIN 4 MG TABLETS
050473 - LUMIGAN 0.03% EYE DROPS (2.
050474 - TIMOLOL MALEATE 0.5% EYE DR
050475 - OXYCODONE W/APAP 5-325 MG T
050476 - AEROCHAMBER Z-STAT/PLUS W/O
050477 - QVAR 80 MCG ORAL INHALER
050478 - ALBUTEROL HFA 90MCG ORAL IN
050479 - GUAIFEN/CODEIN 100-10MG/5ML
050480 - LORAZEPAM 1 MG TABLETS
050482 - ..
050483 - Review of systems:
050485 - ..
050486 - Constitutional: Appetite and energy level are stable still
050487 - able to walk Lafayette Reservoir.
050489 - ..
050490 - This report is incorret, and ignores reporting since April, that
050491 - Millie cannot walk a lap at Lafayette, and can barely walk from the
050492 - parking lot to the store. Millie's letter this morning submitting the
050493 - agenda for the meeting, and which Doctor Johnson took 20 minutes to
050494 - read prior the the meeting, ref SDS 0 4W8K, states that Millie can
050495 - barely function; she cannot hike even 1 lap (3 miles) at Lafayette
050496 - reservoir, and can barely walk from the paring lot into the hospital
050497 - for meeting with the doctor. reporting on 091112 0752. ref SDS 29 L65W
050499 - ..
050500 - [...below representation that the doctor performed standard
050501 - of care comparing trade-offs of oncology treatments also
050502 - did not occur, and conflicts with the record. ref SDS 0
050503 - M86O
050505 - ..
050506 - Medical Chart Review of Systems continues...
050507 -
050508 - Eyes: Vision is OK.
050509 - ENT: No nose bleeds.
050510 - Cardiovascular: No SOB, palpitations or chest pain
050511 - Respiratory: No hemoptysis or cough. Some DOE noted
050512 - GI: Diarrhea resolved
050513 - GU: No hematuria or dysuria
050515 - ..
050516 - Musculoskeletal: Left neck spasm and right shoulder pain
050517 - improved with Robaxin
050519 - ..
050520 - Skin: Pruritis of chest wall
050521 - Neurological: No confusion, sensory changes or motor weakness
050522 - Psychiatric: Anxious
050524 - ..
050525 - Physical Exam:
050526 - ECOG Performance Score 0
050527 - BP 126/74 | Pulse 75 | Temp (Src) 98.2 øF (36.8 øC) (Oral) |
050528 - Wt 143 lb (64.864
050529 - kg) | SpO2 93%
050530 - Head: alopecia
050531 - Eyes: normal conjunctiva
050532 - Mouth: normal mucosa
050533 - Lymph: no nodes palpable in neck, axillae or groin
050535 - ..
050536 - Breasts: evidence of progression of erythema to other breast
050538 - ..
050539 - Cancer spreading to right breast, actually the right side, per
050540 - examination above, ref SDS 0 8G6O, is major progression of Millie's
050541 - patient profile, since the right side has been mostly free of IBC for
050542 - 8 years.
050543 -
050544 - [On 091203 1017 Millie's letter confirms progression of
050545 - IBC onto the entire right side, caused by untreated
050546 - cancer in the breastbone area due medical mistakes
050547 - getting radiation from UCSF. ref SDS 32 A98Y
050549 - ..
050550 - Medical Chart Review of Systems continues...
050551 -
050552 - Lungs: clear to percussion and auscultation
050553 - Heart: regular without murmur or gallop
050554 - Abd: soft with normal bowel sounds. No masses or organomegaly
050555 - Ext: no edema
050556 - Skin: no rashes or palpable masses
050557 - Bones: no tenderness
050558 - Neuro: awake, alert, and oriented. Moves all extremities well. Normal gait.
050560 - ..
050561 - Lab:
050562 - WBC 9.4 K/uL
050563 - RBC L 2.90 M/uL
050564 - Hemoglobin L 8.9 g/dL
050565 - Hematocrit L 27.8 %
050566 - MCV 96 fL
050567 - RDW H 19.1 %
050568 - Plt 174 K/uL
050570 - ..
050571 - PT, Patient H 31.3 Sec
050572 - PT INR 3.0 Ratio
050574 - ..
050575 - CA 15-3
050576 - -----------
050577 - 299 H
050578 - 299 H
050579 - 343 H
050580 - 297 H
050581 - 302 H
050582 - 346 H
050583 - 335 H
050584 - 350 ?
050585 - 389 H
050587 - ..
050588 - PFT's 08/31/09
050589 - - No obstruction
050590 - - Good response to bronchodilators
050591 - - Moderate decrease in diffusion capacity
050593 - ..
050594 - Imaging:
050596 - ..
050597 - 09/19/09 CT THORAX W CONTRAST -
050599 - ..
050600 - No pulmonary emboli on a technically good study.
050602 - ..
050603 - This CT test was ordered for Millie's treatment in the Emergency Room
050604 - on 090919, and to treat painful breathing. ref SDS 25 DA6Q
050606 - ..
050607 - UCSF called on 090716, and ended Millie's treatment targeted to her
050608 - patient profile with MPA, because of concerns that MPA had caused
050609 - Millie to get another pulmonary embolism that is life threatening, and
050610 - based on Millie suffering compromised breathing, and MPA protocol
050611 - lists blood clots as a rare side effect, which can cause pulmonary
050612 - embolism which causes diminished breathing, heavy chest, cough.
050613 - ref SDS 22 EE6P
050615 - ..
050616 - This report finding no evidence of PE demonstrates that UCSF's reason
050617 - for ending Millie's treatment with MPA on 090716, may have been
050618 - premature, and further that Millie can be treated again with MPA, in
050619 - the same way Kaiser treated Millie with AC on 050104, and prior
050620 - treatment in July 2002, and similarly, Kaiser planning today to
050621 - prescribe Abraxane that is a stronger form of Taxol, shows resuming
050622 - prior discontinued treatments may be appropriate in some cases,
050623 - ref SDS 0 NA3O,
050625 - ..
050626 - Medical Chart report on CT test 090919 continues...
050627 -
050628 - The lungs show multiple areas of ground glass opacity and
050629 - multiple small areas of more confluent density. Tiny left
050630 - pleural effusion. S/P left mastectomy. A few additional minor
050631 - findings, as described above. Since July 20, 2009 CT scan of
050632 - the chest, there has been resolution of many of the pulmonary
050633 - opacities but there are now many new ones, especially in the
050634 - left lower lobe and in the right upper lobe. The left pleural
050635 - effusion is much smaller. Otherwise, no change.
050637 - ..
050638 - This report that some ground glass opacity nodules are resolved in
050639 - some areas, and new ones appear in other areas, aligns with Doctor
050640 - Hsu's report on 090312, that radiation continues to affect tissue,
050641 - enabling recovery for months after ending treatments. ref SDS 12 F860
050642 - Doctor Hsu repeated this prognosis again during a follow up meeting at
050643 - UCSF on 090423 0830. ref SDS 16 YN5N
050645 - ..
050646 - Doctor Mates, Chief Radiology at Kaiser in Walnut Creek, seemed to
050647 - indicate in a call on 090625, that ground glass opaciteis shown in
050648 - Millie's CT test at Kaiser on 090612, and which caused Millie severe
050649 - resperatory compromise, shown by treatment for painful breathing taht
050650 - required care in the Emergency Department on 090720, ref SDS 23 GE5H,
050651 - and again on 090919, ref SDS 25 L78M, Millie was hospitalized for a
050652 - week, might eventually resolve and heal without treatment. ref SDS 21
050653 - IJ4W
050655 - ..
050656 - Medical Chart Image Tests continues...
050658 - ..
050659 - 09/19/09 CHEST, SINGLE
050661 - ..
050662 - 07/31/09 RIBS, UNILATERAL, 2 VIEWS - Right ribs appear intact
050664 - ..
050665 - 07/20/09 CT THORAX W CONTRAST - 1. Negative for pulmonary embolus. 2. New
050666 - small left pleural effusion. No pleural enhancement or evidence of loculation.
050667 - 3. Otherwise stable chest CT compared with recent examination from one month
050668 - earlier.
050670 - ..
050671 - 06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
050673 - ..
050674 - 06/12/09 CT NECK W CONTRAST
050676 - ..
050677 - 03/17/09 DXA BONE DENSITY, AXIAL - 1. Bone mineral density calculated for the
050678 - LUMBAR SPINE is statistically consistent with osteopenia. 2. Bone mineral
050679 - density calculated for the TOTAL HIP is statistically consistent with
050680 - osteopenia.
050682 - ..
050683 - 01/29/09 SHOULDER, COMPLETE 2+ VIEWS
050685 - ..
050686 - 01/22/09 SHOULDER, COMPLETE 2+ VIEWS - Orthopedic follow up. See Orthopedic
050687 - note for details. S/P reduction of anterior shoulder dislocation.
050689 - ..
050690 - 01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder. Fracture right
050691 - humeral head
050693 - ..
050694 - 01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes of the cervical
050695 - spine without evidence of acute C spine fracture or loss in alignment.
050697 - ..
050698 - 01/22/09 CT HEAD W/O CONTRAST - 1. No evidence of acute infarct or hemorrhage.
050699 - 2. Sinus disease. Mild nasal septal deviation to the right.
050701 - ..
050702 - Assessment:
050703 -
050704 - 1. Metastatic breast cancer (IBC) lung, lymph node and chest
050705 - wall; progression?
050706 - 2. ACD
050707 - 3. DOE; due to radiation injury vs lymphangitic spread; stable
050708 - 4. Neck spasm resolved
050710 - ..
050711 - Plan:
050712 -
050713 - 1. D/C Gemzar because of progression
050714 - 2. Start Vinorelbine (Navelbine) 20 mg/m2 iv weekly
050716 - ..
050717 - 3. I have discussed the potential risks (side effects and
050718 - complications) and benefits of the recommended and
050719 - alternative oncologic treatment(s). I have answered the
050720 - patient's questions. I believe the patient is competent
050721 - and can understand the recommendations that I have made.
050722 - The patient agrees with these recommendations.
050724 - ..
050725 - This part of the medical chart sounds like the Legal Department asked
050726 - the doctor to add this language responding to Millie's continuing
050727 - request for standard of care comparing trade-offs to evaluate
050728 - treatments targeted to her patient profile, and asked again in
050729 - Millie's letter this morning submitting the agenda for the meeting.
050730 - ref SDS 29 L66S, and further requesting review of 20 or so treatments
050731 - submitted to the team and which have not been compared for trade-offs.
050732 - ref SDS 29 LE3R
050734 - ..
050735 - This representation of discussion, like erroneous representation that
050736 - Millie is still hiking laps at Lafayette reservoir, per above,
050737 - ref SDS 0 RT94, did not take place; Doctor Johnson said the only
050738 - treatments he has left at Kaiser are Abraxane and Ixempra; he
050739 - prescribed Abraxane and said it is a stronger form of Careboplatin;
050740 - nothing else was presented, and nothing was said about Ixempra. After
050741 - the meeting research indicates Abraxane may be another form of Taxol,
050742 - per above. ref SDS 0 KB4F
050744 - ..
050745 - Medical Chart Image Tests continues...
050746 -
050747 - 4. Neupogen as needed
050748 - 5. Continue serial CA 15-3's
050749 - 6. Continue Robaxin
050750 - 7. Consider ABRAXANE or IXEMPRA next
050751 - 8. RTC monthly prior to chemotherapy
050753 - ..
050756 -
050757 -
050758 -
050759 -
050760 -
050761 -
0508 -