CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A1 0000. ref SDS 85 0000.
040502 -
040503 -
040505 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 010427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks
040902 - so good nobody can believe she has such severe cancer, ref SDS 85
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through
040904 - 11 relapses to resist chemotherapy.  The doctor advised that Kaiser
040905 - has a new strategy prescribing therapy that is effective for treating
040906 - cancer as a chronic disease by "targeting" the genetic profile of
040907 - cancer that has mutated in patients, like Millie, to resist
040908 - chemotherapy. ref SDS 85 SJ6N
040910 -  ..
040911 - On 100501 1037 Millie letter to medical team confirms understanding of
040912 - new strategy to treat Millie's cancer with targeted therapy.
040913 - ref SDS 86 F25O
040915 -  ..
040916 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040917 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040918 - of cancer caused by UCSF medical mistakes. ref SDS 87 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 89 YX8L  Kaiser contends that all of the
040923 - strategies for "targeted" therapies have been executed for Millie,
040924 - which seems conflicting with the record in this case. ref SDS 89 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 90 TD5W
040930 -  ..
040931 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040932 - with Abraxane chemotherapy that seems to be failing, and then after 3
040933 - more weeks without treatment, following a trip abroad, the doctor will
040934 - discuss "next steps." ref SDS 91 YL5N
040936 -  ..
040937 - On 100503 2338 Millie reports to medical team that she will implement
040938 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040939 - letter on 010503, as assurance that recovery will be equal to changing
040940 - treatment immediately on 100505. ref SDS 92 6X7S
040942 -  ..
040943 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040944 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040945 - communicate with Doctor Johnson, or had already done so, to coordinate
040946 - with Kaiser on planning Millie's next treatment to recover from the
040947 - 11th relapse of cancer. ref SDS 93 NT5N
040949 -  ..
040950 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040951 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040952 - ref SDS 94 KE4K
040954 -  ..
040955 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040956 - seemingly on an accelerating rise, which threatens to cascade out of
040957 - control, because Abraxane chemotherapy is not effective. ref SDS 95
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 96 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 97 PK9O
040967 -  ..
040968 - On 100527 0217 Millie files claim with Kaiser Claims Resolution
040969 - Department for standard of care to recover from 11th relapse of cancer
040970 - caused by medical mistakes getting radiation treatments at UCSF on
040971 - referral from Kaiser. ref SDS 98 IZ7N
040973 -  ..
040974 - On 100528 0322 Millie requests support from Medicare to separate
040975 - recovery for medical mistakes getting radiation from UCSF, from health
040976 - care benefits limited by Medicare insurance coverage. ref SDS 99 QQ6N
040978 -  ..
040979 - On 100528 1031 called Medicare they have formed a team to review
040980 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040981 - response to Millie's claim. ref SDS A0 4W5F
040983 -  ..
040984 - 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040985 - collaborate with UCSF on treatment for Millie to recover from UCSF
040986 - medical mistakes.  He discussed treating Millie with MPA, but this was
040987 - not prescribed because Millie was treated with MPA in 2009, and UCSF
040988 - ended the treatment due to fears about blood clot side effects, which
040989 - were believed to cause breathing problems Millie had, though later
040990 - breathing problems were discovered to be caused by defective radiation
040991 - treatment.  Since Doctor Johnson said Kaiser has no more treatments
040992 - for Millie, the only way Millie can get relief from pain caused by
040993 - cancer that is progressing without treatment is get treatment in
040994 - Hospice.  Since Hospice is the only choice of care offered today,
040995 - Millie accepted this.
040997 -  ..
040998 - On 100601 1531 Sharon called to schedule starting Hospice medical
040999 - services beginning tomorrow between 0900 - 1000. ref SDS 0 036C
041000 -
041001 -
041003 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Sharon Smith called, representing Kaiser Hospice program, which is a
041402 - Medicare health benefit.  This first call is made from something like
041403 - the "Intake-Admissions" office.
041404 -
041405 -                       925 229 7801
041407 -  ..
041408 - Shelly Tayler manages the Hospice Intake Admissions Department...
041409 -
041410 -                       925 229 7813
041412 -  ..
041413 - Dana Smith is the chief of Kaiser's Hospice Department...
041414 -
041415 -                       925 229 7812
041417 -  ..
041418 - Sharon was aware of Rod providing patient assistance, indicating she
041419 - has been briefed on Millie's patient history, in that Rod does not
041420 - appear in any Kaiser health care records for Millie, including the
041421 - medical chart.
041422 -
041423 -            [On 100701 0915 Carol called and represented herself as
041424 -            Chief of Hospice. ref SDS A7 036C
041426 -  ..
041427 - Millie was sleeping, but woke up and listened to the discussion with
041428 - Sharon, and made a few comments.
041430 -  ..
041431 - Sharon asked if Kaiser should call Millie's daughter, Pam, who has
041432 - durable power of attorney, for assistance setting up Hospice support
041433 - in the call today?
041435 -  ..
041436 - Millie said that calling Pam for initial work with Hospice today is
041437 - not unnecessary,
041439 -  ..
041440 - Sharon advised that the Hospice Department received an e-consult from
041441 - Doctor Johnson presenting Millie's complex patient history, listed on
041442 - 090213. ref SDS 29 AC6G  This aligns with the medical chart for the
041443 - meeting today that reports Doctor Johnson's plan to file an e-consult
041444 - for Hospice. ref SDS A1 7E4P
041446 -  ..
041447 - Sharon described having read an extensive narrative on Millie's
041448 - patient history, saying Millie has been through a lot.  This sounds
041449 - like Doctor Johnson used cut and paste to copy the narrative from
041450 - Millie's medical chart into the e-consult, as he has done previously
041451 - ordering tests.
041453 -  ..
041454 - Sharon asked about mobility - does Millie use a wheelchair, walker,
041455 - cane, or have any injuries that make walking difficult and risk
041456 - falling?  Will the nurse need extra help to provide Hospice care?
041458 -  ..
041459 - Reported Millie does not use a walker nor wheelchair.  Mobility has
041460 - suffered recently from rising fatigue, caused by side effects of
041461 - chemotherapy and from advancing cancer that resists treatment with
041462 - chemotherapy.
041464 -  ..
041465 - Sharon asked if Millie has any skin problems, like lesions, itching,
041466 - open wounds with blood or puss seeping that require special dressing
041467 - by the Hospice nurse?
041469 -  ..
041470 - Explained Millie's primary problems are in her skin, diagnosed a IBC
041471 - on 040614, ref SDS 3 6T5G, with initial symptoms reported in testing
041472 - in 2002.
041474 -  ..
041475 - Millie's only open wound is in the breastbone area caused by untreated
041476 - cancer due to medical mistake getting radiation treatment from UCSF on
041477 - referral from Kaiser, reported by Doctor Hsu at UCSF on 090609.
041478 - ref SDS 39 W65W  The medical team has had difficulty providing care
041479 - to fix this mistake, and without treatment, it will get even worse.
041481 -  ..
041482 - Sharon related having extensive experience treating patients with IBC.
041483 - She feels Millie has been fortunate getting good care, because 9 years
041484 - is a long time to survive IBC.
041486 -  ..
041487 - Sharon asked for extent of internal cancer involving lungs, brain,
041488 - pancreas, etc., so the Hospice nurse can be prepared for physical
041489 - compromise, and level of support Millie needs.  Sharon noted that
041490 - patients with IBC suffer progression to internal organs where cancer
041491 - spreads faster than treatment can resolve, leading to death.
041493 -  ..
041494 - Millie spoke up and noted that her friend, Laura, got IBC in 2007, and
041495 - was treated at UCSF.  Laura's cancer spread to the brain and pancreas.
041496 - She died this past January, after a valiant fight, reported on 100106
041497 - 1048. ref SDS 55 ZY5J
041499 -  ..
041500 - Sharon asked if Millie has anxiety and is depressed entering Hospice
041501 - and giving up treatment?
041503 -  ..
041504 - Millie was greatly encouraged on 100228, because Doctor Johnson
041505 - notified that testing shows the main progression of her cancer is in
041506 - the skin, so she has no internal involvement that accelerates spread
041507 - of disease to prevent effective treatment and recovery. ref SDS 70
041508 - 4Q54
041510 -  ..
041511 - The medical chart today, and for the past 9 yers, shows Millie is ECOG
041512 - performance score 0 - she is without internal involvement and physical
041513 - durress. ref SDS A1 W15Y
041515 -  ..
041516 - Sharon asked why Millie is entering Hospice with ECOG performance
041517 - score 0, since normally this occurs with ECOG > 2 , shown by research
041518 - on 090205 1600. ref SDS 28 JG5I
041520 -  ..
041521 - Millie is discouraged and frustrated being forced to give up treatment
041522 - to recover from UCSF medical mistakes, because Kaiser and UCSF do not
041523 - have time to provide standard of care.  Doctor Johnson's report this
041524 - morning was depressing at Kaiser saying communication with Doctor Rugo
041525 - at UCSF has failed using the telephone and email to collaborate with
041526 - Kaiser on providing necessary and reasonable care for Millie to
041527 - recover from mistakes getting radiation treatments at UCSF on referral
041528 - from Kaiser, shown in the record on 100601 0830, ref SDS A1 OK8U
041530 -  ..
041531 - Millie suffers emotional compromise losing faith in health care to
041532 - meet commitments for over a year.  After Doctor Rugo reported on
041533 - 090616, that everybody at Kaiser and UCSF is on board for Millie to
041534 - recover from medical mistakes, case management mutated to resist
041535 - performing the work, similar to Millie's cancer mutating to resist
041536 - chemotherapy.  Emotional durress from failed case management combined
041537 - with physical durress from failure to provide treatment targeted to
041538 - Millie's cancer causes severe anxiety and depression, i.e., giving up.
041540 -  ..
041541 - Sharon advised that patients enter Hospice after choosing to end
041542 - treatment, or when they can no longer recover because treatment is not
041543 - effective.  Sharon noted that patients getting Hospice care must give
041544 - up pursuing treatment.
041546 -  ..
041547 - Millie feels she must enter Hospice to relieve pain and suffering from
041548 - chemotherapy and advancing cancer, becaues Kaiser and UCSF provided
041549 - treatment that is not effective for recovering from medical mistakes,
041550 - and refuse necessary and reasonable treatment that is effective for
041551 - Millie to recover from UCSF medical mistakes.  Without a prescription
041552 - for treatment, Millie feels her only choice is to get pain relief with
041553 - Hospice care, because her doctors do not have time to pursue
041554 - treatment, reported in the meeting earlier today at Kaiser.
041555 - ref SDS A1 4H4J
041557 -  ..
041558 - Sharon advised that Millie can end Hospice, if Kaiser and UCSF provide
041559 - standard of care to recover from medical mistakes.  Sharon emphasized
041560 - that patients always the right to recover from medical mistakes.
041561 -
041562 -        [On 100602 0913 Liz confirmed Sharon's advice that Millie has
041563 -        the right to recover from medical mistakes. ref SDS A2 OQ8K
041565 -         ..
041566 -        [On 100602 1046 Eileen reports that Kaiser denied Millie's
041567 -        claim; but, after reading the claim, denial was withdrawn, and
041568 -        the matter forwarded to Claims Resolution Department for
041569 -        processing. ref SDS A3 UN5P
041571 -  ..
041572 - Sharon asked if Millie is suffering pain, and have any medications
041573 - been prescribed?
041575 -  ..
041576 - Reviewed medical chart for the meeting yesterday shows Millie suffers
041577 - pain on a scale of 1 - 10, at about a 6 on her left arm, and across
041578 - her chest, mainly now on the right side.  Advised the medical chart
041579 - shows morphine and oxycodone are prescribed.  This morning Doctor
041580 - Johnson prescribed additional mediation with Relafen to control
041581 - itching. ref SDS A1 7E9W
041583 -  ..
041584 - Sharon asked if Millie's emotional distress causes anger and invective
041585 - directed at care givers; she explained that suffering pain causes
041586 - impatient, quick tempered complaining against her doctors, nurses,
041587 - patient assistant.  Will this be a problem for the Hospice nurse?
041589 -  ..
041590 - Advised that everybody loves Millie, because she never complains.  She
041591 - has always followed her doctor's advice without anger nor invective,
041592 - despite frustrations, shown by the meeting with Doctor Johnson this
041593 - morning,   Millie will try her best to be a good Hospice patient, as
041594 - she has tried the past 10 years to be a good partner with the medical
041595 - team.
041597 -  ..
041598 - Sharon asked if Millie has any breathing problems?  Will Hospice have
041599 - to provide oxygen, or special mediations?
041601 -  ..
041602 - Reported severe breathing problems were caused by progressive
041603 - radiation injury to her lung from medical mistakes getting radiation
041604 - treatment at UCSF, also, reported by Doctor Hsu on 090609. ref SDS 39
041605 - R24G  Sharon asked if Millie is on oxygen and/or is getting treatment
041606 - for shortness of breath.  Explained that painful breathing finally
041607 - resolved in December and January.  Since then breathing has returned
041608 - to normal.
041610 -  ..
041611 - Sharon said that a nurse will call tomorrow between 0800 - 0900, and
041612 - advise she will arrive for a meeting between 0900 - 1000, and the
041613 - meeting will require about 3.5 hours.
041615 -  ..
041616 - Sharon explained that a nurse will visit Millie tomorrow and ask that
041617 - Millie sign 3 documents.
041619 -  ..
041620 - The scope of these documents was not clear during the call.
041622 -  ..
041623 - Sharon indicated that Millie will not get copies of the documents she
041624 - signs.  The nurse will bring the documents to Kaiser, and Doctor
041625 - Johnson will sign them.  Sharon seemed to say that Millie can go to a
041626 - Kaiser Business Office and get a copy documents she signs tomorrow.
041628 -  ..
041629 - Sharon asked about Millie's religious affiliation.
041631 -  ..
041632 - Mil was raised in a Catholic family 70 years ago.  She is mostly
041633 - agnostic and Unitarian, without specific church affilication.  Millie
041634 - has not been to Church in 30 years, except for weddings, funerals, and
041635 - christenings.
041637 -  ..
041638 - Sharon asked if Millie will want life sustaining measures, beyond
041639 - paliation?
041641 -  ..
041642 - Advised that Millie signed an Advance Directive to avoid life
041643 - sustaining measures, reported during meeting with Doctor Johnson at
041644 - Kaiser on 100302 0830. ref SDS 72 P58M
041645 -
041646 -        [On 100602 0913 Liz asked again about Millie signing an Advance
041647 -        Directive on file at Kaiser. ref SDS A2 PE6G
041649 -         ..
041650 -        [On 100604 1350 Linda, Hospcie Case Manager, asked again for
041651 -        Millie's Advance Directive to avoid life-sustaining measures.
041652 -        ref SDS A5 MP4K
041654 -         ..
041655 -        [On 100607 1243 Judy reported that searching the records does
041656 -        not show Millie has an Advance Directive on file at Kaiser;
041657 -        Judy will investigate and let Millie know if this work needs to
041658 -        be done again. ref SDS A6 AO6J
041660 -  ..
041661 - Mil recalled that she signed an electronic online document in Doctor
041662 - Johsnon's office, and received a pink document, which is displayed on
041663 - the refrigerator door.
041665 -  ..
041666 - Sharon said to show that to the nurse tomorrow.
041668 -  ..
041669 - Sharon asked if Millie has any cats?
041671 -  ..
041672 - Reported that Mil has 2 cats.
041674 -  ..
041675 - Sharon advised that Hospice requires cats to be restricted from the
041676 - patient during the nurses visit, and for the purpose of protecting the
041677 - nurse from cat bites.
041679 -  ..
041680 - Sharon advised that patients must secure any weapons in the home,
041681 - before the nurse arrives to visit.
041683 -  ..
041684 - Advised there are no weapons in the home.
041686 -  ..
041687 - Sharon explained that Hospice care is limited.  She gave and example
041688 - if Millie needs fluid replacement, say with saline, blood, etc., she
041689 - will have to visit Kaiser Chemotherapy Infusion Clinic.
041690 -
041691 -
041692 -
041693 -
041694 -
041695 -
041696 -
041697 -
041698 -
0417 -