THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com


S U M M A R Y


DIARY: June 1, 2010 08:30 AM Tuesday; Rod Welch

Millie meeting Doctor Johnson work plan recover 11th relapse cancer.

1...Summary/Objective
2...Medical Chart


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CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0403 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0403 -    ..
0404 - Summary/Objective                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
0405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040501 - Follow up ref SDS 87 0000. ref SDS 86 0000.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040502 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040504 -  ..
0406 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0407 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0408 - Background                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0409 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040901 - On 100427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040902 - so good nobody can believe she has such severe cancer, ref SDS 87                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040904 - 11 relapses to resist chemotherapy.  Kaiser has a new strategy for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040905 - Millie to recover from UCSF medical mistakes, discovered on 090609,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040906 - ref SDS 38 W65W, by prescribing therapy for treating cancer as a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040907 - chronic disease by "targeting" the genetic profile of cancer that has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040908 - mutated in patients, like Millie, to resist chemotherapy. ref SDS 87                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
040909 - SJ6N  Millie overjoyed Kaiser's "new" strategy implements UCSF's work                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040910 - plan prescribing PARP, and issued over a year ago on 090616.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040911 - ref SDS 39 D647                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040913 -  ..
040914 - On 100501 1037 Millie letter to medical team confirms Kaiser's new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040915 - strategy to treat Millie's cancer with "targeted therapy." ref SDS 88                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040916 - F25O  Millie requests Kaiser immediately switch from Abraxane                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040917 - chemotherapy that has failed, and implement Doctor Rugo's plan at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040918 - on 090616, to treat Millie with PARP that is "targeted" to Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040919 - rare patient profile of "triple negative" and avoids pain and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040920 - suffering from chemotherapy side effects, and for the purpose of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040921 - recovering from UCSF medical mistakes. ref SDS 88 U47P and ref SDS 88                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040922 - U49V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040924 -  ..
040925 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040926 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040927 - of cancer caused by UCSF medical mistakes. ref SDS 89 HH4I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040929 -  ..
040930 - On 100502 2143 Kaiser confirms that some patients respond well to new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040931 - "targeted" therapies. ref SDS 91 YX8L  Kaiser contends that all of the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
040932 - strategies for "targeted" therapies have been executed for Millie,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040933 - which seems conflicting with the record in this case. ref SDS 91 MZ4N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040935 -  ..
040936 - On 100503 1522 Millie notifies medical team that time of the essence                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040937 - to get the next treatment going. ref SDS 92 TD5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040939 -  ..
040940 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040941 - with Abraxane chemotherapy that seems to be failing, and then after 3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040942 - more weeks without treatment, following a trip abroad, the doctor will                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040943 - discuss "next steps." ref SDS 93 YL5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040945 -  ..
040946 - On 100503 2338 Millie reports to medical team that she will implement                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040947 - Kaiser's guidance to delay changing treatments, and takes Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040948 - letter on 010503, as assurance that recovery will be equal to changing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040949 - treatment immediately on 100505. ref SDS 94 6X7S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040951 -  ..
040952 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040953 - Care Clinic, called and notified Millie that Doctor Rugo will soon                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040954 - communicate with Doctor Johnson, or had already done so, to coordinate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040955 - with Kaiser on planning Millie's next treatment to recover from the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
040956 - 11th relapse of cancer. ref SDS 95 NT5N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040958 -  ..
040959 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040960 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040961 - ref SDS 96 KE4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
040963 -  ..
040964 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040965 - seemingly on an accelerating rise, which threatens to cascade out of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040966 - control, because Abraxane chemotherapy is not effective. ref SDS 97                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
040967 - L54I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040969 -  ..
040970 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040971 - Abraxane. ref SDS 98 KE4K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
040973 -  ..
040974 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 99 PK9O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040976 -  ..
040977 - On 100527 0217 Millie files claim with Kaiser Case Resolution                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
040978 - Department for standard of care to recover from 11th relapse of cancer                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040979 - caused by medical mistakes getting radiation treatments at UCSF on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040980 - referral from Kaiser. ref SDS A0 IZ7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040982 -  ..
040983 - On 100528 0322 Millie requests support from Medicare to separate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040984 - recovery for medical mistakes getting radiation from UCSF, from health                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040985 - care benefits limited by Medicare insurance coverage. ref SDS A1 QQ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
040987 -  ..
040988 - On 100528 1031 called Medicare they have formed a team to review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
040989 - Millie's case, and contacted Kaiser's Claims Resolution Department for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040990 - response to Millie's claim. ref SDS A2 4W5F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040992 -  ..
040993 - On 100601 0136 Millie submitted agenda to medical team for meeting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
040994 - with Doctor Johnson at Kaiser on the work plan for Millie to recover                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
040995 - from UCSF medical mistakes. ref SDS A3 QQ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
040997 -  ..
040998 - On 100601 0830 Doctor Johnson reported that Kaiser has not had time to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
040999 - collaborate with UCSF on treatment for Millie to recover from UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041000 - medical mistakes.  He discussed treating Millie with MPA, but this was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041001 - not prescribed because Millie was treated with MPA in 2009, and UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041002 - ended the treatment due to fears about blood clot side effects, which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041003 - were believed to cause breathing problems Millie had, though later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041004 - breathing problems were discovered to be caused by defective radiation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041005 - treatment.  Since Doctor Johnson said Kaiser has no more treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041006 - for Millie, the only way Millie can get relief from pain caused by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041007 - cancer that is progressing without treatment is get treatment in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041008 - Hospice.  Since Hospice is the only choice of care offered today,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041009 - Millie accepted this. ref SDS 0 036C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041010 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041011 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041012 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041013 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041015 -  ..
0411 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0412 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0413 - Progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
0414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041401 - Doctor Johnson looks well.  He explained a new tan from working in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041402 - gqrden at home over the long Memorial day weekend.  The doctor has a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041403 - slight cold or the flu this morning, from overwork treating patients                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041404 - in Oncology, supporting a new Oncology Department at the new Kaiser                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041405 - hospital in Antiock, and from duties as Chief of a new Paliation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041406 - Department, which Doctor Johnson has developed the past 5 years.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041408 -  ..
041409 - During the meeting today, one of the receptionists at the front desk,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041410 - knocked and came into the Examination Room.  She avised Doctor Johnson                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041411 - that a patient getting chemotherapy has just requested an exigent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041412 - meeting with Doctor Johnson.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041414 -  ..
041415 - Doctor Johnson advised that his schedule is too hectic.  He cannot add                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041416 - another meeting to see the patient.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041418 -  ..
041419 - Doctor Johnson received Millie's claim requesting immediate treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041420 - with PARP or equal, implementing UCSF work plan to provide necessary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041421 - and reasonable care for Millie to recover from UCSF medical mistakes,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041422 - filed on 100527. ref SDS A0 IZ7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041424 -  ..
041425 - The doctor also received Millie's letter sent early this morning with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041426 - via email, and submitting an agenda for the meeting today, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041427 - requesting treatment with PARP as set out in Millie's claim, reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041428 - on 100601 0136, ref SDS A3 QQ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041430 -  ..
041431 - Doctor Johnson was encouraged that Millie's lab on Saturday, 100529,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041432 - shows blood counts are excellent. ref SDS A3 1P5W   He was very                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041433 - disappointed Millie's cancer has gotten worse without treatment for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041434 - the past 4-weeks, ref SDS A3 1P6U, since she requested switching                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041435 - treaetment on 100501. ref SDS 88 U44V                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041437 -  ..
041438 - Millie asked for a stronger medication to reduce itching that is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041439 - getting worse from IBC lesions rising mostly on the right side.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041440 - said the problem is worse at night, becasue when groggy, she tears her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041441 - skin scratching, and this causes bleeding.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041443 -  ..
041444 - Doctor Johnson prescribed Atarax to relieve itching, which is called                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041445 - pruritis in the medical chart. ref SDS 0 W28P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041446 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041447 -            [On 100728 1016 Millie starting to decline, and so is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041448 -            medicated with morphine; she then needed less Atarax and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041449 -            cortisone to relieve itching. ref SDS B9 QK56                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041451 -  ..
041452 - Doctor Johnson examined new problem of swelling in both lower legs,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041453 - reported in Millie's letter this morning on 100601 0136, ref SDS A3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041454 - 1Q3S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041456 -  ..
041457 - There is a vertical vein visible on the inner side of both lower legs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041458 - Millie said this area is painful to slight pressure by touch.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041460 -  ..
041461 - Doctor Johnson diagnosed Phlebitis.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041463 -  ..
041464 - Phlebitis came to prominence when President Nixon resigned in 1974.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041465 - Shortly out of office, the ex-president was diagnosed with life                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041466 - threatening Phelibitis infection, reported by Time magazine Monday,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041467 - Nov. 11, 1974...                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041468 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041469 -        THE EX-PRESIDENT: Nixon: Surgery, Shock and Uncertainty                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041471 -               ..
041472 -              http://www.time.com/time/magazine/article/0,9171,911480,00.html                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041474 -         ..
041475 -        Nixon's trauma... twelve days in Memorial [hospital] in late                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041476 -        September and early October for treatment of phlebitis, the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041477 -        painful inflammation of the veins in his left leg that... could                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041478 -        at any time cause a fatal blood clot to travel upward in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041479 -        bloodstream through his heart to the lungs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041481 -  ..
041482 - Doctor Johnson prescribed immediate treatment with Relafen for 2 weeks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041483 - to reduce Phlebitis inflammation and swelling.  Asked the doctor to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041484 - include this in the medical chart, and this was entered, shown below.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041485 - ref SDS 0 7E9W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041486 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041487 -            [On 100602 0913 Millie reported to the Hospice rep, Liz,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041488 -            that Doctor Johnson prescribed treatment for 2-weeks with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041489 -            Relafen to recover from Phlebitis, ref SDS A5 3V70; Liz                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041490 -            advised that Ralafen can complement morphine to reduce                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041491 -            Millie's discomfort from IBC, and so increased treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041492 -            beyond 2-weeks. ref SDS A5 3V94                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041494 -  ..
041495 - Phlebitis is the second near-fatal infection Millie has suffered since                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041496 - getting shingles on 100104.  At that time, Doctor Zhang diagnosed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041497 - severe infection was caused by treating Millie with chemotherapy,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041498 - which conflicts with her patient profile, reported on 100104 1115.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041499 - ref SDS 56 PS49  Earlier, on 090601, the Kaiser Pharmacist reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041500 - that chemotherapy exposes Millie to fatal infections, ref SDS 37 FR8L,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041501 - and that chemotherapy is no longer effective for treating Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041502 - cancer. ref SDS 37 JH4K  Despite conflicts with Millie's patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041503 - profile, Kaiser treated Millie with Gemzar chemotherapy beginning on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041504 - 090728 0930, ref SDS 43 W65H, implementing UCSF recommendations and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041505 - work plan for Millie to recover from UCSF medical mistakes, reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041506 - on 090716 2106. ref SDS 41 EE5W  On 091112, Doctor Johnson reported                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041507 - communication with Doctor Rugo on treating Millie with Navelbine and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041508 - Abraxane after Gemzar, and until UCSF can provide "targeted" treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041509 - with PARP. ref SDS 47 QN5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041511 -  ..
041512 - This record of 2 near fatal infections while getting treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041513 - chemotherapy demonstrates why Millie needs treatment "targeted" to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041514 - cancer that does not cause side effects, and is more effective than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041515 - chemotherapy, reported on case study on 090213 1140. ref SDS 28 PT3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041517 -             ..
041518 -            [On 100706 1452 Linda, Hospice Case Manager, reported no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041519 -            signs of phlebitis in either leg, since ending chemotherapy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041520 -            and getting treatment. ref SDS B8 2F9K                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041532 -  ..
041533 - Millie asked this morning if there are any conflicts between Relafen                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041534 - prescribed today to recover from Phlebitis, and her other medications,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041535 - including warfarin (Coumadin)?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041537 -  ..
041538 - Doctor Johson advised that Relafen is in Kaiser's computer, and so                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041539 - Millie's Coagulation Control Case Manager, Gloria, will automatically                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041540 - be notified by Kaiser's Knowledge Management computer system to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041541 - investigate for drug conflicts, and can make any adjustments needed to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041542 - prevent complications.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041544 -  ..
041545 - Millie was very emotional about complications piling up from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041546 - chemotherapy that has been ineffective treating her cancer, since last                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041547 - August, as related in her letter on 100501, asking for treatment with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041548 - PARP "targeted" to her cancer, like cetuximab, that does not cause                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041549 - severe side effects, ref SDS 88 U49V, and which Doctor Johnson said a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041550 - week earlier on 100427, is the best strategy for Millie's care.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041551 - ref SDS 87 SJ6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041553 -  ..
041554 - Millie has submitted numerous letters to Kaiser the past year                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041555 - requesting the medical team collaborate by telephone and email on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041556 - implementing the UCSF work plan to treat Millie's cancer with PARP in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041557 - time for recovering from UCSF medical mistakes, beginning on 090725                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041558 - 2017. ref SDS 42 T64P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041559 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041560 -            [On 100622 1511 case study showing Millie requested                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041561 -            treatment 44 times to recover from UCSF medical mistakes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041562 -            ref SDS B3 576S                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041564 -  ..
041565 - Doctor Johnson advised that Kaiser cannot order treatment prescribed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041566 - by Doctor Rugo at UCSF for saving Millie's life by recovering from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041567 - medical mistakes getting radiation treatments at UCSF, as requested in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041568 - Millie's letter again this morning, ref SDS A3 1Q6P, because he has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041569 - been unable over the past 4 weeks to communicate with Doctor Rugo at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041570 - UCSF using the telephone and email, planned by Doctor Johnson in the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041571 - meeting at Kaiser on 100427 0830, ref SDS 87 WT9M, and a week later                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041572 - planned by Doctor Rugo in UCSF's letter to Kaiser on 100501, to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041573 - implement UCSF's work plan on 090616, prescribing PARP for Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041574 - next "targeted" treatment to recover from UCSF medical mistakes.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041575 - ref SDS 89 456L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041577 -  ..
041578 - Last year, Doctor Johnson was worried Millie's care would "fall                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041579 - through the cracks" in the health care system due to communications                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041580 - failure, reported on 090205 1318., ref SDS 26 278T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041581 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041582 -            [On 100606 2314 Doctor Johnson reported that Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041583 -            has still not returned his call from Kaiser requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041584 -            treatment plans for Millie to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041585 -            mistakes. ref SDS B1 S66O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041587 -             ..
041588 -            [On 100616 0832 Jennifer reported that Kaiser's claim team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041589 -            has suffered delays resolving Millie's claim for standard                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041590 -            of care to recover from UCSF medical mistakes, due to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041591 -            delays communicating with the doctor. ref SDS B2 WN6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041593 -             ..
041594 -            [On 100927 1152 doctor hectic schedule "still running                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041595 -            around like chicken with head cut off." ref SDS C1 H68J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041597 -  ..
041598 - Doctor Johnson related having received a letter from Doctor Rugo using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041599 - UCSF securemail with encryption to protect Millie's privacy, and for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041600 - the purpose of implementing Doctor Rugo's work plan to save Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041601 - life, presented in UCSF's letter using public domain email sent to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041602 - team on 100501 1711, ref SDS 89 456L, and responding to Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041603 - request for life-saving treatment sent to the medical team using                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041604 - public domain email for timely, immediate action earlier the same day                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041605 - on 100501 1037. ref SDS 88 F25O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041607 -  ..
041608 - Doctor Johnson further disclosed today, that he was unable to open                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041609 - Doctor Rugo's encrypted letter.  Failure to communicate using secure                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041610 - email encrypted to comply with HIPAA regulations to protect patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041611 - rights for confidential health records violates patient rights to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041612 - choose good health exercised in Millie's letter to the medical team on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041613 - 100502 that waived her right under HIPAA regulations for confidential                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041614 - health records, and directed that the medical team use public domain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041615 - email for reliable commnication in time to save her life. ref SDS 90                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041616 - CO3W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041618 -  ..
041619 - Doctor Johnson's report today of failure to communicate with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041620 - Rugo at UCSF over the past month using securemail shows continuing                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041621 - problems that prevent effective health care.  On 100502, Millie was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041622 - unable to open securemail received from the Doctor Johnson at Kaiser.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041623 - ref SDS 91 HH4I  The next day, Doctor Johnson solved the problem by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041624 - re-submitting the letter with public domain email, reported on 100503                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041625 - 1945, ref SDS 93 HH4I, and which implemented Millie's instructions to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041626 - the medical team the day before on 100502 0140. ref SDS 90 CO3W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041628 -  ..
041629 - Doctor Johnon advised today that he did not use public domain email                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041630 - to communicate with Doctor Rugo over the past 4-weeks on saving                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041631 - Millie's life.  Since public domain email has been used for 99% of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041632 - communication for collaboration between Kaiser, UCSF, and the patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041633 - over the past 10 years, and has been effective extending Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041634 - survival 4 times longer than disease trajectory, reported by Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041635 - Johnson on 090325, ref SDS 30 P39M, there is no evident justification                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041636 - for failure to provide notice in this case.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041637 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041638 -            [On 100626 0003, Medicare regulations that guide Kaiser's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041639 -            medical practice make patient health the paramount                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041640 -            consideration for communication giving notice. ref SDS B4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041641 -            TQ5T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041643 -             ..
041644 -            [On 100813 2000 similar problems of computer access                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041645 -            occurring in computer industry due to variances in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041646 -            capitilizing text strings as grounds to deny timely access                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041647 -            to mission critical content. ref SDS C0 V15F                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041649 -  ..
041650 - After getting Doctor Rugo's secure email, Doctor Johnson sent an                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041651 - encrypted securemail to Doctor Rugo saying he could not open her                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041652 - letter.  He then received an unsecure letter using public domain email                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041653 - from Doctor Rugo, saying that she could not open Doctor Johnson's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041654 - reply, and providing her telephone number, asking Doctor Johnson to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041655 - call her at UCSF about ordering Millie's care.  Doctor Johnson called                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041656 - UCSF and left a message for Doctor Rugo to call him back using his                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041657 - office telephone number at Kaiser.  He has received several messages                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041658 - from Doctor Rugo and called back and left several messages, but so far                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041659 - in the past 30 days, Doctor Johnson has not communicated with Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041660 - Rugo either by email or telephone, contrary to Doctor Rugo's work plan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041661 - for Kaiser and UCSF to collaborate on Millie's care, reported 4-weeks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041662 - ago on 100501 2017, ref SDS 89 456L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041664 -  ..
041665 - UCSF sending encrypted secure email to Kaiser on Millie's health care                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041666 - aligns with Doctor Rugo's letter to Millie on 100501, saying she                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041667 - cannot use unsecure public domain email to notify Millie on progress                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041668 - scheduling work for Millie to recover from UCSF medical mistakes,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041669 - ref SDS 89 HH4I, and despite having used public domain email                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041670 - successfully for the past 7 years, without breach of Millie's privacy,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041671 - despite Millie having notified the medical team that risks of fatal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041672 - complications using unsecure public domain email for timely, accurate,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041673 - comprehensive case management are far less than risks of fatality from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041674 - communication failures and delays using securemail with encryption,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041675 - and so Millie approves the team using public domain email in her case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041676 - for purposes of getting treatment in time to be effective, reported in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041677 - Millie's letter to the medical team the next day on 100502 0140.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041678 - ref SDS 90 CO3W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041680 -  ..
041681 - Doctor Johnson said that without support from Doctor Rugo at UCSF, he                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041682 - has no treatments targeted to Millie's cancer for her to recover from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041683 - UCSF medical mistakes, which have now caused the 11th relapse of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041684 - cancer.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041686 -  ..
041687 - This record indicates UCSF has defaulted on referral obligations to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041688 - fix medical mistakes, as noted in Millie's letter to Doctor Johnson on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041689 - 100503, asking for notice if UCSF performs commitment to communicate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041690 - with Kaiser on Millie's care. ref SDS 94 6X8W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041691 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041692 -            [On 100606 2314 Doctor Johnson reported that Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041693 -            has still not returned his call from Kaiser requesting UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041694 -            treatment plans for Millie to recover from medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041695 -            mistakes. ref SDS B1 S66O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041697 -  ..
041698 - The doctor discussed one treatment using Medroxyprogesterone that is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041699 - targeted to Millie's patient profile; he did not disclose the source                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041700 - for this idea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041702 -  ..
041703 - Doctor Johnson used the computer in the examination room to check the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041704 - Internet, and found Medroxyprogesterone is part of the UCSF protocol                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041705 - for MPA.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041707 -  ..
041708 - We reviewed the record showing MPA was prescribed by Doctor Hsu as the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041709 - first treatment for Millie to recover from UCSF medical mistakes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041710 - providing radiation treatments, reported on 090609, ref SDS 38 W66W  A                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041711 - week later on 090616, Doctor Rugo started Millie on MPA, and advised                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041712 - that Kaiser and UCSF had agreed in a letter sent with email that after                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041713 - MPA, Millie would be treated with PARP. ref SDS 39 KD6L  A month                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041714 - later, on 090716, UCSF ended treatment with MPA, becasue Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041715 - suffered severe beathing problems, and blood clots are a rare side                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041716 - effect of MPA, and Millie was already being treated for pulmonary                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041717 - embolism due to blood clots from treatment with bevacizumab in 2004.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041718 - UCSF called at 8pm that night, and said Millie's next treatment would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041719 - be with PARP, as agreed in the letter with Kaiser, but PARP would not                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041720 - be ready until September, and so UCSF would pay Kaiser to treat Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041721 - with Gemzar until September, as reported in Millie's letter to the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041722 - medical team on 090716 2106. ref SDS 41 EE5W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041724 -  ..
041725 - This morning, Doctor Johnson checked Millie's medical chart on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041726 - computer and found his report for the meeting at Kaiser on 090626                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041727 - approving Millie's treatment at UCSF with Medroxyprogesterone, shown                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041728 - in parentheses as "MAP," but actually reflecting the UCSF protocol for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041729 - MPA. ref SDS 40 837H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041731 -  ..
041732 - Doctor Johnson then recalled that blood clots are a rare side effect                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041733 - of MPA, reported in UCSF literature received in the record on 090514.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041734 - ref SDS 35 KW3P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041736 -  ..
041737 - The doctor feels that Millie's patient history of pulmonary embolism                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041738 - and previous breathing problems, while being treated with MPA,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041739 - precludes prescribing MPA again today, and since email and telephone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041740 - problems prevented collaborating with Doctor Rugo the past month to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041741 - prescribe PARP, as originally agreed in the letter cited by Doctor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041742 - Rugo on 090616, Kaiser cannot order treatment with PARP, despite                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041743 - evidence showing PARP is targeted to Millie's patient profile, and has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041744 - no painful side effects, as reviewed by Doctor Johnson during the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041745 - meeting at Kaiser on 100112. ref SDS 60 N586                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041747 -  ..
041748 - Doctor Johnson scrolled a few more web sites on the Internet for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041749 - another 5 minutes or so, and found listings for cancer treatments.  He                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041750 - feels these providers cannot treat Millie's complex patient profile,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041751 - reported on 090213 1140. ref SDS 28 AC6G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041753 -  ..
041754 - Previously on 090909, Doctor Johnson reported he had time to perform                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041755 - research on the 20 so treatments targeted to cancer, and submitted to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041756 - the medical team, at his request on 090326, but which up to that time                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041757 - on 090909, the medical team had failed to review. ref SDS 44 VF9Q  A                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041758 - month later, however, the doctor disclosed that a hectic schedule                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041759 - prevented providing standard of care for Millie, reported on 091027                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041760 - 0830. ref SDS 46 GN5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041762 -  ..
041763 - Today, Doctor Johnson did not submit any work product showing level of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041764 - effort to provide necessary and reasonable care for Millie to recover                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041765 - from UCSF medical mistakes.  No notes, diaries, reports, charts,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041766 - showing calls and meetings with others to evaluate and negotiate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041767 - treatments for Millie.  The doctor submitted no emails contacting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041768 - providers with Millie's treatment history, and offering financial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041769 - inducments to exercise doctor discretion for medical necessity to save                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041770 - Millie's life, which Doctor Rugo reported on 090514, was planned for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041771 - Millie at UCSF. ref SDS 35 265I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041773 -  ..
041774 - On 090616, Doctor Rugo advised during a meeting at Kaiser that UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041775 - has many treatments planned for Millie to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041776 - mistakes, including phase I and II clincial trials, since her patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041777 - profile is too complex for many phase III and IV studies, ref SDS 39                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041778 - BL4N, discussed previously meeting at UCSF on 090514. ref SDS 35 3F7M                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041779 - At that time, on 09514, Doctor Rugo planned for doctor discretion to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041780 - adjust study criteria for medical necessity to fit Millie's complex                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041781 - patient profile. ref SDS 35 265I  UCSF demonstrated ability to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041782 - correlate treatment protocol for Millie's history of prior treatments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041783 - by omitting cyclophosphaide from MPA protocol, reported on 090616                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041784 - 1245. ref SDS 39 YO4J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041786 -  ..
041787 - These innovations were confirmed in a letter Doctor Rugo sent to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041788 - Doctor Johnson at Kasier on 090514 0830, ref SDS 35 DI63, and cited a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041789 - month later during a meeting at UCSF planning to start Millie's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041790 - recovery from medical mistakes at UCSF first with MPA, and then with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041791 - PARP, reported on 090616. ref SDS 39 KD6L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041793 -  ..
041794 - Today, the doctor explained that research to find and devise solutions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041795 - for Millie's treatment history takes a lot of time.  This aligns with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041796 - Doctor Johnson's report on 091027, that his plan on 090909, to review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041797 - the 20 or so treatments submitted to the medical team on 090326,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041798 - failed because his schedule changed, and became too hectic, so he                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041799 - didn't have enough time to exercise doctor discretion to prescribe                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041800 - care for medical necessity so that Millie can recover from UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041801 - medical mistakes. ref SDS 46 GN5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041803 -  ..
041804 - Doctor Johnson said he is very sorry practical solutions and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041805 - innovations at UCSF cannot be ordered to treat Millie at Kaiser with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041806 - standard of care for Millie's patient profile using PARP or equal that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041807 - "targets" the genetic weakness of her cancer cells, and with no                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041808 - painful side effects, as requested in Millie's claim filed on 100527,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041809 - ref SDS A0 IZ7N, citing agreement in a letter between Kaiser and UCSF,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041810 - reported by Doctor Rugo on 090616, ref SDS 39 KD6L, and further as                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041811 - requested again in Millie's letter this morning, reported on 100601                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041812 - 0136. ref SDS A3 1Q6P  The doctor spread his hands saying he simply                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041813 - cannot communicate with Doctor Rugo at UCSF by telephone or email over                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041814 - the past 4-weeks to provide treatment for Millie to recover from UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041815 - medical mistakes, per above. ref SDS 0 4F6I                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041817 -             ..
041818 -            [On 100605 1817 Doctor Johnson reported he received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041819 -            Millie's letter on 100603 0449, ref SDS A8 036C, and which                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041820 -            transmitted the record meeting at Kaiser on 100601, when                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041821 -            the doctor ordered Hospice for Millie, rather than                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041822 -            treatment targeted to her patient profile. ref SDS B0 FT4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041824 -             ..
041825 -            [On 100606 2314 Doctor Johnson reported that Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041826 -            has still not returned his call from Kaiser requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041827 -            treatment plan for Millie to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041828 -            mistakes. ref SDS B1 S66O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041830 -             ..
041831 -            [On 100616 0832 Jennifer reported that Kaiser's claim team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041832 -            has suffered delays resolving Millie's claim for standard                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041833 -            of care to recover from UCSF medical mistakes, due to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041834 -            delays communicating with the doctor. ref SDS B2 WN6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041836 -  ..
041837 - The medical chart for the meeting at Kaiser on 091112, showed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041838 - consideration of Abraxane and Ixempra chemotherapy. ref SDS 47 RV60                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041839 - At that time, Ixempra was not actually considered.  Abraxane was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041840 - discussed on 091112. ref SDS 47 UN46  The team has continually                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041841 - determined that chemotherapy is not appropriate for Millie's patient                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041842 - profile because her cancer has mutated to resist chemotherapy, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041843 - because chemotherapy has painful side effects that have accumulated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041844 - beyond Millie's ability to tolerate, also discussed on 091112.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041845 - ref SDS 47 CP9K  This makes chemotherapy torture.  It does not treat                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041846 - Millie's cancer, and squeezes out the will to live                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041848 -  ..
041849 - At this point, Millie was crying and said she has tried her best the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041850 - past 8 months to be a good partner suffering agony since August, 2009,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041851 - getting chemotherapy, which Doctor Johnson and the Kaiser Pharmacist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041852 - have both said is wrong and ineffective for treating Millie's advanced                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041853 - cancer, and is actually harmful for her weakened immune system, see                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041854 - case study on 090213. ref SDS 28 PT3N  Chemotherapy Kaiser has                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041855 - ordered, contrary to prescribed and essential "targeted therapies,"                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041856 - has reduced Millie's life to a point of such misery that she would                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041857 - rather be dead, as noted in Millie's claim filed on 100527,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041858 - ref SDS A0 X65W, and which requests Kaiser provide necessary and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041859 - reasonable care to recover from UCSF medical mistakes. ref SDS A0 X58U                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041861 -  ..
041862 - Doctor Johnson offered to enroll Millie in Hospice to avoid further                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041863 - pain and suffering from chemotherapy that has not been effective for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041864 - the past year, because Millie's cancer has mutated to resist                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041865 - chemotherapy, reported by Doctor Johnson beginning on 080829, shown in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041866 - case study listed in the record for 090213 1140, ref SDS 28 PT3N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041868 -  ..
041869 - Millie feels she has no choice, because getting prescribed treatment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041870 - using "targeted therapy" initially with PARP to get better without                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041871 - painful side effects caused by chemotherapy now seems hopeless.  Delay                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041872 - has denied Millie all treatment options - UCSF has run out the clock.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041874 -  ..
041875 - Doctor Johnson seemed genuinely sorry that email and telephone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041876 - problems, related today, per above, ref SDS 0 D658, prevent the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041877 - medical team from providing standard of care for Millie to recover                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041878 - from UCSF mistakes treating Millie with radiation on referral from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041879 - Kaiser.  He feels everyone has worked hard the past year to find the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041880 - time to review the 20 or so treatments targeted to Millie's cancer,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041881 - and which do not cause painful side effects which Millie has suffered                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041882 - needlessly the past 8 months, and so have now destroyed the will to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041883 - live.  It is sad that telephone and email problems have prevented                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041884 - medical professionals from reviewing a list of treatments requested by                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041885 - UCSF and by Kaiser, and which Doctor Johnson has been trying to find                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041886 - time for ordering, since his letter over a year ago on 090326.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041887 - ref SDS 33 T64N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041888 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041889 -            [On 100602 1525 Millie received sympathy letter from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041890 -            Arlette on ending treatment to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041891 -            mistakes. ref SDS A7 036C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041893 -             ..
041894 -            [On 100605 1817 Doctor Johnson reported he received                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041895 -            Millie's letter transmitting the record meeting with him at                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041896 -            Kaiser on 100601, when he signed Millie up for Hospice.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041897 -            ref SDS B0 FT4G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041899 -             ..
041900 -            [On 100630 1148 Millie received letter from Doctor Johnson                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041901 -            asking if Millie wants to dis-enroll from Hospice.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041902 -            ref SDS B5 OY5G                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041904 -             ..
041905 -            [On 100701 0915 received call from Carol saying she is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041906 -            Chief of Hospice, and that she was told Millie wants to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041907 -            dis-enroll from Hospice, ref SDS B7 Q85S, which conflicts                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041908 -            with the record of notice to Kaiser in thes letter on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041909 -            100630 1537. ref SDS B6 M93Y                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041911 -  ..
041912 - Doctor Johnson explained extensive experience working with Hospice,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041913 - as chief of the department earlier in his career.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041915 -  ..
041916 - The doctor assured Millie that Hospice will avoid further pain and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041917 - suffering from chemotherapy, and from chemotherapy side effects, and                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041918 - can prevent pain from rising cancer that will occur without treatment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041919 - He feels Hospice is excellent at controlling pain while Kaiser reviews                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041920 - Millie's claim for care to recover from medical mistakes made by UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041921 - on referral by Kaiser, filed on 100527 0217. ref SDS A0 IZ7N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041923 -  ..
041924 - Millie said anything will be better than chemotehrapy the past 8                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041925 - months that has caused her cancer to spread and tortured her with                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041926 - constant pain and suffering, including causing fatal infections                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041927 - diagnosed again by Doctor Johnson this morning, per above. ref SDS 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041928 - OP4G  Now, she just wants to end the torture.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
041930 -  ..
041931 - Doctor Johnson then entered an order in the computer transferring                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041932 - Millie's care to Hospice - took about 10 seconds.  The doctor advised                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041933 - that he will continue following Millie's progress, but from now on the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041934 - Hospice department will be responsibile to provide timely case                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041935 - management for Millie rather than Oncology.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041936 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041937 -            [On 100606 2314 Doctor Johnson reported that Doctor Rugo                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
041938 -            has still not returned his call from Kaiser requesting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041939 -            treatment plan for Millie to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041940 -            mistakes. ref SDS B1 S66O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041942 -             ..
041943 -            [On 100616 0832 Jennifer reported that Kaiser's claim team                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041944 -            has suffered delays resolving Millie's claim for standard                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041945 -            of care to recover from UCSF medical mistakes, due to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041946 -            delays communicating with the doctor. ref SDS B2 WN6N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041948 -  ..
041949 - Doctor Johnson left the office for a few mintues to check on                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041950 - something.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
041952 -  ..
041953 - Arlette came into the examination room to say hello.  She gave Millie                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041954 - a big hug, and said "Gosh, you look wonderful.  How have you been?"                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041956 -  ..
041957 - Millie said fine, and asked how Arlette is doing?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041959 -  ..
041960 - Arlette has had a terrible week scrambling to recover from being let                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041961 - down and misled by her real estate agent.  She sold her home, and the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041962 - real estate agent said the new buyers agreed not to take posession for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041963 - 2 weeks, while Arlette finds another place.  Sounded like the real                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041964 - estate agent misled both the new buyers and Arlette, with the result                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041965 - that Arlette suffered fiancially, and was forced to move out                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041966 - immediately with no place to go and no where to store her belongings,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
041967 - cats and dogs.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041969 -  ..
041970 - She was unable to get recovery from the unscrupulous real estate                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041971 - agent, because he skipped town with the money.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041972 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041973 -            [On 100603 0603 Millie's letter wishes Arlette well                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
041974 -            recovering from difficulties losing her home, and getting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041975 -            resettled. ref SDS A9 036C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
041977 -             ..
041978 -            [On 101110 2025 letter to Arlette asks how she is doing in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041979 -            her new apartment. ref SDS C2 U19X                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
041981 -  ..
041982 - A friend who works at Kaiser put her up for a week.  Yesterday,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041983 - Arlette finally found an apartment to rent, so her next big problem is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041984 - getting everything moved in, and finding storage, selling, giving or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041985 - throwing away everything that was in her forer home, that won't fit in                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
041986 - her small apartment.  She hopes over the next 6 months to buy a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041987 - foreclosure property, so all the finances will work out.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
041989 -  ..
041990 - Arlette feels she is finally starting to get over the shock of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
041991 - everything, and see her way forward.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
041992 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
041993 -        [On 100603 0603 Millie's letter wishes Arlette well recovering                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
041994 -        from difficulties losing her home, and getting resettled.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
041995 -        ref SDS A9 DA3W                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
041997 -  ..
041998 - Millie stood up and hugged Arlette, and said she hopes everything                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
041999 - works out.  Millie asked if there is anything she can do to help                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
042000 - Arlette wheather this storm?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042002 -  ..
042003 - Arlette said no, and feels she is on the road to recovery now that                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042004 - she has a place to stay, and will be moving into an apartment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
042005 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042006 -            [On 100602 1525 Millie received sympathy letter from                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042007 -            Arlette on ending treatment to recover from UCSF medical                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042008 -            mistakes. ref SDS A7 036C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
042010 -  ..
042011 - Arlette left.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
042013 -  ..
042014 - Doctor Johnson returned, and said everything is set up for Millie to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042015 - start Hospice.  He commended Kaiser for making this transition fast                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042016 - and easy for doctors and patients.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042018 -  ..
042019 - Doctor Johnson said he's sorry that lining up treatment for Millie to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
042020 - recover from cancer is not fast and easy.  He is very disappointed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
042021 - that Doctor Rugo has not returned his calls and email on a work plan                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
042022 - for Millie to recover from UCSF medical mistakes, per above.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
042023 - ref SDS 0 4F6I  The doctor feels Millie will get good care to avoid                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
042024 - pain in Hospice.  He commended the Hospice pharmacist, Bob, for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042025 - excellent work controlling patient pain.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
042026 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042027 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042028 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042029 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042030 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042031 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
042032 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0421 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

SUBJECTS
Default Null Subject Account for Blank Record                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
0503 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050401 -  ..
050402 - Medical Chart                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050403 - 
050404 - Follow up ref SDS 87 R45K, ref SDS 86 R45K.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
050405 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050406 -    1.  Subject:  Visit 06/01/10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050407 -        Patient presents with: RECHECK                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050408 -        Received: 6/1/10 9:17 AM                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050409 -        To: Mildred A Buck                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050410 -        From: ROBERT ALLSTON JOHNSON MD                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050412 -         ..
050413 -    2.  History of Present Illness:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050414 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050416 -        74 Y female with a history of IBC of left breast who was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050417 -        initially diagnosed 03/04/02.  S/P AC x's 4 from 04/23/02                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050418 -        through 07/01/02 followed by Taxotere ending 12/04/02.  She had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050419 -        recurrent disease noted initially in the cervical LN's                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050420 -        03/03/04.  On E2100 Study with Taxol/Avastin, but she had a PE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050421 -        noted on CT 11/03/2004.  Then, because of progression of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050422 -        disease, the patient was started on Taxotere and Xeloda                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050423 -        4/15/05.  She had a total of 8 cycles ending 9/16/05.  She had                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050424 -        a palliative left mastectomy performed 10/21/05.  Then her left                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050425 -        chest lesions began expanding again.  The patient started                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050426 -        Taxotere and Xeloda again 07/21/06 for 7 cycles.  She was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050427 -        started on a Clinical Trial 02/01/07 at UCSF and was randomized                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050428 -        to the Erbitux only (no Carbo) Arm.  She had weekly Carboplatin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050429 -        added 03/13/08 because of progression of disease.  Her disease                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050430 -        progressed again and she began a Phase I/II Study of Sunitinib                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050431 -        (SU11248) at UCSF 11/14/08.  Lengthy discussion about current                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050432 -        status and response to therapy.  Because of cytopenias, MTX to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050433 -        be D/C'd and Sutent and CTX held and then dose reduced.  The                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050434 -        patient started hyperthermia/XRT at UCSF 02/19/09 and completed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050435 -        it 03/17/09.  She has started the MPA Clinical Trial at UCSF                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050436 -        06/16/09 but this has been D/C'd.  She started Gemzar 07/28/09                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050437 -        and received Cycle #4 11/05/09.  Because of evidence of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050438 -        progression she was switched to Navelbine 11/18/09.  However,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050439 -        she then developed erythema and nodularity on her right breast.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050440 -        Because of this and a rising CA 15-3 she was switched to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050441 -        Abraxane 03/03/10.  She states that lymphedema continues to                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050442 -        increased in the right arm.  Neuropathy pain persists across                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050443 -        right forehead, head, and down neck to across upper back.  She                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050444 -        went on cruise May 15.  She is here for FU.  She c/o pruritis                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050445 -        of her skin lesions.  Also has tenderness of veins LLE.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050447 -         ..
050448 -    3.  Current medications:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050449 -        HYDROCODONE/ACETAMINOPH 5-5                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050450 -        WARFARIN 4 MG TABLETS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050451 -        LUMIGAN 0.03% EYE DROPS (2.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050452 -        TIMOLOL MALEATE 0.5% EYE DR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050453 -        OXYCODONE W/APAP 5-325 MG T                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050454 -        AEROCHAMBER Z-STAT/PLUS W/O                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050455 -        QVAR 80 MCG ORAL INHALER                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050456 -        ALBUTEROL HFA 90MCG ORAL IN                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050457 -        GUAIFEN/CODEIN 100-10MG/5ML                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050458 -        LORAZEPAM 1 MG TABLETS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050460 -         ..
050461 -    4.  Review of systems:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050462 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050463 -        Constitutional: Appetite and energy level are improving.  Plans                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050464 -        on taking trip to the Mediterranean in May; 12 day cruise                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050466 -         ..
050467 -        Eyes: Seen by Ophthalmology 01/11/10                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050468 -        ENT: No nose bleeds.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050469 -        Cardiovascular: No SOB, palpitations or chest pain                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050470 -        Respiratory: No hemoptysis or cough. No DOE noted.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050471 -        GI: No nausea, vomiting or diarrhea                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050472 -        GU: No hematuria or dysuria                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050474 -         ..
050475 -        Musculoskeletal: Left neck spasm and right shoulder pain stable                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050476 -        with Robaxin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050478 -         ..
050479 -        Skin: Pruritis of chest wall resolved                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050481 -         ..
050482 -        Neurological: Persisting mild postherpetic neuropathy                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050484 -         ..
050485 -        Psychiatric: No evidence of anxiety or depression today                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050487 -         ..
050488 -    5.  Physical Exam:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050489 -        ECOG Performance Score 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050490 -        BP 178/88 | Temp (Src) 97.9 F (36.6 C) (Oral) | Wt 136 lb 12.8 oz (62.052                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050491 -        kg) | SpO2 97%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050492 -        Head: shingles right side of forehead largely gone                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050493 -        Eyes: normal conjunctiva                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050494 -        Mouth: normal mucosa                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050495 -        Lymph: no nodes palpable in neck or axillae                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050496 -        Breasts: evidence of erythema to other breast. Less edema in both arms                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050497 -        Lungs: clear to percussion and auscultation                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050498 -        Heart: regular without murmur or gallop                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050499 -        Abd: soft with normal bowel sounds. No masses or organomegaly                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050500 -        Ext: Edema increasing in both arms now                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050501 -        Bones: no tenderness                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050502 -        Neuro: awake, alert, and oriented. Moves all extremities well. Normal gait.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050504 -         ..
050505 -    6.  Lab:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050506 -        PT, Patient H 35.4 Sec                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050507 -        PT INR 3.3 Ratio                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
050508 -        Bili, Tot Adult 0.4 mg/dL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050509 -        Creatinine 0.65 mg/dL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050510 -        ALT (SGPT) 15 U/L                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050511 -        WBC 10.7 K/uL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050512 -        RBC 3.80 M/uL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050513 -        Hemoglobin L 11.4 g/dL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050514 -        Hematocrit 34.9 %                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050515 -        MCV 92 fL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050516 -        RDW H 15.4 %                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050517 -        Plt 243 K/uL                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050519 -         ..
050520 -    7.  CA 15-3                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050521 -        -----------                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050522 -        520 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050523 -        424 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050524 -        367 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050525 -        384 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050526 -        369 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050527 -        426 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050528 -        328 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050529 -        275 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050530 -        212 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050531 -        248 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050532 -        211 H                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050534 -         ..
050535 -    8.  Imaging:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050536 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050537 -        02/18/10 CT THORAX W CONTRAST - 1. Mild interval improvement of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050538 -        the patchy ground glass opacities bilaterally.  There are still                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050539 -        a few patchy densities noted predominantly in the bilateral                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050540 -        lung bases.  New area of subsegmental atelectasis vs                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050541 -        post-inflammatory scarring right upper lobe.  Resolution of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050542 -        small left pleural effusion.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050544 -         ..
050545 -    9.  01/19/10 MRI BRAIN WO/W CONTRAST(STD) - No significant abnormalities.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050547 -         ..
050548 -   10.  09/19/09 CT THORAX W CONTRAST - No pulmonary emboli on a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050549 -        technically good study.  The lungs show multiple areas of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050550 -        groundglass opacity and multiple small areas of more confluent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050551 -        density.  Tiny left pleural effusion.  S/P left mastectomy.  A                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050552 -        few additional minor findings, as described above.  Since July                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050553 -        20, 2009 CT scan of the chest, there has been resolution of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050554 -        many of the pulmonary opacities but there are now many new                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050555 -        ones, especially in the left lower lobe and in the right upper                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050556 -        lobe.  The left pleural effusion is much smaller.  Otherwise,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050557 -        no change.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050559 -         ..
050560 -   11.  09/19/09 CHEST, SINGLE                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050562 -         ..
050563 -   12.  07/31/09 RIBS, UNILATERAL, 2 VIEWS - Right ribs appear intact                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050565 -         ..
050566 -   13.  07/20/09 CT THORAX W CONTRAST -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050567 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050568 -        1.  Negative for pulmonary embolus.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050569 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050570 -        2.  New small left pleural effusion.  No pleural enhancement or                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050571 -            evidence of loculation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050573 -             ..
050574 -        3.  Otherwise stable chest CT compared with recent examination                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050575 -            from one month earlier.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050577 -         ..
050578 -   14.  06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050580 -         ..
050581 -   15.  06/12/09 CT NECK W CONTRAST                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050583 -         ..
050584 -   16.  03/17/09 DXA BONE DENSITY, AXIAL -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050585 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050586 -        1.  Bone mineral density                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050587 -            calculated for the LUMBAR SPINE is                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
050588 -            statistically consistent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050589 -            with osteopenia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
050591 -             ..
050592 -        2.  Bone mineral density calculated for the                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050593 -            TOTAL HIP is statistically consistent with osteopenia.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050595 -         ..
050596 -   17.  01/22/09 SHOULDER, COMPLETE 2+ VIEWS - Orthopedic follow up.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050597 -        See Orthopedic note for details.  S/P reduction of anterior                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050598 -        shoulder dislocation.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050600 -         ..
050601 -   18.  01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050602 -        Fracture right humeral head                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050604 -         ..
050605 -   19.  01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes of                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050606 -        the cervical spine without evidence of acute C spine fracture                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050607 -        or loss in alignment.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050609 -         ..
050610 -   20.  01/22/09 CT HEAD W/O CONTRAST -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050611 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050612 -        1.  No evidence of acute infarct or hemorrhage.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050613 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050614 -        2.  Sinus disease. Mild nasal septal deviation to the right.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050616 -         ..
050617 -   21.  Assessment:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050618 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050619 -        1.  Persisting mild postherpetic neuropathy. Pruritic now.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
050620 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050621 -        2.  Metastatic breast cancer (IBC) lung, lymph node and chest wall                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050622 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050623 -        3.  Cancer pain controlled better on MS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
050625 -             ..
050626 -        4.  Lymphedema slightly worse on right; has compression garment                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050628 -             ..
050629 -        5.  Anticoagulation monitoring                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
050631 -             ..
050632 -        6.  Pruritus of skin lesions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
050634 -         ..
050635 -   22.  Plan:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050636 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050637 -        1.  D/C Abraxane 100 mg/m2 or 150 mg/m2 iv qw x 3 weeks every 4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050638 -            weeks                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050639 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050640 -        2.  Try Atarax (for pruritis) [reduce IBC itching]                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
050642 -             ..
050643 -        3.  Add Relafen (for phlebitis)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
050645 -             ..
050646 -        4.  Hospice referral; eConsult sent                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050647 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050648 -                [On 100601 1531 Sharon called to schedule meeting for                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050649 -                Millie to get Hospice care. ref SDS A4 OL77                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
050650 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050651 -                [On 100602 0913 Liz arrives to start Hospice support.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050652 -                ref SDS A5 036C                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050654 -                 ..
050655 -                [On 100602 1046 Eileen reports that Kaiser denied                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
050656 -                Millie's claim; after reading the claim, denial was                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
050657 -                withdrawn, and the matter forwarded to Claims                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
050658 -                Resolution Department for processing. ref SDS A6 UN5P                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
050660 -             ..
050661 -        5.  RTC one month                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
050662 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050663 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050666 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050667 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050668 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050669 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050670 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050671 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050672 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050673 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050674 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050675 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050676 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
050677 -                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
0507 -