CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 4 0000. ref SDS 3 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
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 2
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 2 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 3
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 3 U47P and ref SDS 3
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 4 HH4I
040926 -  ..
040927 - On 100502 2143 Kaiser confirms that some patients respond well to new
040928 - "targeted" therapies. ref SDS 5 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 5 MZ4N
040932 -  ..
040933 - On 100503 1522 Millie notifies medical team that time of the essence
040934 - to get the next treatment going. ref SDS 6 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 7 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 8 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 9 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 10 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 11
040964 - L54I
040966 -  ..
040967 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040968 - Abraxane. ref SDS 12 KE4K
040970 -  ..
040971 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 13 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 14 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 15 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 16 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 3 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 4
041013 - 036C
041015 -  ..
041016 - On 100602 1046 Diane received notice from Medicare to file claim for
041017 - Millie to get treatment for recovering from UCSF medical mistakes; she
041018 - is preparing a statement of claim. ref SDS 0 036C  Advised Diane to
041019 - use Millie's statement of claim submitted to Kaiser on 100527.
041020 - ref SDS 0 MZ5H  Eileen called later and reported that Kaiser denied
041021 - Millie's claim on the grounds that Medicare does not authorize payment
041022 - for treatment to recover from cancer, after a patient starts Hospice.
041023 - ref SDS 0 UN4M  Requested that Eileen read he claim and then make a
041024 - good faith determiantion. ref SDS 0 I33H  Eileen called back after
041025 - reading the claim and advised the denial of claim has been withdrawn,
041026 - and the matter is referred to Claims Resolution Department.
041027 - ref SDS 0 UN5P
041028 -
041029 -
041030 -
041032 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Diane Sharp called on behalf of Kaiser Member Services.
041403 -  ..
041404 - Diane's office is in Stockton.
041406 -  ..
041407 - Diane did not provide a phone number.
041409 -  ..
041410 - Diane reported she received notice from Medicare that Millie has filed
041411 - a compliant against Kaiser seeking recovery for medical mistakes made
041412 - by UCSF providing radiation services on referral from Kaiser.
041413 -
041414 -            [On 100603 0449 Millie notified medical team that Kaiser
041415 -            called today about moving forward to resolve medical
041416 -            mistakes getting radiation treatment at UCSF on referral
041417 -            from Kaiser. ref SDS 19 IX9Q
041419 -  ..
041420 - Diane asked for a statement of Millie's claim.
041422 -  ..
041423 - Referred Diane to Millie's letter on 100527, sent to Paula in Kaiser's
041424 - Claims Resolution Department. ref SDS 14 IZ7N
041426 -  ..
041427 - Diane asked for Paula's phone number to call and coordinate Millie's
041428 - recovery with the Claims Resolution Department.
041429 -
041430 -
041432 -  ..
0415 -
0416 -
0417 - 1114
0418 -
041801 - Diane called back.
041802 -
041803 - She has talked to Paula, per above, ref SDS 0 MZ5H, and so now is
041804 - preparing a statement of Millie's claim.  Diane asked again for
041805 - assistance preparing Millie's statement of claim.
041807 -  ..
041808 - Referred Diane again to Millie's letter to Kaiser's Claims Resolution
041809 - Department.  The first paragraph has the title - Statement of Claim,
041810 - reported in the record on 100527 0217. ref SDS 14 IZ7N  Asked Diane to
041811 - use Millie's statment of claim in Kaiser's records processing Millie's
041812 - claim.
041814 -  ..
041815 - Diane said she will make a review and prepare a claim on behalf of
041816 - Millie, and this will be sent to another department for action.
041817 -
041818 -
041820 -  ..
0419 -
0420 -
0421 - 1504
0422 -
042201 - Stacey Algee called...
042202 -
042203 -                      888 987 7247
042205 -  ..
042206 - Stacey has the statement of claim prepared by Diane, per above.
042207 - ref SDS 0 025H
042209 -  ..
042210 - Stacey did not give the name of her department.  She asked to verify
042211 - Millie's address.
042213 -  ..
042214 - Stacey will send Millie's claim to a Kaiser analyst for evaluation.
042216 -  ..
042217 - She said the analyst will contact Millie within 72 hours on
042218 - disposition of the claim.
042219 -
042220 -
042221 -
042223 -  ..
0423 -
0424 -
0425 - 1628
0426 -
042601 - Eileen Mofitt called...
042602 -
042603 -                        888 987 7247
042605 -  ..
042606 - Eileen related having analysed Millie's claim, as planned in the call
042607 - from Stacey an hour and half ago, per above. ref SDS 0 615A
042609 -  ..
042610 - Eileen did not say where her office is located -- Oakland, Stockton,
042611 - Pleasenton???
042613 -  ..
042614 - Eileen said she has sent a letter to Millie denying her claim, and is
042615 - calling to explain the basis for denial, and answer any questions, so
042616 - Millie feels comfortable about the fairness of Kaiser's claims
042617 - determination process.
042619 -  ..
042620 - Eileen advised that the statement of claim shows Millie wants Kaiser
042621 - to send Millie for treatment in a clinical trial at UCSF.  She said
042622 - Medicare requires patients to self-refer for clinical trials, so
042623 - Kaiser is denying Millie's claim.
042625 -  ..
042626 - Asked where Eileen got the statment of claim, since Millie has not
042627 - requested treatment in a clinical trial at UCSF?
042629 -  ..
042630 - Eileen said she reviewed documentation prepared by Diane Sharp, per
042631 - telecon above. ref SDS 0 025H
042633 -  ..
042634 - Advised that Millie's claim is presented in her letter to Kaiser's
042635 - Claims Resolution Department, dated 100527, ref SDS 14 IZ7N, with copy
042636 - to Medicare on 100528. ref SDS 15 QQ6N
042638 -  ..
042639 - Eileen seemed to indicate that Diane did not quote nor cite Millie's
042640 - letter to Kaiser on 100527 presenting her claim.  She asked for the
042641 - gist of the claim.
042643 -  ..
042644 - Advised Eileen that Millie reserves the right for Kaiser to respond to
042645 - her claim as presented on 100527, ref SDS 14 IZ7N, not as summarized
042646 - in the gist of a telephone call today.
042648 -  ..
042649 - Eileen asked again for a summary of Millie's claim, so she can do her
042650 - job of making a good faith review and meet Kaiser quality care
042651 - requirements for timely response.
042653 -  ..
042654 - Read the statement of claim in Millie's letter to Kaiser on 100527,
042655 - which says nothing about clinical trials. ref SDS 14 IZ7N
042657 -  ..
042658 - Eileen advised that a doctor or doctors in her office reviewed
042659 - Millie's claim for additional treatment, and Kaiser is sending a
042660 - letter to Millie denying the claim, because Millie entered Hospice
042661 - yesterday on 100601, and Medicare will not pay Kaiser for treatment
042662 - after patients start Hospice.  Eileen said she is awfully sorry that
042663 - this unfortunate timing problem requires Kaiser to deny Millie's claim
042664 - for treatment to recover from medical mistakes that threaten her life.
042666 -  ..
042667 - Explained that Millie's claim is seperate from Medicare benefits, and
042668 - so does not require Medicare to pay Kaiser for additional treatment.
042669 - Since UCSF made the medical mistakes that caused injury requiring
042670 - treatment, and Kaiser can collect from UCSF for the cost of recovery.
042671 - Recommended again that Kaiser Claims Review look at the actual claim
042672 - Millie filed on 100527, ref SDS 14 IZ7N, in order to make good faith
042673 - determination on the merits.
042675 -  ..
042676 - Eileen said she is confused.  She does not understand why a claim is
042677 - necessary against Kaiser for non-performance?  Since UCSF made the
042678 - mistakes, Kaiser can order the work and collect from UCSF?  She asked
042679 - why is this a problem?
042681 -  ..
042682 - Reviewed the record on 091112, showing Paula's report that she was
042683 - told Kaiser does not want to collect from UCSF for the cost of
042684 - recovering from UCSF medical mistakes, they prefer to avoid providing
042685 - necessary and reasonable care for Millie to recover, and let her
042686 - suffer the consequences. ref SDS 1 A593
042688 -  ..
042689 - Suggested that Eileen get the actual claim filed on 100527 from Diane
042690 - in Member Services, or from Paula in Claims Resolution, as filed on
042691 - 100527, ref SDS 14 IZ7N, and then decide what response Kaiser should
042692 - make.
042694 -  ..
042695 - Eileen said she will investigate further.
042696 -
042697 -
042699 -  ..
0427 -
0428 -
0429 - 1659
0430 -
043001 - Eileen called back, and talked for about 30 mintues.
043002 -
043003 - She has now obtained and read Millie's claim filed on 100527, with
043004 - Kaiser's Claims Resolution Department. ref SDS 14 IZ7N  Eileen has
043005 - discussed the merits with doctors in her department.  They now feel
043006 - Millie's claim for relief from injury caused by UCSF medical mistakes
043007 - is not limited by Medicare entitlement, and so Millie getting care in
043008 - Hospice does not prevent Kaiser from fixing mistakes made by UCSF
043009 - doing work for Millie on referral from Kaiser.  Her team has therefore
043010 - decided not to send a letter denying Millie's claim, reported earlier
043011 - per above. ref SDS 0 UN72
043012 -
043013 -        [On 100630 1148 Doctor Johnson reports Millie's claim for
043014 -        relief from medical mistakes should be denied because she chose
043015 -        to enter Hospice to obtain pain relief from chemothearpy.
043016 -        ref SDS 20 X45K
043018 -  ..
043019 - Eileen is sending Millie's case to the Case Resolution Department for
043020 - review and equitable resolution.  This accomplishes goals the Medicare
043021 - team set on 100528, notifying Kaiser's Claims Resolution Department to
043022 - review Millie's case. ref SDS 16 IM4F
043024 -  ..
043025 - During the call, Eileen asked about details of medical mistakes, and
043026 - efforts to obtain relief over the past year, as set out in Millie's
043027 - claim on 100527. ref SDS 14 X933
043029 -  ..
043030 - Eileen finally, said she has to end the call in order to work on a
043031 - claim for another patient.  Eileen said she is sorry about what
043032 - happened to Millie, and feels Millie is a very special lady to have
043033 - lived with this nightmare for so long.
043035 -  ..
043036 - She said someone from Case Resolution Department will call tomorrow
043037 - to report progress reviewing Mil's claim.
043038 -
043039 -
043040 -
043041 -
043042 -
043043 -
043044 -
043045 -
043046 -
043047 -
0431 -