THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: June 14, 2010 02:57 AM Monday; Rod Welch

Kaiser UCSF asked to give Millie choice of treatment or Hospice.

1...Summary/Objective


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SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 54 0000. ref SDS 53 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 19
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 19 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 20 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 21 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 22 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 22 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 23 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 24 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 25 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 26 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 27 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 28
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 29 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 30 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 31 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 32 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 33 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 20 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 21
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 38 036C  Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 38 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 38 UN4M  Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 38 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 38 UN5P
041023 -  ..
041024 - On 100603 0449 Millie notified medical team that Kaiser called today
041025 - about moving forward to resolve medical mistakes getting radiation
041026 - treatment at UCSF on referral from Kaiser. ref SDS 39 IX9Q
041028 -  ..
041029 - On 100606 1604 Doctor Johnson notifies Millie that her cancer marker
041030 - has remained fairly stable the past 3 weeks since ending treatment
041031 - with Abraxane on 100512; actually went up less without Abraxane, than
041032 - with it, because Millie's cancer resists chemotherapy. ref SDS 40 036C
041034 -  ..
041035 - On 100606 1638 Millie thanks Doctor Johnson for submitting good news
041036 - cancer marker CA 15-3 606 much smaller rise than exptected after
041037 - ending treatment for 3 weeks. ref SDS 41 036C; asks if Doctor Rugo ever
041038 - returned Doctor Johnson's call from Kaiser, as planned in Doctor
041039 - Rugo's letter on 100501?
041041 -  ..
041042 - On 100606 2317 Millie receives letter from Doctor Johnson reporting
041043 - that Doctor Rugo has never returned his call asking UCSF for Millie's
041044 - treatment plan, which demonstrates failure to perform on Doctor Rugo's
041045 - commitment in UCSF letter sent to the medical team on 100501.
041046 - ref SDS 42 036C
041048 -  ..
041049 - On 100607 0932 called Cherry at Medicare about progress on contacting
041050 - Kaiser to process Millie's claim filed on 100527, and planned in the
041051 - call with Medicare (Cherry and Beth) as action item #8, planned the
041052 - next day on 100528 1031, ref SDS 33 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 43 036C
041055 -  ..
041056 - On 100607 1021 called Paula at Kaiser - she said someone else is
041057 - handling Millie's claim, because the claim has not been denied, and
041058 - Paula only handles denied claims. ref SDS 44 036C; Paula further
041059 - reported that Kaiser no longer objects to demaning UCSF correct
041060 - medical mistakes, so Millie's claim should be easy to resolve.
041061 - ref SDS 44 QN9F
041063 -  ..
041064 - On 100607 1117 letter to Paula confirming Kaiser's work plan to
041065 - process Millie's claim for care promptly in order to save her life.
041066 - ref SDS 45 036C
041068 -  ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 46 036C  Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 46 C354  Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 46 G84Q
041075 -  ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 47 036C  Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 47 8O4H  Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 47
041080 - PRXY
041082 -  ..
041083 - On 100609 1232 letter to CMS and Kaiser submitts agenda for conference
041084 - call to review progress on Kaiser resolving Millie's claim for
041085 - recovery from UCSF medical mistakes. ref SDS 48 036C
041087 -  ..
041088 - On 100609 1300 CMS and Kaiser conference call to report progress on
041089 - reviewing Millie's claim for treatment to recover from UCSF medical
041090 - mistakes in time to be effective. ref SDS 49 036C
041092 -  ..
041093 - On 100609 1522 Jennifer called for assistance processing Millie's
041094 - claim to recover from medical mistakes getting radiation treatment at
041095 - UCSF on referral from Kaiser. ref SDS 50 036C
041097 -  ..
041098 - On 100611 1451 Jennifer advised Kaiser extended the date for
041099 - responding to Millie's claim from 100610 to 100624, based on Millie
041100 - filing updated statement of authorized representative. ref SDS 54 036C
041101 - Jennifer reported she reviewed 6-issues discussed on 100609, and will
041102 - address these issues responding to Millie's claim. ref SDS 54 FQ4G
041103 - Jennifer asked how Kaiser can treat Millie to recover from UCSF
041104 - medical mistakes, if Millie refuses chemotherapy and has entered
041105 - Hospice. ref SDS 54 FQ4M
041107 -  ..
041108 - On 100611 2326 Millie received Jennifer's letter confirming the date
041109 - for Kaiser to respond to Millie's claim has been extended to 100624,
041110 - ref SDS 55 6P53, and further advising that issues Kaiser will determine
041111 - responding to Millie's claim for recovering from UCSF medical mistakes
041112 - are as set out in the record for telecon on 100609. ref SDS 55 036C
041114 -  ..
041115 - On 100614 0257 letter to Kaiser Medicare CMS claim team requests
041116 - immediate written proposal evaluating treatment options for Millie to
041117 - consider. ref SDS 0 036C
041118 -
041119 -
041121 -  ..
0412 -
0413 -
0414 - Progress
0415 -
041501 - Letter to Kaiser and Medicare claim teams says...
041502 -
041503 -    1.  Subject: Kaiser Extends Response Millie's Claim June 24
041504 -        Date: Mon, 14 Jun 2010 03:49:44 -0700
041517 -         ..
041518 -    2.  Thanks for your letter late Friday night, confirming that
041519 -        Kaiser has extended response date on Mil's claim to June 24,
041520 -        and Kaiser will determine 6-issues in responding to Millie's
041521 -        claim [reporting on 100611 2326. ref SDS 55 036C, citing
041522 -        telecon on 100609, formulating the 6-issues. ref SDS 50 XK50
041524 -         ..
041525 -    3.  Extending time for responding to Millie's claim is helpful for
041526 -        quality care on claims analysis, allowing time for
041527 -        investigation and deliberation.
041529 -         ..
041530 -    4.  Millie has for the past year, since discovery by Doctor Hsu on
041531 -        090609, that cancer [...in her breastbone area...] was
041532 -        untreated at UCSF for 6 months, requested treatment in time to
041533 -        be effective [...reported on 090609 0900. ref SDS 8 W65W...].
041534 -        Recovery began a week later when Doctor Rugo announced on
041535 -        090616, that "everybody is on board" at Kaiser and UCSF,
041536 -        ref SDS 9 D647, to provide necessary and reasonable care
041537 -        targeted to Millie's patient profile, starting with MPA, then
041538 -        PARP. ref SDS 9 KD6L  However, at the first stop [...after the
041539 -        1st cycle of MPA...], Millie was suddenly told in the dark of
041540 -        night that "nobody is on board"!  She was all alone headed for
041541 -        a "train wreck," rather than the road to recovery [...reported
041542 -        on 090716 2106. ref SDS 10 EE5W...].
041544 -         ..
041545 -    5.  The longer Millie goes untreated the more the end becomes a
041546 -        self-fulfilling prophecy that places standard of care on a
041547 -        slippery slope to [...at best...] sloth, neglect, and
041548 -        indifference, [and, at worst, criminal conspiracy to withhold
041549 -        effective care and instead prescribe chemotherapy that is not
041550 -        effective for Millie, and causes intolerable pain and suffering
041551 -        that tortures the patient into submission accepting Hospice and
041552 -        death, in order for providers to save money, i.e., unjust
041553 -        enrighment, thus, transforming the doctor from "care giver"
041554 -        into a "death panel of one," discussed with Jennifer at Kaiser
041555 -        on 100611 1521. ref SDS 54 Y14J...], shown, so it seems, by
041556 -        difficulty [...at Kaiser and UCSF...] using email and the
041557 -        telephone, reported on 100601. ref SDS 35 4F6I
041559 -         ..
041560 -    6.  Since Millie has been treated with ineffective chemotherapy for
041561 -        a year under a regimen of Medicare benefits, rather than
041562 -        receive necessary and reasonable care in time to recover from
041563 -        medical mistakes, her cancer is progressing toward a strategic
041564 -        inflection point that prevents any semblance of recovery.
041565 -        Therefore, as requested in June, July, August...December, 2009,
041566 -        continuing in January, February, March...June, 2010, time is of
041567 -        the essence to treat Millie for recovering from medical
041568 -        mistakes.
041570 -         ..
041571 -    7.  Within the next 2 days, please cull the medical team to
041572 -        identify treatments among the 21 listed in the claim [...shown
041573 -        on 100527 0217. ref SDS 31 X77U...], and such other, if any, as
041574 -        may present a stronger chance of recovery, and submit a written
041575 -        medical opinion on Millie's chances of pulling back from the
041576 -        brink she now faces, so that she can choose whether or not to
041577 -        attempt recovery.  This may be PARP cited by Doctor Rugo on
041578 -        090616, as Millie's next treatment after MPA, and reviewed by
041579 -        Doctor Johnson at Kaiser on 100112, ref SDS 16 OJ8G; or, there
041580 -        may be something else that yields better results, and can be
041581 -        provided in time to be effective.
041583 -             ..
041584 -            [On 100616 0832 Jennifer did not have time to call on
041585 -            Tuesday, 100615; telecon the next day indicated Jennifer
041586 -            made progress on compensation to hold Millie harmless from
041587 -            UCSF medical mistakes, but she has been unable to schedule
041588 -            treatment, ref SDS 56 PSSV, because Kaiser's claim team has
041589 -            suffered delays communicating with Millie's medical team,
041590 -            as occurred the past year; Jennifer scheduled to call on
041591 -            Friday, 100618, to report progress on Millie starting
041592 -            treatment in time to recover from UCSF medical mistakes.
041593 -            ref SDS 56 WN6N
041595 -             ..
041596 -            [On 100618 0843 Jennifer did not call on Friday, and did
041597 -            not return call asking about progress getting Millie a
041598 -            prescription. ref SDS 57 036C
041600 -         ..
041601 -    8.  Since Kaiser's medical chart on 100601, shows Millie is ECOG
041602 -        performance score 0, ref SDS 35 W15Y, and her latest scan shows
041603 -        she had no internal involvement [...reported on 100228 2216.
041604 -        ref SDS 18 IN6I, and citing Doctor Johnson's assessment that
041605 -        Millie's main problem is in the skin, ref SDS 18 4Q54...], and
041606 -        since her cancer marker actually slowed the rate of increase
041607 -        the past 4 weeks, with CA 15-3 606 [...reported on 090323 1352.
041608 -        ref SDS 5 J13O...] Mil's condition may be recoverable to a life
041609 -        worth living with targeted care planned on 090616 [...and cited
041610 -        by Doctor Johnson on 100427, as the strategy best suited to
041611 -        Millie's patient profile, ref SDS 19 SJ6N...].  What then is
041612 -        needed to get "everybody on board"?  Understandably, Millie
041613 -        will only consider further treatment with assurance that
041614 -        painful side effects will not occur.  This has been
041615 -        characterized as a "cetuximab" solution, because Millie had
041616 -        this treatment at UCSF for nearly 2 years, and suffered almost
041617 -        zero side effects, with no pain of any kind.
041619 -         ..
041620 -    9.  As we discussed this past Friday, on 100611, Millie can be
041621 -        justly credited with choosing Hospice only after she is
041622 -        presented with written evidence of viable alternatives, if any,
041623 -        which she can consider in her own time, without social
041624 -        pressures of an examination room, but of course in consultation
041625 -        with her doctors and support team.  The right to choose life or
041626 -        death is a big issue. ref SDS 54 FQ4M
041628 -         ..
041629 -   10.  If Mil, decides to try treatment again, then there will be time
041630 -        to address subsidiary issues in her claim.
041632 -         ..
041633 -   11.  Thanks for "burning the mid-night oil" seen by your letter
041634 -        issued at 1015pm, and for confirming 6-issues to be determined
041635 -        in Kaiser's response to Millie's claim.
041636 -
041643 -
041644 -
041645 -
041646 -
041647 -
041648 -
041649 -
041650 -
041651 -
041652 -
041653 -
041654 -
041655 -
0417 -