THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net
S U M M A R Y
DIARY: January 13, 2010 12:48 PM Wednesday;
Rod Welch
Kaiser called to schedule MRI brain scan for Millie.
1...Summary/Objective
2...Case Study Problems Blood Draws CT Tests IV Needles and Power Port
..............
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CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Chris called to schedule test for brain cancer.
040902 -
040903 - She advised that Doctor Johnson changed the order from CT to an MRI
040904 - brain test to evaluate headaches Millie reported during the meeting at
040905 - Kaiser yesterday.
040907 - ..
040908 - Asks for Millie's height - 5'2" and weight - 136.
040910 - ..
040911 - Chris said that MRI tests do not require oral contrast medium.
040913 - ..
040914 - Schedule - 100119 1130
040916 - ..
040917 - Chris advised that patients check-in for MRI tests at the same counter
040918 - for check-in to get CT tests.
040920 - ..
040921 - Reviewed requirements for accessing Millie's Bard Power Port to
040922 - inject contrast medium.
040924 - ..
040925 - Chris will coordinate with IR to schedule a nurse to observe the test
040926 - on 100119. Chris will also coordinate to schedule Millie for port
040927 - access on 100119 1100.
040928 -
040929 - [On 100115 1509 Chris called and reported that the Radiology
040930 - Department in Walnut Creek has arranged with IR to support
040931 - Millie's MRI test on 100119 1120, and that the MRI Department
040932 - will use the Huber needle accessed earlier in the morning when
040933 - Millie gets a blood draw at Kaiser in Martinez. ref SDS 36 MO5I
040935 - ..
040936 - Reviewed challenges working with Radiology on coordinating with other
040937 - departments on saving time and money using Millie's Power Port, shown
040938 - in case study, shown below. ref SDS 0 9J6F
040940 - ..
040941 - Chris said she will personnally make sure everybody is prepared for
040942 - Millie to get a CT test using her Power Port.
040943 -
040944 -
040945 -
0410 -
SUBJECTS
CT Test Problems Power Port Huber Needle Save Time Money Prevent Pai
1603 -
160401 - ..
160402 - Case Study Problems Blood Draws CT Tests IV Needles and Power Port
160403 -
160404 -
160405 - 1. Kaiser having difficulty finding veins for
160406 - blood draws and chemotherapy infusion treatments;
160407 - Millie's right arm swollen, black and blue from
160408 - trauma caused by needle punctures; doctor
160409 - orders surgery to implant port
160410 - catheter that solves
160411 - problems.............................. 040318 1615, ref SDS 1 CO3G
160413 - ..
160414 - 2. IV needle punctures can only be safely set on
160415 - the right arm because Millie's cancer is on her
160416 - left side with complications of lymphedema and
160417 - Cellulitis; Kaiser avoids blood draws from legs
160418 - and other areas, so veins in the right arm are
160419 - now severely scarred which prevents enough
160420 - blood to flow for conventional IV's to
160421 - be effective therefore the
160422 - doctor ordered a port
160423 - catheter.............................. 040318 1615, ref SDS 1 OF7H
160425 - ..
160426 - 3. Doctor Riley-Paull surgically implants port
160427 - catheter in Millie's right uppoer chest for
160428 - blood draws and infusion procedures
160429 - that avoids difficulties from
160430 - performing IV needle
160431 - penetrations......................... 040419 0645, ref SDS 2 0001
160433 - ..
160434 - 4. Millie asks UCSF to schedule CT tests every
160435 - 12 weeks instead of 8 weeks, so that her right
160436 - arm has more time to heal from injuries caused
160437 - by multiple needle punctures needed to find
160438 - a vein with sufficient flow for injecting
160439 - contrast medium performing
160440 - CT tests............................. 070920 0830, ref SDS 3 5E5J
160442 - ..
160443 - 5. Millie letter to medical team confirms request
160444 - to Doctor Rugo for UCSF to schedule Millie's
160445 - CT tests at Kaiser every 12 weeks instead of
160446 - 8 weeks so that her the arm has more time
160447 - to recover from injuries caused by
160448 - injecting contrast medium to
160449 - perform CT tests..................... 071007 0603, ref SDS 4 S67U
160451 - ..
160452 - 6. UCSF letter notifies medical team that Millie's
160453 - CT tests changed from 8 to 12 weeks in order
160454 - reduce pain and suffering from needle
160455 - puncture wounds caused by injecting
160456 - test contrast medium................. 071009 1152, ref SDS 5 986H
160458 - ..
160459 - 7. Needle puncture causing pain and suffering
160460 - for Millie and emotional trauma for nurses
160461 - trying to find vein for conventional IV
160462 - required to inject contrast medium
160463 - for CT tests.......................... 080425 1509, ref SDS 6 FP6F
160465 - ..
160466 - 8. Millie asked the medical team for a solution
160467 - to reduce pain and suffering for the patient
160468 - and medical staff by performing blood draws
160469 - and infusion procedures with the port
160470 - rather than IV needle
160471 - penetrations......................... 080428 2343, ref SDS 7 1H6Y
160473 - ..
160474 - 9. Doctor Johnson, Millie's primary care physician
160475 - at Kaiser, notifies medical team that Kaiser is
160476 - checking on switching to a "Huber" needle to
160477 - use the port catheter instead of IV needle
160478 - penetrations for injecting contrast
160479 - medium on CT test
160480 - procedures........................... 080429, ref SDS 8 1H6Y
160482 - ..
160483 - During meeting at UCSF on referral from
160484 - Kaiser, Brigid explains that Huber needles
160485 - must be used with new technology called "Power
160486 - Ports" which requires surgically removing
160487 - Millie's port catheter placed i 2004,
160488 - and implanting
160489 - the Power Port in order inject high
160490 - pressure contrast medium used
160491 - for CT tests.........................
160493 - ..
160494 - 10. Doctor Johnson, primary care physician in
160495 - Kaiser Oncology orders surgery upgrading
160496 - port catheter to Power Port for injecting
160497 - high pressure contrast medium to perform CT
160498 - and other imaging tests, as well as inject
160499 - chemotheray treatments and make blood draws,
160500 - and for the purpose of saving time and money,
160501 - and also preventing pain and suffering
160502 - for the patient nurses who are both
160503 - severely traumatized by difficulty
160504 - finding a good vein for setting
160505 - an IV to inject contrast
160506 - medium................................ 080502 1200, ref SDS 9 WX6I
160508 - ..
160509 - 11. Surgery Department calls and schedules procedure
160510 - on 080708 to implant Power Port for blood
160511 - draws and injections of treatments and
160512 - contrast medium for CT
160513 - tests................................. 080617 1227, ref SDS 10 MG5I
160515 - ..
160516 - 12. Radiology Department calls and schedules CT
160517 - test on 080718 1100 using new Power Port
160518 - to inject contrast
160519 - medium................................ 080617 1227, ref SDS 10 DF55
160520 - advises patient to coordinate with
160521 - Chemotherapy Infusion Department on
160522 - scheduling to access Millie's new
160523 - Power Port, implanted on 080708, with
160524 - a Huber needle on 080718 1030 allowing
160525 - enough time for walking to Radiology
160526 - for the CT Department to use the Power
160527 - Port access to inject contrast
160528 - medium for Millie's CT
160529 - test.................................. 080617 1227, ref SDS 10 DF6Y
160531 - ..
160532 - 13. CT Department refused to coordinate with
160533 - the Oncology Chemotherapy Infusion Department
160534 - to access Millie's Power Port on 080718
160535 - for the CT test, because coordinating
160536 - across departments is hard
160537 - work.................................. 080617 1227, ref SDS 10 6Z76
160539 - ..
160540 - 14. Chemotherapy Infusion Department refused
160541 - to schedule accessing Millie's Power
160542 - Port for injecting contrast medium to
160543 - perform CT test on 080718, and advised
160544 - Millie that the CT Department should
160545 - make the injection with an IV in Millie's
160546 - arm rather than use the Power Port
160547 - scheduled to be implanted by the
160548 - Surgery Department on 080708
160549 - to support CT
160550 - tests................................. 080617 1227, ref SDS 10 WM4M
160552 - ..
160553 - 15. Millie suffers shock, stress, anxiety from
160554 - conflicts between work ordered by the doctor
160555 - and refusal to perform by nursing staff;
160556 - fears recurrence of pain and suffering
160557 - caused by IV injection proposed by
160558 - Oncology Chemotherapy Infusion Clinic
160559 - which was intended to be avoided by
160560 - surgically implanting a Power Port
160561 - on 080708............................. 080617 1227, ref SDS 10 WM69
160563 - ..
160564 - 16. Labor jurisdiction dispute between nurses
160565 - and technicians explained as cause for
160566 - difficulty coordinating schedule to
160567 - access Millie's Power Port for
160568 - CT test on 080718.................... 080617 1227, ref SDS 10 RP6J
160570 - ..
160571 - 17. Port access was finally scheduled on 080718
160572 - 1030 in Oncology Chemotherapy Infusion
160573 - Clinic to allow 30 minutes for walking to
160574 - the CT Department in time for
160575 - CT test at 1100...................... 080617 1227, ref SDS 10 OQ61
160577 - ..
160578 - 18. Millie notified medical team at Kaiser
160579 - and UCSF that CT test is scheduled to use
160580 - Power Port on
160581 - 080718............................... 080619 1438, ref SDS 11 YU6X
160582 - cites requirements to resolve
160583 - protocol and certification issues
160584 - over next 4 weeks.................... 080619 1438, ref SDS 11 YV4R
160586 - ..
160587 - 19. Primary care physician in Oncology plans
160588 - to attend Millie's test in CT Department
160589 - on 080718 to avoid labor dispute by
160590 - directing the work, if nobody else is
160591 - assigned with skills and experience to
160592 - access Millie's Power Port
160593 - for injecting contrast
160594 - medium............................... 080627 1200, ref SDS 12 GO3G
160596 - ..
160597 - 20. Doctor accessed vein on top of right hand
160598 - for IV to draw blood for test to verify INR
160599 - low enough for surgery; used local anesthetic
160600 - that prevented pain, and used hand pump
160601 - to force enough blood to flow from the
160602 - vein to perform the
160603 - test................................. 080708 0630, ref SDS 13 ME85
160605 - ..
160606 - 21. Surgery Power Port implanted for injections
160607 - and blood draws that prevent pain and suffering
160608 - caused by conventional IV needle
160609 - penetrations......................... 080708 0630, ref SDS 13 WD9J
160610 - Power Port documentation warns that
160611 - trained clinician should evaluate health
160612 - of patient for getting CT test contrast
160613 - medium injections through the Power
160614 - Port................................. 080708 0630, ref SDS 13 EE5T
160616 - ..
160617 - 22. Bella, Assistant Charge Nurse, Oncology
160618 - Chemotherapy Infusion Clinic did not receive
160619 - Millie's letter through Kaiser distribution
160620 - channels on coordinating the work for
160621 - accessing Millie's Power Port
160622 - required for CT test on
160623 - 080718,.............................. 080711 0930, ref SDS 14 RW4R
160624 - Paula, Director of Oncology Chemotherapy
160625 - Infusion Clinic Services, disclosed that
160626 - nobody has contacted the Clinic with
160627 - assignments for Millie's CT test
160628 - on 080718............................ 080711 0930, ref SDS 14 OC9G
160630 - ..
160631 - 23. Chemotherapy Infusion Department recommends
160632 - patient coordinate with CT Department to be
160633 - prepared on 080718 for implementing doctor's
160634 - order on accessing Millie's Power
160635 - Port to inject contrast
160636 - medium............................... 080711 0930, ref SDS 14 RN5O
160638 - ..
160639 - 24. Millie visits CT Department, who reports not
160640 - having received any of 11 documents submitted
160641 - the past 3 months coordinating Millie's
160642 - CT test scheduled for 080718, and using
160643 - the Power Port implanted on 080708
160644 - to inject contrast
160645 - medium............................... 080711 0930, ref SDS 14 7K8I
160647 - ..
160648 - 25. CT Department advised that the doctor's order
160649 - "fell through the cracks" for Millie's CT test
160650 - on 080718 to use her Power Port accessed in
160651 - Oncology Chemotherapy Infusion Clinic with
160652 - Huber Needle to inject contrast medium,
160653 - and so the CT Department is not prepared,
160654 - despite the CT Department having on 080617,
160655 - ref SDS 0 XR6G, initially planned to
160656 - perform the work as currently
160657 - scheduled............................ 080711 0930, ref SDS 14 PP7O
160659 - ..
160660 - 26. CT Department reports plans to begin
160661 - training test technicians to use Power
160662 - Ports for injecting contrast
160663 - medium............................... 080711 0930, ref SDS 14 JQ55
160664 - CT Department will not be prepared
160665 - in time to perform Millie's CT test
160666 - on 080718 using Millie's Power
160667 - Port ordered by the
160668 - doctor............................... 080711 0930, ref SDS 14 JQ62
160670 - ..
160671 - 27. CT Department advises that Millie's primary
160672 - care doctor in Oncology does not have
160673 - credentials to support the
160674 - CT test scheduled for
160675 - 080718............................... 080711 0930, ref SDS 14 JQ87
160677 - ..
160678 - CT Department proposes delaying Millie's
160679 - test for months until technicians are trained
160680 - and certified to use Millie's
160681 - Power Port........................... 080711 0930, ref SDS 14 JR30
160683 - ..
160684 - 28. CT Department proposes using IV needle
160685 - penetration for Millie's CT test because
160686 - 3 months has not been enough time to
160687 - prepare for implementing doctor's order
160688 - on using Millie's Power Port to prevent
160689 - pain and suffering from IV
160690 - needle penetration................... 080711 0930, ref SDS 14 JR40
160692 - ..
160693 - 29. Millie notified the doctor that proactive
160694 - support from the doctor is required to implement
160695 - the docotr's order for the CT Department to
160696 - use Millie's Power Port for the
160697 - test on 080718....................... 080712 0900, ref SDS 15 K13Q
160699 - ..
160700 - 30. Arlette called and reported the doctor solved
160701 - coordination problems arranging for a nurse in
160702 - Interventional Radiology with certificate to
160703 - support CT test using Millie's Power Port;
160704 - advises that Millie's CT test
160705 - is good to go on
160706 - 080718............................... 080715 1016, ref SDS 16 RB4N
160708 - ..
160709 - 31. Millie's letter notifies Kaiser that UCSF
160710 - will leave the Huber needle accessing the
160711 - Power Port for chemotherapy treatment on
160712 - 080717 in place for the CT test the next
160713 - day at Kaiser on 080718, so the schedule
160714 - today for the Infusion Clinic at
160715 - Kaiser to access the port is
160716 - not needed........................... 080715 1016, ref SDS 16 AW9S
160718 - ..
160719 - 32. Kaiser CT Department changes work plan -- access
160720 - to Power Port and removing the Huber needle
160721 - after the test will be performed in the CT
160722 - Department; Millie's meeting in the
160723 - Oncology Chemotherapy Infusion
160724 - Clinic on 080718 1030 was
160725 - cancelled by the CT
160726 - Department........................... 080716 1238, ref SDS 17 AN5I
160728 - ..
160729 - 33. CT test nurse from Interventional Radiology
160730 - requests manufacturer's Instructions for
160731 - Use on Bard Power
160732 - Port................................. 080718 1030, ref SDS 18 2U8V
160733 - because documents received by Millie
160734 - from surgeon on 080708, and submitted to
160735 - Oncology for distribution to support CT
160736 - test was not received by the CT Department
160737 - nor to Interventional
160738 - Radiology............................ 080718 1030, ref SDS 18 2U51
160740 - ..
160741 - 34. CT test at Kaiser in Walnut Creek failed
160742 - using Power Port because Interventional
160743 - Radiology and CT technicians misapplied
160744 - "Instructions for Use" obtained from
160745 - the patient rather than from Kaiser,
160746 - and while hurrying to absorb
160747 - complex procedures without
160748 - having a Kaiser
160749 - protocol............................. 080718 1030, ref SDS 18 LK3R
160751 - ..
160752 - 35. After staff change, second try failed
160753 - using Power Port for CT test, Millie
160754 - suffers painful
160755 - bleeding............................. 080718 1030, ref SDS 18 A26Y
160757 - ..
160758 - 36. CT Department manager at Kaiser in Walnut
160759 - Creek apologized for Millie's pain and
160760 - suffering from failure using Power
160761 - Port to inject contrast
160762 - medium............................... 080718 1030, ref SDS 18 FM74
160764 - ..
160765 - 37. CT Department at Kaiser in Oakland successful
160766 - using Bart Power Port for Millie's next
160767 - CT test, and without support
160768 - from Interventional
160769 - Radiology............................ 080911 1330, ref SDS 20 LK3R
160770 - and after getting guidance from
160771 - Bard on Power Port
160772 - procedures........................... 080911 1330, ref SDS 20 JX60
160774 - ..
160775 - 38. Kaiser CT Department in Walnut Creek
160776 - investigating how Kaiser in Oakland handled
160777 - laws about accessing a central venous
160778 - artery with CT test equipment
160779 - using a Power
160780 - Port................................. 081017 1415, ref SDS 21 8Y4N
160781 - and seemed to indicate that the Power
160782 - Port can be accessed by qualified nurses
160783 - in the Oncology Chemotherapy Infusion Clinic
160784 - and so the CT Department does not need
160785 - support from Bard, the Power
160786 - Port manufacturer.................... 081017 1415, ref SDS 21 035K
160788 - ..
160789 - 39. Millie's next CT test -- Dennis, CT Department
160790 - supervisor at Kaiser in Walnut Creek, was not
160791 - available to manage use of Power Port to correct
160792 - problems that occurred previoulsy
160793 - in July.............................. 081107 1300, ref SDS 22 VR4L
160794 - Pat, who had worked on Millie's CT
160795 - test using the Power Port for the 1st time,
160796 - and had scheduled the 2nd test, did not remember
160797 - Millie nor that the test would use
160798 - Bard Power Port
160799 - technology........................... 081107 1300, ref SDS 22 MX4L
160800 - Steve, District Manager for Bard, who
160801 - had talked to Dennis and said Kaiser was
160802 - "good to go" using the Bard Power Port for
160803 - the CT test, and Julie, who had offered to
160804 - be on-site for the first test in July, did
160805 - not have time to support the 2nd attempt
160806 - using Bard equipment, which had
160807 - failed on the 1st
160808 - attempt.............................. 081107 1300, ref SDS 22 2F6S
160809 - nobody seemed to be prepared for
160810 - applying manufacturer's instructions;
160811 - communication to collaborate on coordinating
160812 - the work failed by relying on memory of very
160813 - talented, dedicated people under
160814 - stress with limited
160815 - time................................. 081107 1300, ref SDS 22 2F32
160817 - ..
160818 - 40. Bard did not attend Millie's CT test on
160819 - 081107 because Kaiser told Bard not to attempt
160820 - further help for Kaiser because CT tests
160821 - can be done for all patients without
160822 - using Power Port
160823 - technology........................... 081117 1622, ref SDS 23 M559
160825 - ..
160826 - 41. Millie's 3rd attempt getting CT test at
160827 - Kaiser in Walnut Creek -- patient assistant
160828 - visits Kaiser in Walnut Creek the day before
160829 - the test; CT Department reports continuing
160830 - communication failures on implementing
160831 - doctor's order to use Millie's
160832 - Power Port for the
160833 - CT test.............................. 081229 1350, ref SDS 24 5F5M
160834 - problems resolved during meeting
160835 - so CT Department prepared to
160836 - perform CT test with Power
160837 - Port next day........................ 081229 1350, ref SDS 24 MR6K
160839 - ..
160840 - 42. CT test successful using Bart Power Port
160841 - at Kaiser in Walnut Creek applying planning
160842 - the day before to implement the doctor's order
160843 - for the Infusion Clinic to access Millie's
160844 - Power Port, and then to remove the Huber
160845 - needle after the test in the CT
160846 - Department........................... 081230 1020, ref SDS 25 DU3F
160848 - ..
160849 - 43. For next CT test - letter to Doctor Davidson,
160850 - Chief Radiology Imaging Services Diablo Service
160851 - Area asks for alternate contrast medium using
160852 - Gastrogafin, or equivalent, rather than
160853 - Barium Sulfate Suspension that
160854 - causes severe medical
160855 - problems............................. 090409 2347, ref SDS 26 OW5Q
160857 - ..
160858 - 44. CT test using Power Port was successful
160859 - performed in 20 minutes, but Kaiser did not
160860 - provide a solution for alternate oral contrast
160861 - medium, so Millie suffered recurrent and
160862 - multiple health problems using
160863 - Barium Sulfate Suspension
160864 - contrast medium...................... 090413 1500, ref SDS 27 QO9M
160866 - ..
160867 - 45. CT test using Power Port was successful
160868 - performed in 20 minutes using Millie's
160869 - Power Port to inject contrast
160870 - medium............................... 090612 1120, ref SDS 28 026E
160872 - ..
160873 - 46. CT test ordered in Emergency Room Department
160874 - to evaluate Millie's painful breathing
160875 - Doctor refused to prescribe using Millie's
160876 - Power Port for injecting contrast medium,
160877 - on mistaken belief that the CT Department
160878 - could not use Power Port technology, and
160879 - this caused severe pain and suffering
160880 - for Millie and for nurses who were
160881 - traumatized by failure to
160882 - find blood flow with
160883 - conventional IV...................... 090720 1437, ref SDS 29 RW43
160885 - ..
160886 - 47. CT test ordered in Emergency Room Department
160887 - to evaluate Millie's painful breathing - corrects
160888 - problem on prior test - Doctor applies "lessons
160889 - learned" from problems during prior visit on
160890 - 090702, and this time prescribes
160891 - using Millie's Power
160892 - Port................................. 090919 0742, ref SDS 30 04G4
160893 - however, on arrival in the CT
160894 - Department prior problems occurred again; the
160895 - weekend crew was not familiar with using Power
160896 - Port technology; failure of management to prepare
160897 - a protocol caused failure to implement doctor's
160898 - order to use the Power Port with consequent
160899 - pain and suffering for Millie and trauma for
160900 - technicians who again required muiltiple
160901 - needle punctures, several hours, and
160902 - extra cost to perform a 20
160903 - minute task.......................... 090919 0742, ref SDS 30 MI9Q
160905 - ..
160906 - 48. Millie's letter to medical team reported
160907 - progress in Kaiser's Emergency Room Department
160908 - providing training and support for staff that
160909 - corrects prior problems on 090720 using
160910 - Millie's Power Port technology for saving
160911 - time and money performing blood
160912 - draws and infusion
160913 - procedures........................... 090922 0028, ref SDS 31 NW7U
160915 - ..
160916 - 49. Millie's letter to medical team reported
160917 - that despite improvements in the Emergency
160918 - Room Department, problems continue in the CT
160919 - Department using her Power Port for injecting
160920 - testing contrast medium; Millie recommends
160921 - that Kaiser prepare a protocol for
160922 - Power Port procedures to improve
160923 - medical services and patient
160924 - outcomes............................. 090922 0028, ref SDS 31 NW8X
160926 - ..
160927 - 50. Requirements for Power Port protocol evidenced
160928 - by mistakes using .75" Huber needle in the
160929 - Chemotherapy Infusion Clinic; Bard calls for
160930 - a 1" Huber Needle; using the wrong needle
160931 - causes flow failure; multiple needle punctures
160932 - are needed to solve the problem, causing patient
160933 - to suffer pain and emotional trauma, and
160934 - the nurse likewise suffrs emotional
160935 - trauma............................... 091019 0007, ref SDS 32 0Z9P
160937 - ..
160938 - 51. Millie's letter reminds medical team to submit
160939 - copy of protocol for using Power Port with 1"
160940 - Huber needle to perform blood
160941 - draws and infusion
160942 - treatments........................... 091112 0752, ref SDS 33 L64R
160944 - ..
160945 - 52. During meeting at Kaiser, Doctor Johnson,
160946 - Millie's primary care physician, sent an
160947 - internal electronic letter to Paula notifying
160948 - the Chemotherapy Infusion Clinic that the doctor
160949 - prescribes blood draws and chemotherapy infusion
160950 - treaments using Millie's Power Port with a 1"
160951 - high-strength Huber Needle in order to avoid
160952 - the high risk of compounding Millie's cancer
160953 - and lymphedema from using conventional needle
160954 - penetrations in both arms, applying prior
160955 - guidance on 040318 to avoid needle punctures
160956 - in the left arm, because at that time cancer
160957 - infected only the left breast, ref SDS 0 NZ5M,
160958 - but Millie's cancer has recently migrated to
160959 - infect both her left and right
160960 - sides................................ 091112 0930, ref SDS 34 UN8F
160962 - ..
160963 - 53. Chemotherapy Infusion Clinic at Kaiser
160964 - refused to perform emergency blood draw
160965 - ordered by Doctor Zhang to evaluate
160966 - diagnosis of severe
160967 - shingles............................. 100104 1216, ref SDS 35 4W56,
160968 - and using Millie's Power Port with a
160969 - 1" Huber needle to prevent trauma from
160970 - needle penetrations into Millie's arms both
160971 - infected with IBC and lymphedema, ordered by
160972 - Doctor Johnson during the meeting at Kaiser
160973 - on 091112 0930, ref SDS 34 UN8F; as a result,
160974 - blood draw was performed in the Lab with
160975 - conventional needle penetration
160976 - contrary to the doctor's
160977 - order................................ 100104 1216, ref SDS 35 4Q40
160979 - ..
160980 - 54. Infusion Clinic at Kaiser in Martinez, CA
160981 - reported a new policy to avoid using port
160982 - catheter technology for blood draws because
160983 - some patients may have a small risk of complications
160984 - caused by using Heperin to maintain
160985 - the port catheter.................... 100119 0830, ref SDS 37 X56L
160986 - Millie cited the record of having
160987 - zero (0) risk since she never suffered
160988 - complications from the medical team using
160989 - Heperin to maintain her Power Port for hundreds
160990 - of procedures over an 8-year period, and further
160991 - explained Doctor Johnson's order for Kaiser to
160992 - use Millie's Power Port for blood draws and
160993 - infusion procedures in order to avoid the high
160994 - risk of compounding Millie's cancer and
160995 - lymphedema which now infect both
160996 - arms................................. 100119 0830, ref SDS 37 QR72
160997 - as a result, Kaiser's Infusion Clinic
160998 - in Martinez uses Millie's Power Port
160999 - to perform blood draws that
161000 - minimize the risk of
161001 - complications........................ 100119 0830, ref SDS 37 QR8G
161003 - ..
161004 - 55. Millie letter asks medical team to coordinate
161005 - blood draw at the Chemotherapy Infusion Clinic
161006 - in Walnut Creek using her Power Port ordered
161007 - by the Coagulation Control Case Manager treating
161008 - Millie's pulmonary embolism with Coumadin, and
161009 - for the purpose of evaluating
161010 - INR.................................. 100203 1148, ref SDS 38 J54W
161012 - ..
161013 - 56. Arlette called and advised she received Millie's
161014 - letter notifying the medical team that Gloria
161015 - ordered an interim blood draw to test INR on
161016 - Friday, 100205, and in order to make timely
161017 - adjustment to Millie's Coumadin prescription
161018 - on Friday to reduce the risk of
161019 - pulmonary embolism................... 100203 1410, ref SDS 39 QJ85; Arlette reported that
161020 - the Kaiser Chemotherapy Infusion
161021 - Clinic in Walnut Creek refuses to perform
161022 - the doctor's order to use Millie's Power Port
161023 - for blood draws, and directs Millie instead
161024 - to have blood drawn in the Lab which can
161025 - only use a conventional IV needle puncture,
161026 - refusal to use Millie's Power Port relies
161027 - on the new general policy to avoid a small
161028 - risk of complications which some patients
161029 - have from using Heperin to maintain port
161030 - catheters, even though Millie's patient
161031 - history shows there is no risk of complications
161032 - using her Power Port and there is
161033 - significant risk using
161034 - conventional IV needle
161035 - puncture for blood
161036 - draws................................ 100203 1410, ref SDS 39 115H
161038 - ..
161039 - 57. Millie's letter to medical team asks primary
161040 - care physician to enter in Millie's medical chart
161041 - notice to the Chemotherapy Infusion Clinic that
161042 - Millie's patient profile requires drawing blood
161043 - from Millie's Power Port rather than use IV needle
161044 - penetration balancing very low risks of Heperin
161045 - contamination in the Power Port which has never
161046 - occurred in Millie's case over 8 years, against
161047 - lymphedema recently diagnosed in the right arm
161048 - which, has prevented IV needle penetrations
161049 - in the left arm for 8
161050 - years................................ 100204 1325, ref SDS 40 SB6S
161052 - ..
161053 - 58. Blood draw performed contrary to doctor's
161054 - order in Kaiser Lab using conventional IV
161055 - in Millie's right arm infected with
161056 - IBC and lymphedema................... 100205 0938, ref SDS 41 QJ85
161058 - ..
161059 - 59. Kaiser CT Department reports progress
161060 - developing protocol for using Power Ports
161061 - to inject contrast medium for patients,
161062 - like Millie, who suffer severe complications
161063 - using conventional IV needle
161064 - penetrations......................... 100218 1000, ref SDS 42 M67K
161065 - however, new protocol was not applied
161066 - for Millie's CT test................. 100218 1000, ref SDS 42 T67O
161068 - ..
161069 - 60. Millie notifies medical team that medication
161070 - conflicts cause high risk complications; and
161071 - similarly blood draws using conventional IV
161072 - needle penetrations cause physical and emotional
161073 - pain and suffering for Millie and health care
161074 - providers, and that the doctor ordered
161075 - surgery to implant a Power Port
161076 - to solve this precise
161077 - problem.............................. 100301 0005, ref SDS 43 OP4Y
161079 - ..
161080 - 61. Millie's IBC significantly expanded on the
161081 - right side with cancer marker rising
161082 - higher than anytime in Millie's
161083 - 9 years of care...................... 100302 0830, ref SDS 44 FB4R
161084 -
161085 -
161086 -
161087 -
161088 -
161089 -
1611 -