CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A0 0000. ref SDS 99 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 83
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 83 SJ6N
040910 -  ..
040911 - On 100501 1037 Millie letter to medical team confirms Kaiser's new
040912 - strategy to treat Millie's cancer with "targeted therapy." ref SDS 84
040913 - F25O  Millie requests Kaiser immediately switch from Abraxane
040914 - chemotherapy that has failed, and implement Doctor Rugo's plan at UCSF
040915 - on 090616, to treat Millie with PARP that is "targeted" to Millie's
040916 - rare patient profile of "triple negative" and avoids pain and
040917 - suffering from chemotherapy side effects, and for the purpose of
040918 - recovering from UCSF medical mistakes. ref SDS 84 U47P and ref SDS 84
040919 - U49V
040921 -  ..
040922 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040923 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040924 - of cancer caused by UCSF medical mistakes. ref SDS 85 HH4I
040926 -  ..
040927 - On 100502 2143 Kaiser confirms that some patients respond well to new
040928 - "targeted" therapies. ref SDS 87 YX8L  Kaiser contends that all of the
040929 - strategies for "targeted" therapies have been executed for Millie,
040930 - which seems conflicting with the record in this case. ref SDS 87 MZ4N
040932 -  ..
040933 - On 100503 1522 Millie notifies medical team that time of the essence
040934 - to get the next treatment going. ref SDS 88 TD5W
040936 -  ..
040937 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040938 - with Abraxane chemotherapy that seems to be failing, and then after 3
040939 - more weeks without treatment, following a trip abroad, the doctor will
040940 - discuss "next steps." ref SDS 89 YL5N
040942 -  ..
040943 - On 100503 2338 Millie reports to medical team that she will implement
040944 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040945 - letter on 010503, as assurance that recovery will be equal to changing
040946 - treatment immediately on 100505. ref SDS 90 6X7S
040948 -  ..
040949 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040950 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040951 - communicate with Doctor Johnson, or had already done so, to coordinate
040952 - with Kaiser on planning Millie's next treatment to recover from the
040953 - 11th relapse of cancer. ref SDS 91 NT5N
040955 -  ..
040956 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040957 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040958 - ref SDS 92 KE4K
040960 -  ..
040961 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040962 - seemingly on an accelerating rise, which threatens to cascade out of
040963 - control, because Abraxane chemotherapy is not effective. ref SDS 93
040964 - L54I
040966 -  ..
040967 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040968 - Abraxane. ref SDS 94 KE4K
040970 -  ..
040971 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 95 PK9O
040973 -  ..
040974 - On 100527 0217 Millie files claim with Kaiser Claims Resolution
040975 - Department for standard of care to recover from 11th relapse of cancer
040976 - caused by medical mistakes getting radiation treatments at UCSF on
040977 - referral from Kaiser. ref SDS 96 IZ7N
040979 -  ..
040980 - On 100528 0322 Millie requests support from Medicare to separate
040981 - recovery for medical mistakes getting radiation from UCSF, from health
040982 - care benefits limited by Medicare insurance coverage. ref SDS 97 QQ6N
040984 -  ..
040985 - On 100528 1031 called Medicare they have formed a team to review
040986 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040987 - response to Millie's claim. ref SDS 98 4W5F
040989 -  ..
040990 - 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040991 - collaborate with UCSF on treatment for Millie to recover from UCSF
040992 - medical mistakes.  He discussed treating Millie with MPA, but this was
040993 - not prescribed because Millie was treated with MPA in 2009, and UCSF
040994 - ended the treatment due to fears about blood clot side effects, which
040995 - were believed to cause breathing problems Millie had, though later
040996 - breathing problems were discovered to be caused by defective radiation
040997 - treatment.  Since Doctor Johnson said Kaiser has no more treatments
040998 - for Millie, the only way Millie can get relief from pain caused by
040999 - cancer that is progressing without treatment is get treatment in
041000 - Hospice.  Since Hospice is the only choice of care offered today,
041001 - Millie accepted this.
041003 -  ..
041004 - On 100601 1531 Sharon called to schedule starting Hospice medical
041005 - services beginning tomorrow between 0900 - 1000. ref SDS A0 036C
041007 -  ..
041008 - On 100602 0913 Liz provides orientation on Hospice care; she confirms
041009 - Sharon's report yesterday, that if Kaiser performs on the insurance
041010 - agreement to provide standard of care for Millie's patient profile,
041011 - than Millie can elect to recover from 11th relapse of cancer, rather
041012 - than continue with Hospice support for dying peacefully. ref SDS 0
041013 - 036C
041014 -
041015 -
041016 -
041018 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Liz explained Hospice services are for terminal patients not getting
041402 - treatment to recover from cancer.  She submitted a thick folder with
041403 - perhaps 50 pages of documents.  She used documents in the folder to
041404 - guide discussion during the meeting, including identify Millie's
041405 - Hospice support team at Kaiser.
041407 -  ..
041408 - Liz asked if Millie has an Advance Directive on file at Kaiser?  She
041409 - looked for this at Kaiser before coming to the meeting and could not
041410 - find documentation.
041411 -
041412 -        [On 100604 1350 Linda, Hospcie Case Manager, asked again for
041413 -        Millie's Advance Directive to avoid life-sustaining measures.
041414 -        ref SDS A3 FO4G
041416 -         ..
041417 -        [On 100607 1243 Judy reported that searching the records
041418 -        does not show Millie has an Advance Directive on file at
041419 -        Kaiser; Judy will investigate and let Millie know if this
041420 -        work needs to be done again. ref SDS A4 AO6J
041422 -  ..
041423 - Millie related signing an Advance Directive and it was signed by
041424 - Doctor Johnson during a meeting at Kaiser on 100302. ref SDS 70 P58M
041425 - This was reported to Sharon during the call yesterday when she called
041426 - to schedule Millie starting in Hospice, shown in the record on 100601
041427 - 1531, ref SDS A0 JY56
041429 -  ..
041430 - Liz asked who among family and friends will provide Millie's support
041431 - group for Hospice care going forward.
041433 -  ..
041434 - Millie advised that Rod is the support group.
041436 -  ..
041437 - Liz said Millie will have another doctor asisgned from Hospice.  The
041438 - team will continue to work with Doctor Johnson, who has extensive
041439 - experience treating Millie the past 10 years.
041441 -  ..
041442 - Liz has worked with Doctor Johnson a lot.
041444 -  ..
041445 - Millie related getting excellent care through 10 relapses, reported by
041446 - Doctor Johnson on 090213. ref SDS 28 4W72
041448 -  ..
041449 - During the meeting today, Liz sat in the rocking chair next to the
041450 - coffee table, close to Millie on the sofa, and she used a notebook
041451 - computer on her lap to enter notes of the discussion.  Liz also seemed
041452 - to have some of Millie's patient history accessible on her computer
041453 - today.
041454 -
041455 -               [On 100604 1350 Linda, Millie's Hospice case manager,
041456 -               also used a notebook computer to write notes on the
041457 -               meeting, and to look up details on Millie's patient
041458 -               history. ref SDS A3 BO4O
041460 -                ..
041461 -               [On 100607 1243 Judy, Hospice social provider, used a
041462 -               notebook computer to write notes that jog her memory on
041463 -               what was discussed during the meeting. ref SDS A4 HL7G
041465 -  ..
041466 - Liz submitted a lot of papers in a Hospice folder.  She said that
041467 - Kaiser cannot submit this material in computer files for efficient
041468 - case management.  She read through some of Kaiser's documentation,
041469 - including Millie's onsite Hospice support team...
041470 -
041471 -        1.  Hospice case manager will be Linda.  She will typically
041472 -            visit Millie once a week, and may come for the first visit
041473 -            on Friday, 100604.
041475 -             ..
041476 -        2.  Hospice also provides social support once a month.  The
041477 -            social worker is another Linda.
041479 -             ..
041480 -        3.  Home support aid for bathing and helping with meals, etc.
041482 -             ..
041483 -        4.  Religious counseling with non-denominational Chaplin.
041485 -             ..
041486 -        5.  Home companinoship with volunteers.
041488 -             ..
041489 -        6.  24-7 telephone support with after-hours advice nurse.
041491 -             ..
041492 -        7.  Emergency care from Fire Department.
041494 -  ..
041495 - Liz asked about religious affiliation and if Millie would like the
041496 - Hospice Chaplin to visit for faith and comfort, per above? ref SDS 0
041497 - K87I
041499 -  ..
041500 - Millie related discussion with Sharon yestreday, declining religious
041501 - support, reported on 100601 1531. ref SDS A0 IR6H  She feels her
041502 - family and strong network of support from friends will continue to
041503 - sustain her faith and emotional comfort.
041505 -  ..
041506 - Liz was pleased to see Millie is mobile, and able to function normally
041507 - in all respects for personal care and hygene at this time.  She asked
041508 - if Millie has any equipment available for assisting physical needs,
041509 - for example a walker and stool to sit while taking a shower.
041510 -
041511 -            [On 100715 0935 Millie got the phone and address for Atta
041512 -            Vista Services, listed in Kaiser's documentation received
041513 -            today. ref SDS A5 XS5H
041515 -  ..
041516 - Millie advised she still has a walker from breaking her ankle 10 years
041517 - ago while working out in the gym.  There is also a stool for the
041518 - shower provided for Rod, after heart surgery in October 2009.
041520 -  ..
041521 - Liz asked for Millie's height and weight.
041522 -
041523 -               Height............ 5'2"
041524 -               Weight............ 132 as of 100529
041526 -  ..
041527 - Millie has lost about 5 pounds in the past month, and 10 pounds in 2
041528 - months, due to reduced appetite.
041530 -  ..
041531 - Millie feels Rod is making the meals too large.  She is trying to eat
041532 - more, but sometimes feels nauseous with all the medications, and just
041533 - can't eat.
041535 -  ..
041536 - Liz suggested meals with smaller portions that do not look
041537 - overwhelming.
041539 -  ..
041540 - Liz asked about Millie's pain on a scale of 1 - 10.
041542 -  ..
041543 - Millie said that at the moment, her pain is 5 or 6.
041545 -  ..
041546 - Millie described "ill-feeling" like her chest is being squeezed mostly
041547 - on the right side by rising inflammation from IBC progressing, since
041548 - she has been without effective treatment since July of last year, and
041549 - has had no treatment for 3 weeks.
041551 -  ..
041552 - Liz related that Hospice strives to provide medication to control pain
041553 - below 5.
041555 -  ..
041556 - Millie said that is why she signed up for Hospice.  She has no choice,
041557 - discussed with Doctor Johnson yesterday on 100601 0830. ref SDS 99
041558 - 4G6G
041560 -  ..
041561 - Liz confirmed discussion with Sharon yesterday, that if Kaiser and
041562 - UCSF can resolve telephone and email problems so Millie can recover
041563 - from UCSF medical mistakes with treatment that controls Millie's
041564 - cancer without painful side effects, then Millie can end Hospice to
041565 - continue her life. ref SDS A0 JN5J
041566 -
041567 -            [On 100602 1046 Eileen reports that Kaiser denied
041568 -            Millie's claim; but, after reading the claim, denial was
041569 -            withdrawn, and the matter forwarded to Claims
041570 -            Resolution Department for processing. ref SDS A2 UN5P
041572 -  ..
041573 - Liz asked for Millie's current pain medications.
041575 -  ..
041576 - Millie listed primary pain medications in the medical chart at Kaiser.
041577 -
041578 -            1.  Morphine 12-hour time release.
041579 -
041580 -            2.  Percocet for breakthrough pain.
041582 -  ..
041583 - Millie further reported that during a meeting at Kaiser yesterday on
041584 - 100601, Doctor Johnson diagnosed phlebitis in Millie's lower legs.  He
041585 - prescribed treatment with Relafen for 2 weeks to recover from
041586 - inflammation from Phlebitis. ref SDS 99 OP4G
041588 -  ..
041589 - Liz and Millie went upstairs to write inventory of Millie's prescribed
041590 - medications.  She entered in her notebook computer prescriptions as
041591 - entered on all of the bottles.
041593 -  ..
041594 - Liz advised that Millie is getting a very low dose of morphine, and
041595 - this can be increased to reduce pain.
041597 -  ..
041598 - Millie recalled that she forgot to take morphine this morning due to
041599 - activity getting the house in order ready for Liz's visit.
041601 -  ..
041602 - Liz feels that this record does not support changing Millie's current
041603 - medications prescription.  She also noted that the new medication with
041604 - Relafen for Phlebitis complements morphine and Percocet to relieve
041605 - pain in Millie's chest from advancing IBC.  Since Millie just started
041606 - taking Relafen last night, Liz wants to try for a day or so to keep
041607 - the current prescription for morphine, and then evaluate changes if
041608 - needed.  She noted that increasing and extending treatment with
041609 - Ralafen beyond 2 weeks, can be tried before increasing morphine, since
041610 - it would not increase drowsiness.
041612 -         ..
041613 -        [On 100604 1350 Linda orders increasing morphine to 2 pills at
041614 -        once, twice a day, doubling morphine. ref SDS A3 PC65
041616 -  ..
041617 - Liz discussed changing Millie's prescription for Percocet to just
041618 - oxycodone.  She also explained that Hospice will have delivered an
041619 - emergency "Kit" of additional medications to have on hand as needed
041620 - later to help Millie.
041622 -  ..
041623 - Liz called Bob, who is the pharmacist for Hospice.  They consulted on
041624 - Millie's medications for pain.  Bob concurred that since Millie missed
041625 - taking morphine this morning, and just started treatment to control
041626 - inflammation from phlebitis, this should be tried for another few days
041627 - before adjusting doses, as Liz discussed with Millie, per above.
041628 - ref SDS 0 3V7X
041630 -  ..
041631 - Millie was concerned that since she missed taking morphine at 0700
041632 - this morning, she has to wait until 1900 tonight to keep her
041633 - treatments on the 12-hour time release cycle.
041635 -  ..
041636 - Liz explained that Millie can take morphine immediately, and still
041637 - take another at 1900.  She said the timing is not exact.  She seemed
041638 - to say Millie can take morphine as needed, but should report any
041639 - increase so the Hospice team and Doctor Johnson can make decisions
041640 - based on actual amount of medication Millie is taking.
041642 -  ..
041643 - Millie took her morphine medication.
041645 -  ..
041646 - Liz said that Linda, Millie's case manager for Hospice, may make her
041647 - first visit on Friday, 100604.  Millie can report results trying to
041648 - control pain with currently prescribed medications, and Linda can
041649 - consult with Bob again to consider adjustments if needed to achieve
041650 - pain level below 4.
041651 -
041652 -        [On 100604 1350 Linda orders increasing morphine to 2 pills at
041653 -        once, twice a day, doubling morphine. ref SDS A3 PC65
041655 -  ..
041656 - Millie's big concern is to balance taking morphine and other pain
041657 - relief medications that make her drowsy.  She prefers a slight
041658 - increase in pain to 5, if getting below 4 requires spending all day in
041659 - bed drugged like a zonbie.
041661 -  ..
041662 - Liz emphasized that this is a patient choice, and that Hospice will
041663 - work closely with Millie to balance being as active as possible, and
041664 - tolerating pain from advancing cancer.
041665 -
041666 -        [On 100604 1350 Linda orders increasing morphine to 2 pills at
041667 -        once, twice a day, doubling morphine. ref SDS A3 PC65
041669 -  ..
041670 - Liz also called and left a message for Doctor Johnson, asking about
041671 - changing Millie's pain medication for Percocet to just oxycodone.  She
041672 - also related Bob's analysis to wait a few days to evaluate adjusting
041673 - pain medication.
041675 -  ..
041676 - Liz took out a portable printer and connected to a wall socket in the
041677 - living room.  She connected her notebook computer to the printer to
041678 - print the list she prepared of Millie's medications, per above.
041679 - ref SDS 0 PS7U  Liz appologized saying she has trouble with the
041680 - printer lately, so this may not work.  The printer was serviced
041681 - recently, but still has problems.
041683 -  ..
041684 - Related problems Doctor Johnson and Doctor Rugo are having using the
041685 - computer for case management, reported in the meeting yesterday at
041686 - Kaiser. ref SDS 99 4F6I
041688 -  ..
041689 - Liz was overjoyed that the printer worked.  She handed Millie a piece
041690 - of paper and said to put it in a safe place that is fast to get for
041691 - easy access.
041693 -  ..
041694 - Liz advised that she will prepare a report on understandings from the
041695 - meeting today, including discussion of Hospice objectives,
041696 - requirements, and commitments.  She said the report will be available
041697 - to her Hospice team on the coputer for fast and easy case management.
041699 -  ..
041700 - Asked about Millie getting a letter sent through email transmitting
041701 - Liz's report to confirm understandings from meeting today, including
041702 - the list of treatments.  This increases productivity 1000% to make
041703 - case management fast and easy for Millie, as Liz plans for the Hospice
041704 - team.
041706 -  ..
041707 - Liz said that none of her patients have ever asked for a report on the
041708 - work.
041710 -  ..
041711 - Liz said that all patient calls to the Hospice office are tape
041712 - recorded, so that provides an accurate record, if anybody needs to
041713 - check.
041715 -  ..
041716 - Reviewed advantages of getting a written record which can then be
041717 - converted into the power of knowledge for working intelligently, as
041718 - shown in this record, and explained in NWO. ref OF 11 PX6J
041720 -  ..
041721 - Liz will talk to Doctor Johnson about the work practice applying
041722 - Kaiser's policy to improve care with doctor/patient partnership, and
041723 - this has been effective for 9 years using email, reported by Doctor
041724 - Johnson on 090213. ref SDS 28 FZ4H  He commented again on benefits of
041725 - effective case management supported by fast and easy access to
041726 - Millie's patient history submitted routinely with email. ref SDS 43
041727 - XM9J
041728 -
041729 -
041731 -  ..
0418 -
0419 -
0420 - 1744
0421 -
042101 - Daniel called with Hospice After-hours Advice.
042102 -
042103 -                    866 331 3217
042105 -  ..
042106 - Daniel has read Liz's report on Millie's pain at level 5 during the
042107 - meeting at 0930 this morning, per above. ref SDS 0 3V53
042109 -  ..
042110 - He asked for the level now.
042112 -  ..
042113 - Millie advised she feels pain is about level 5, as it was this
042114 - morning.
042116 -  ..
042117 - We reviewed Liz's consultations with Bob and call to Doctor Johnson,
042118 - planning to assess current medications and doses until Friday, when
042119 - Linda may visit to start Hospice case management, per above.
042120 - ref SDS 0 NN8F
042122 -  ..
042123 - Daniel feels that Millie's goals are appropriate to balance medication
042124 - for pain against having an active life worth living.  He feels that
042125 - everybody is on the same page, and evaluating the pain issue again on
042126 - Friday after several days experience with the current protocol is a
042127 - good work plan.
042129 -  ..
042130 - Thanked Daniel for following up.
042132 -  ..
042133 - Asked for an email address to confirm understandings.
042135 -  ..
042136 - Daniel said that isn't necessary, because Kaiser trains the Hospice
042137 - team to write everything down, and besides calls are tape recorded, as
042138 - Liz noted earlier today, per above. ref SDS 0 DN3L
042139 -
042140 -     [On 100604 1350 Linda reported she did not get a copy of Millie's
042141 -     letter to the medical team showing everybody is the same page for
042142 -     pain medication. ref SDS A3 XL7H
042143 -
042144 -
042145 -
042146 -
042147 -
042148 -
042149 -
0422 -