CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A9 0000. ref SDS A8 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 87
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 87 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 88 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 89 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 91 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 91 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 92 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 93 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 94 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 95 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 96 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 97
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 98 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 99 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 A0 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 A1 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 A2 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 A4 036C
041001 -  ..
041002 - On 100602 0913 Liz provides orientation on Hospice care; she confirms
041003 - Sharon's report yesterday, that if Kaiser performs on the insurance
041004 - agreement to provide standard of care for Millie's patient profile,
041005 - than Millie can elect to recover from 11th relapse of cancer, rather
041006 - than continue with Hospice support for dying peacefully. ref SDS A5
041007 - 036C
041009 -  ..
041010 - On 100602 1046 Diane received notice from Medicare to file claim for
041011 - Millie to get treatment for recovering from UCSF medical mistakes; she
041012 - is preparing a statement of claim. ref SDS A6 036C  Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS A6 MZ5H  Eileen called later and reported that Kaiser denied
041015 - Millie's claim on the grounds that Medicare does not authorize payment
041016 - for treatment to recover from cancer, after a patient starts Hospice.
041017 - ref SDS A6 UN4M  Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS A6 I33H  Eileen called back after
041019 - reading the claim and advised the denial of claim has been withdrawn,
041020 - and the matter is referred to Claims Resolution Department.
041021 - ref SDS A6 UN5P
041023 -  ..
041024 - On 100603 1112 Linda called to schedule a visit for Hospice social
041025 - support. ref SDS A8 036C
041027 -  ..
041028 - On 100604 1350 Linda visited to begin case management for Millie's
041029 - Hospice care. ref SDS A9 036C
041031 -  ..
041032 - On 100606 1243 Judy visited Millie to begin Hospice social support,
041033 - covering from Linda. ref SDS 0 036C
041034 -
041035 -
041037 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Judy explained she is substituting today, for Linda, who is on
041402 - vacation this week, and will be Millie's social Hospice support going
041403 - forward.
041405 -  ..
041406 - Judy said she talked to Linda, Millie's Case Manager, this morning
041407 - before coming to visit Millie, and Linda said she did not get an email
041408 - confirming understandings from the meeting last Friday on 100604 1350.
041409 - ref SDS A9 036C
041411 -  ..
041412 - We corrected the record, that the other Linda (social Hospice
041413 - provider) called last Thursday to schedule Judy's visit today, and at
041414 - that time an email was submitted to Linda for coordinating with Liz
041415 - and Sharon to verify accuracy of the record.
041417 -  ..
041418 - Judy apologized for this communication mistake drawn from the call
041419 - this morning.  She said it is fast and easy to talk on the phone, but
041420 - people get mixed with so many calls and meetings going on all day.
041421 - She will call Linda, the Case Manager, after the meeting today, and
041422 - clarify that Millie's email was sent to the other Linda.
041424 -  ..
041425 - Judy remains uncertain how to get feedback on accuracy of the record
041426 - working with Sharon and Liz last week.  She feels her discussion with
041427 - Linda, Millie's Hospice Case Manger, indicates strong resistance
041428 - against efficient feedback verification with email.
041430 -  ..
041431 - Judy related her personal practice is to use email sparingly; she
041432 - checks it once every few days or weekly, based on time available.
041434 -  ..
041435 - During the meeting this morning, Judy sat in the rocking chair next to
041436 - the coffee table facing Millie on the sofa.  Judy had a notebook
041437 - computer open on her lap.  She explained that jotting down a few notes
041438 - while we talk is fast and easy to jog her memory later on what was
041439 - discussed.  This aligns with Liz's work practice on 100602 0913.
041440 - ref SDS A5 UP5O  Linda, the Case Manager, also used a notebook
041441 - computer to type up her notes during the meeting last week on Friday,
041442 - 100604 1350, ref SDS A9 BO4O,
041444 -  ..
041445 - Judy remarked how good Millie looks and sounds.  She asked how Millie
041446 - is doing?
041448 -  ..
041449 - Millie said she has zero pain today.
041451 -  ..
041452 - Millie related starting to feel better 4 weeks after her last
041453 - chemotherapy on 100512.  The past 5 days being on treatment with
041454 - Relafen to recover from Phlebitis, diagnosed on 100601, ref SDS A3
041455 - VS5N, Millie's pain has declined steadily, as expcted by Liz during
041456 - the first meeting with Hospice on 100602. ref SDS A5 3V94
041458 -  ..
041459 - On Friday, Linda decided to increase Millie's morphine, hoping to
041460 - improve pain control with less Percocet, reported on 100604 1350,
041461 - ref SDS A9 PC65  Millie was concerned that increasing morphine while
041462 - pain seemed to be declining, might reverse recovery from low energy
041463 - and cause alertness to remain at low ebb spending more time in bed.
041465 -  ..
041466 - Today, Millie is very pleased that after increasing morphine this past
041467 - Friday, pain from chemotherapy has continued to fall, and she has
041468 - recovered alertness, with high energy, as seen by Judy.  This morning
041469 - Millie got up at 0500 to feed the cats, and for the first time since
041470 - starting chemotherapy last August, she did not go back to sleep, nor
041471 - stay in bed for most of the day.  She has been up performing chores
041472 - and getting things done as usual for her life style, prior to being
041473 - forced to get chemotherapy by UCSF's sudden failure to perform
041474 - agreement for treating Millie's cancer as a chronic disease using
041475 - therapy targeted to Millie's cancer that does not cause painful side
041476 - effects, reported on 090716 2106. ref SDS 43 EE5W
041478 -  ..
041479 - Millie was further happy to hear today that patients are discharged to
041480 - the general Kaiser patient population, if they don't die within the
041481 - time Medicare sets for Hospice criteria.
041483 -  ..
041484 - We joked about Millie "graduating" with honors from Hospice with a
041485 - degree in "Health and Partnership"?
041487 -  ..
041488 - Judy remarked that talking to Millie seems like meeting with
041489 - colleagues on the job at Kaiser.  Judy noted Millie has a very
041490 - analytic mind.  She asked about Millie's work before retiring?
041492 -  ..
041493 - Millie related being a legal secretary for N&P.
041495 -  ..
041496 - Judy said she will call and leave a message for Linda, the Case
041497 - Manager, with good news; and feels Linda will be delighted to hear
041498 - Millie is getting stronger and more alert despite increasing morphine.
041500 -  ..
041501 - Judy asked about Rod's work that seems closely involved with
041502 - communications - writing things down, keeping everything in order, and
041503 - planning ahead.
041505 -  ..
041506 - Recommended checking the Internet to learn about Communication
041507 - Metrics...
041508 -
041509 -              http://www.welchco.com
041511 -  ..
041512 - Judy asked Millie how she was able to get help with her medical care,
041513 - noting patients have help at home, but rarely have help to coordinate
041514 - the medical team?  Kaiser's Healthwise Handbook calls for doctor
041515 - patient partnership, reported on 990625. ref SDS 1 4185  How was
041516 - Millie able to get this assistance?
041518 -  ..
041519 - Millie explained there is little demand for accurate communication in
041520 - the work place.  Doctor Riley-Paull commented that remembering every
041521 - little thing to avoid mistakes is awfully annoying, reported on
041522 - 080708. ref SDS 12 OK8M  People like to get by ignoring small mistakes
041523 - until they become big problems, so Rod's proactive work practice is
041524 - hard to sell.  Judy's communication issue this morning is an example,
041525 - per above. ref SDS 0 AO56  However patients can't live with medical
041526 - mistakes that grow into big problems, so Millie benefits from
041527 - leveraging Kaiser's team care with Communication Metrics, noted by
041528 - Doctor Johnson on 090213 1140. ref SDS 31 FZ4H
041530 -  ..
041531 - Judy asked if Millie has filed an advance directive; she checked
041532 - Kaiser's computer at the office before leaving for the meeting this
041533 - morning, and did not find documentation on file for Millie's Advance
041534 - Directive?
041536 -  ..
041537 - Millie reported her patient history on signing Advance Directive...
041538 -
041539 -        1.  Advance Directive was signed and filed
041540 -            with Doctor Johnson during meeting at
041541 -            Kaiser................................ 100302 0830, ref SDS 74 P58M
041543 -             ..
041544 -        2.  Sharon asked for Advance Directive during
041545 -            call to start Hospice care for
041546 -            Millie................................ 100601 1531, ref SDS A4 JY56
041548 -             ..
041549 -        3.  Liz asked for Advance Directive during
041550 -            visit to start Hospice care for
041551 -            Millie................................ 100602 0913, ref SDS A5 PE5L
041553 -             ..
041554 -        4.  Linda asked for Advance Directive during
041555 -            visit to start case management
041556 -            providing Hospice care for
041557 -            Millie................................ 100604 1350, ref SDS A9 FO4G
041559 -             ..
041560 -        5.  Judy reports Advance Directive for Millie
041561 -            could not be found in Kaiser's files
041562 -            prior to visiting for Hospice
041563 -            social care........................... 100607 1243, ref SDS 0 668O
041565 -  ..
041566 - Judy said she will check further to verify Millie's Advance Directive
041567 - is on file at Kaiser, or if Millie needs to sign another Advance
041568 - Directive.  Judy's plan for timely follow up aligns with Doctor
041569 - Johnson's concern on 090205 that Millie's care was "slipping through
041570 - the cracks." ref SDS 29 278T
041572 -  ..
041573 - On 100605 1838 Millie notified Doctor Johnson at Kaiser that
041574 - difficulty getting people to listen has been a very trying, emotional
041575 - experience, like balancing pain medication with alertness, and
041576 - treating cancer as a chronic disease for sustaining a quality of life
041577 - worth living. ref SDS B0 CG6W
041579 -  ..
041580 - Judy asked Millie about religious affiliation.  She explained
041581 - counseling from the Hospice Chaplin is appreciated by many patients in
041582 - Hospice care.
041584 -  ..
041585 - Millie related discussion with Sharon reporting no religious
041586 - affilication, and declining to meet with the Hospice Chaplin, reported
041587 - on 100601 1531. ref SDS A4 IR6H  This was discussed again with Liz the
041588 - next day on 100602 0913. ref SDS A5 K887
041590 -  ..
041591 - Judy asked several times in various ways about ordering Chaplin visit
041592 - for emotional comfort.
041594 -  ..
041595 - Millie explained reliance on family and friends for continuing
041596 - emotional support that has been a big help the past few years dealing
041597 - with trauma from continuing delays getting treatment in time to be
041598 - effective recovering from medical mistakes, discussed recently with
041599 - Doctor Johnson at Kaiser on 100601, leading to ordering Hospice care
041600 - to avoid pain.
041602 -  ..
041603 - Judy explained her schedule has been hectic lately, because Kaiser has
041604 - upgraded her computer.  There have been problems with the new system,
041605 - and this has delayed getting things done.  that's one reason why there
041606 - has been duplication on issues starting Millie's Hospice care.  Each
041607 - provider wants to make sure Millie gets all the service and care
041608 - possible to enjoy this phase of her life.
041610 -  ..
041611 - Millie thanked Judy for being thorough on Hospice care.  Getting
041612 - comprehensive care for cancer has been challenging the past few years.
041614 -  ..
041615 - Judy asked for names and addresses of Millie's children so Hospice
041616 - Brevement services can be provided when needed.  Millie feels her
041617 - children are handling her decline well, keeping active with careers,
041618 - raising their own families, and involvement with friends and
041619 - activities.
041621 -  ..
041622 - Millie asked for brevement support for Rod.  We recalled that Doctor
041623 - Johnson has offered on several occassions to stay connected with Rod
041624 - in order to transition after Millie dies.
041626 -  ..
041627 - Judy helped Millie prepare a form to get a discount for PG&E utility
041628 - bills.  Millie signed the form, and Judy will get Doctor Johnson's
041629 - signature, and then have Millie's Hospice application filed with PG&E.
041630 - Judy noted that processing this discount application can take several
041631 - months, so often patients don't actually benefit.  She feels Millie's
041632 - evident strength and vitality today, per above, ref SDS 0 JO4J,
041633 - indicates Millie will get enough benefit to justify the effort filing
041634 - an application.
041636 -  ..
041637 - Judy feels Millie is very well starting Hospice.  She hugged Millie
041638 - good by.
041640 -  ..
041641 - Judy summarized her action items...
041642 -
041643 -        1.  Call Linda the Case Manager, and clarify that the other
041644 -            Linda who provides Millie's social Hospice support is
041645 -            working on efficient communciation with email to verify
041646 -            accuracy of the work. ref SDS 0 AO56
041648 -             ..
041649 -        2.  Call Linda the Case Manager, and report that Millie has
041650 -            achieved a wonderful and remarkable decline to pain level
041651 -            zero. ref SDS 0 IL82
041653 -             ..
041654 -        3.  Verify Millie's Advance Directive is on file at Kaiser, and
041655 -            has not been "lost in the shuffle" nor "fallen through the
041656 -            cracks" in the system. ref SDS 0 DN6F
041658 -             ..
041659 -        4.  Get Doctor Johnson's signature and file Millie's
041660 -            application for PG&E utility discounts available for
041661 -            Hospice patients. ref SDS 0 PTUP
041663 -  ..
041664 - Millie thanked Judy for excellent social support starting Hospice
041665 - care.
041666 -
041667 -
041668 -
041669 -
041670 -
041671 -
041672 -
041673 -
041674 -
041675 -
0417 -