CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 94 0000. ref SDS 92 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
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 45
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 45 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 46 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 47 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 48 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 48 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 49 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 50 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 51 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 52 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 53 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 54
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 55 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 56 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 57 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 58 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 59 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 46 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 47
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 64 036C  Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 64 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 64 UN4M  Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 64 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 64 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 65 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 66 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 67 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 68 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 59 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 69 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 70 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 70 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 71 036C
041068 -  ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 72 036C  Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 72 C354  Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 72 G84Q
041075 -  ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 73 036C  Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 73 8O4H  Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 73
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 74 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 75 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 76 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 80 036C
041101 - Jennifer reported she reviewed 6-issues discussed on 100609, and will
041102 - address these issues responding to Millie's claim. ref SDS 80 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 80 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 81 CV4O, and further advising that issues Kaiser will determine
041111 - responding to Millie's claim for recovering from UCSF medical
041112 - mistakes, ref SDS 81 036C, are as set out in the record for telecon on
041113 - 100609. ref SDS 76 XK50  Jennifer will call on 100615, to report
041114 - progress on respnding to Millie's claim. ref SDS 81 6P53
041116 -  ..
041117 - On 100614 0257 letter to Kaiser Medicar CMS claim team requests
041118 - immediate written proposal evaluating treatment options for Millie to
041119 - consider. ref SDS 82 036C
041121 -  ..
041122 - On 100616 0832 called Jennifer about her plan to call yesterday on
041123 - Tuesday to report progress Kaiser responding to Millie's claim, as set
041124 - out in Jennifer's letter on 100611. ref SDS 83 036C   Jennifer called
041125 - back to ask if Millie wants UCSF or Kaiser to pay for her damages
041126 - caused by UCSF medical mistakes. ref SDS 83 PSSV  Jennifer reported
041127 - delays communicating with Millie's medical team have delayed making
041128 - arrangements for Millie to start treatment recovering from UCSF
041129 - medical mistakes. ref SDS 83 OY4T  She plans to call on Friday, 100618,
041130 - to report progress responding to Millie's claim. ref SDS 83 1K5J
041132 -  ..
041133 - On 100618 0843 called Jennifer at Memeber Case Resolution Department
041134 - about progress responding to Millie's claim. ref SDS 84 036C
041136 -  ..
041137 - On 100620 1112 letter to Kaiser claim team with copy to Medicare, and
041138 - the medical team requests call on Monday 100621, planned for previous
041139 - Friday, 100628, to report progress getting Millie treatment.
041140 - ref SDS 85 036C  Recommends that delay communicating with medical team
041141 - that has delayed Millie starting treatment in time to be effective,
041142 - ref SDS 85 L59P, can be solved by hiring MD Anderson. ref SDS 85 L59X
041144 -  ..
041145 - On 100621 0853 called for Jennifer and left several messages,
041146 - including for her team lead. ref SDS 87 036C  Nobody had time today
041147 - for calling back. ref SDS 87 OP3N
041149 -  ..
041150 - On 100622 1027 Jennifer called and advised that Doctor Johnson
041151 - responded to request for comment on Millie's claim saying he cannot
041152 - provide care for Millie because she entered Hospice on 100601,
041153 - ref SDS 89 036C; recommended Jennifer check Kaiser's medical chart for
041154 - Millie meeting with Doctor Johnson to see Millie was given no choices
041155 - except to enter Hospice in order to avoid further pain and suffering.
041156 - ref SDS 89 NX68
041158 -  ..
041159 - On 100622 1511 letter to claim team and Medicare, and to Millie's
041160 - medical team confirming understanding in Jennifer's call that Millie's
041161 - medical team at Kaiser seems to refuse Millie standard of care to
041162 - recover from UCSF medical mistakes, because she was forced to enter
041163 - Hospice to get relief from pain caused by UCSF medical mistakes.
041164 - ref SDS 90 036C  UCSF delays compounded Millie's injuries, pain, and
041165 - suffering; caution must be exercised to enable recovery, based on
041166 - Millie's right to life. ref SDS 90 575U   Millie's patient history
041167 - shows the doctor's only issue, ref SDS 90 576V, is having time to
041168 - providing standard of care for Millie to recover from medical
041169 - mistakes, and if not, then Kaiser should assign someone who does.
041170 - ref SDS 90 583Y  Kaiser has violated Millie's human rights; a woman's
041171 - right to choose life for herself, should be no less than the right to
041172 - choose for her unborn child, since the right to life and due process
041173 - are protected by the US Constitution. ref SDS 90 584W  Kaiser can
041174 - easily solve the time problem by hiring other people to do the work,
041175 - and charging UCSF. ref SDS 90 585P
041177 -  ..
041178 - 100624 1616 Jennifer called and asked to extend Kaiser's response to
041179 - Millie's claim another day or so, for review with her boss, and with
041180 - the customer. ref SDS 91 036C  Jennifer the original date for Kaiser to
041181 - respond on 100610, required by statute, and then amended to today on
041182 - 100624, can be further amended, and cited unclear authority about 30
041183 - days instead of 14. ref SDS 91 EG5P  Agreed that extending Kaiser's
041184 - response another few days until tomorrow, or Monday, is an acceptable
041185 - risk, even though Millie's cancer markier has increased significantly
041186 - to over 1000, and so that an equitable solution can be implented that
041187 - allows treatment in time to be effective for Millie. ref SDS 91 EG73
041188 - Jennifer will submit her draft response, and call tomorrow for
041189 - discussing Kaiser's solution. ref SDS 91 H98M
041191 -  ..
041192 - On 100625 0852 letter to Kaiser and Medicare claim teams confirming
041193 - Kaiser's request to extend date for responding to Millie's claim
041194 - another few days until Monday in order to get comprehensive solution.
041195 - ref SDS 92 036C
041197 -  ..
041198 - On 100626 0917 received letter from Cherry at Medicare, ref SDS 93
041199 - 036C, submitting CMS regulations, that control due date for Kaiser to
041200 - respond to Millie's claim. ref SDS 93 N64I
041202 -  ..
041203 - On 100628 0228 letter to claim teams at Medicare and Kaiser asking how
041204 - CMS regulations received on 100625, apply to extend Kaiser's response
041205 - date for expediting Millie's recovery. ref SDS 94 036C
041207 -  ..
041208 - On 100628 1033 called CMS Medicare for Beth Simone on regulations for
041209 - Kaiser to respond to Millie's claim.
041210 -
041211 -
041212 -
041213 -
041215 -  ..
0413 -
0414 -
0415 - Progress
0416 -
041601 - Called for Beth Simone and Cherry Castenada.
041602 -
041603 -                     415-744-3617
041605 -  ..
041606 - Beth corrected her email address so that distribution to her on the
041607 - CMS claim team will work correctly.
041609 -  ..
041610 - She requested resubmission of the letter to the team on 100625 0852.
041611 - ref SDS 92 036C
041613 -  ..
041614 - Beth received the letter sent early this morning on 100628 0228.
041615 - ref SDS 94 036C
041617 -  ..
041618 - Beth said that asking for controlling authority on Kaiser's time for
041619 - responding to Millie's claim is a good question.  The CMS claim team
041620 - is researching the issue.
041622 -  ..
041623 - Reviewed CMS regulation received on Friday, seems to set time frames
041624 - for Kaiser (MA) to respond after a request for Expedited Claim has
041625 - been denied, see 422.570, received on 100626 0917. ref SDS 93 DO6S
041627 -  ..
041628 - Explained today, that Millie's claim was not denied, according to
041629 - Eileen at Kaiser on 100602 1046. ref SDS 64 UN5P
041631 -  ..
041632 - Beth indicated that Millie's claim is very complicated.  She feels
041633 - that CMS has learned a lot about health care case management and
041634 - problems providing quality care required by CMS, based on Millie's
041635 - patient history.  This aligns with Jennifer's comments in the call on
041636 - 100624 1616, ref SDS 91 EG95, and earlier saying Millie's "well
041637 - ordered" record helps to undersand complex problems. 100609 1522,
041638 - ref SDS 76 XL76
041640 -  ..
041641 - Beth advised that Cherry has a call to Kaiser asking for their
041642 - authority to extend response to Millie's claim, requested in the
041643 - letter on 100625 0852, ref SDS 92 1X6R, and the follow up this morning
041644 - asking how CMS regulations submitted by Cherry and received on 100626
041645 - 0917, ref SDS 93 036C, apply to authorize extending Kaiser's response
041646 - first by 14 days reported by Kaiser on 100611 2326, ref SDS 81 CV4O,
041647 - and then by 30 days, reported by Kaiser on 100624 1616. ref SDS 91
041648 - KT6R
041650 -  ..
041651 - Asked Beth if CMS regulations support Kaiser demanding from UCSF
041652 - records on Millie's care showing entitlement to recover from medical
041653 - mistakes, shown in section 422.572 para (d), reported for the record
041654 - on 100626 0917, ref SDS 93 6E4N
041656 -  ..
041657 - Beth said that CMS will back later today on results of working with
041658 - Kaiser to get timely response for Millie's claim.
041659 -
041661 -  ..
0417 -
0418 -
0419 - 1521
0420 -
042001 - Called and left message for Beth to call back on status of CMS
042002 - inquiry with Kaiser.
042003 -
042005 -  ..
0421 -
0422 -
0423 - 1654
0424 -
042401 - Beth called back on the speaker phone at Medicare with Cherry and
042402 - Julie, who supported the CMS claim team in a call with Kaiser on
042403 - 100609 1300. ref SDS 75 036C
042404 -
042405 -        [On 100628 2318 letter to CMS submits record of telecon, and
042406 -        requests corrections and additions. ref SDS 95 R44R
042408 -  ..
042409 - Beth advised that Cherry and/or other CMS reps called and talked to
042410 - the Kiaser Medicare compliance officer this afternoon.  Kaiser
042411 - indicated in the call that Kaiser will not respond to Millie's claim
042412 - today, contrary to the commitment from Jennifer, who advised on
042413 - 100624, that she had completed a response to Millie's claim, and
042414 - needed to review with her boss, and so requested agreement to delay
042415 - Kaiser's response until Friday, 100625, or at most until Monday,
042416 - today, reported on 100624 1616, ref SDS 91 036C
042418 -  ..
042419 - Beth advised that Kaiser did not explain in the call today with CMS,
042420 - why Kaiser did not call on Friday, nor today, as planned in Jennifer's
042421 - call on 100624?
042423 -  ..
042424 - Beth further seemed to indicate today, that she was not aware Kaiser
042425 - issued a written commitment to responed on 100624, to Millie's claim
042426 - filed on 100527.  During the call today, we checked the record, and
042427 - found Kaiser's letter dated 100611, expressly states Kaiser's case
042428 - completion date for responding to Millie's claim is 100624.
042429 - ref SDS 81 CV4O  Kaiser's letter on 100611, was submitted to CMS cited
042430 - in a letter a few days later on 100614 0257. ref SDS 82 036C
042432 -  ..
042433 - We learned today, that part of the communication issue is that Beth's
042434 - address was incorrect, per above, ref SDS 0 036C, so she was "out of
042435 - the loop" on some of the correspondence.  This was Rod's fault, and
042436 - was corrected today.
042438 -  ..
042439 - The critical fact is that Kaiser has been "in the loop" at all times,
042440 - and should meet commitments critical to the life of the patient that
042441 - is ebbing away, due to delay correcting medical mistakes for the past
042442 - year.
042444 -  ..
042445 - Beth said that Kaiser notified CMS today that Kaiser has withdrawn its
042446 - commitment to respond on 100624, shown by Kaiser's letter on 100611
042447 - 2326. ref SDS 81 CV4O, and extended by verbal agreement to 100625, or
042448 - at the latest today, on 100628, reported on 100624 1616. ref SDS 91
042449 - SP4L
042451 -  ..
042452 - Beth advised that Kaiser said today that it intends to delay response
042453 - until 100710, to Millie's claim on 100527, contrary to Kaiser's
042454 - commitments on 100611, to respond on 100624, and amended on 100624, at
042455 - Kaiser's request to respond on 100625, reported on 100624 1616,
042456 - ref SDS 91 SP4L
042457 -
042458 -        [On 100628 2318 Millie notified CMS and Kaiser that delaying
042459 -        treatment places Millie in grave jeopardy. ref SDS 95 R44W
042461 -  ..
042462 - Since Millie's cancer marker increased from 606, on 100522, to 1116
042463 - last week on 100622, shown in case study on 090323 1352. ref SDS 5
042464 - J13O, delaying Kaiser response places Millie in grave danger, within
042465 - the meaning of CMS regulation 422.570 (c)(2)(i), reported by Cherry on
042466 - 100626 0917. ref SDS 93 1U33
042468 -  ..
042469 - Beth further reported during the call that CMS learned today, Kaiser
042470 - re-classified Millie's claim filed on 100527, into a "Grievance," and
042471 - so CMS regulations submitted by Cherry on 100626, do not control
042472 - processing of Millie's case, including timeframes.  Kaiser advised CMS
042473 - today, that regulations permit withholding life-saving treatment until
042474 - at least 100710.
042476 -  ..
042477 - Requested CMS regulations on Grievance procedures.
042478 -
042479 -        [On 100629 0003 received CMS regulations on Grievance that
042480 -        allow maximum 30 days, but as expeditiously as necessary to
042481 -        maintain patient health, for Kaiser to respond to Millie's
042482 -        claim ref SDS 96 XN4F
042484 -  ..
042485 - Beth advised that CMS will call Kaiser back tomorrow for grounds that
042486 - justify delaying response until 100710, to Millie's claim requesting
042487 - life-saving treatment.
042489 -  ..
042490 - Key facts on expedited review are....
042491 -
042492 -    1.  Millie filed a claim on 100527, requesting life-saving
042493 -        treatment "targeted" to cancer, which was withheld for over a
042494 -        year preventing recovery from UCSF medical mistakes, and
042495 -        instead Kaiser treated Millie with chemotherapy which Kaiser
042496 -        knew was not effective, presented risks of fatal infection, and
042497 -        caused severe pain and suffering, forcing the patient to loose
042498 -        desire for life, and seek Hospice for medication to relieve
042499 -        pain and suffering while falling into death. ref SDS 57 IZ7N
042501 -         ..
042502 -    2.  On 100601 0136 Millie sent a letter to Kaiser and UCSF
042503 -        requesting necessary and reasonable treatment "targeted" to
042504 -        cancer for recovering from UCSF medical mistakes, and advised
042505 -        that she could not tolerate more chemotherapy, received for the
042506 -        past year. ref SDS 60 1P6U
042508 -         ..
042509 -    3.  On 100601 0830 Millie met with her doctor, who advised he was
042510 -        unable to communicate with UCSF by telephone or by email for an
042511 -        entire month, and so Kaiser could not provide "targeted"
042512 -        treatment for Millie to recover from UCSF medical mistakes,
042513 -        ref SDS 61 4F6I, but could only offer Hospice medication to
042514 -        relieve Millie's pain and suffering, ref SDS 61 4G6G, building
042515 -        up from a year of chemotherapy that caused severe infections of
042516 -        shingles, and on 100601, Phlebitis, ref SDS 61 ZW4L, and so
042517 -        Millie was forced to enter Hospice to relieve pain and
042518 -        suffering, only because she was not provided necessary and
042519 -        reasonable care with treatment "targeted" to kill cancer
042520 -        without causing pain and suffering, like chemotherpay does, and
042521 -        for the purpose of recovering from medical mistakes.
042522 -        ref SDS 61 4H3K
042524 -         ..
042525 -    4.  On 100602 1046, Kaiser called and advised that Millie's claim
042526 -        filed on 100527, was being processed at Kaiser in Stockton.
042527 -        ref SDS 64 036C
042529 -         ..
042530 -    5.  On 100602 1504, Kaiser called back and advised that Millie's
042531 -        claim filed on 100527, was forwarded to a claims analyst, who
042532 -        would contact Millie within 72 hours. ref SDS 64 615A
042534 -         ..
042535 -    6.  On 100602 1628, Eileen Moffitt called, who represented being a
042536 -        claims analyst for Kaiser, and advised that Kaiser denied
042537 -        Millie's claim filed on 100527, because Millie was forced to
042538 -        enter Hospice on 100601. ref SDS 64 UN4M  During the call,
042539 -        Eileen determined Kaiser's denial of Millie's claim to recover
042540 -        from UCSF medical mistakes should be reconsidered. ref SDS 64
042541 -        I34F
042543 -         ..
042544 -    7.  On 100602 1659, Eileen Moffitt called back and advised that
042545 -        Kaiser withdrew its denial of Millie's claim filed on 100527,
042546 -        and submitted the claim for resolution. ref SDS 64 UN5P
042548 -         ..
042549 -    8.  On 100609 1523 CMS and Kaiser claim teams held a conference
042550 -        call and advised that nobody knows who is responsible for
042551 -        preparing Kaiser's response to Millie's claim filed on 100527,
042552 -        ref SDS 75 GF5L; but Kaiser assured during the call that it has
042553 -        complied with requirements for good faith review and equitable
042554 -        adjustment, because Kaiser was required to respond to Millie's
042555 -        claim filed on 100527, by close of business the next day on
042556 -        100610. ref SDS 75 6F64
042558 -         ..
042559 -        At that time, on 100609, Kaiser provided information to Julie
042560 -        at CMS that Kaiser was required by statute to respond to
042561 -        Millie's claim within 14 days, and on 100610. ref SDS 75 6G32
042563 -  ..
042564 - This record suggests that Kaiser in fact applied CMS regulation
042565 - 422.570 (c)(2)(i)...
042566 -
042567 -            How the MA organization must process requests.
042568 -
042569 -            Promptly decide whether to expedite a determination, based
042570 -            on the following requirements [...reported on 100626 0917.
042571 -            ref SDS 93 1U33
042573 -             ..
042574 -            For a request made by an enrollee the MA organization must
042575 -            provide an expedited determination if it determines that
042576 -            applying the standard timeframe for making a determination
042577 -            could seriously jeopardize the life or health of the
042578 -            enrollee or the enrollee's ability to regain maximum
042579 -            function.
042581 -  ..
042582 - Thus, Kaiser determined on or before, 100609, that evidence showed
042583 - Millie's claim filed on 100527, required expedited review because
042584 - delay could seriously jeopardise Millie's life or health, and ability
042585 - to regain maximum function, as called out in CMS regulation 422.570
042586 - (c)(2)(i).
042588 -  ..
042589 - Kaiser may not re-classify for purposes of administrative convenience,
042590 - nor to purposely delay providing care in time to be effective for
042591 - Millie to recover from life-threatening cancer caused by UCSF medical
042592 - mistakes, and in order to cause death that covers up medical mistakes.
042593 - The only rational basis for re-classification is to optimize patient
042594 - outcome.
042596 -  ..
042597 - Beth seemed to indicate today that CMS will ask Kaiser tomorrow what
042598 - new evidence justifies delaying response to Millie's claim, that will
042599 - ensure a better outcome for Millie, and thus accomplish aims of CMS
042600 - regulation 422.570 (c)(2)(i), submitted by Cherry, reported on 100626
042601 - 0917. ref SDS 93 1U33
042603 -  ..
042604 - CMS regulations 422.570  42 CFR Ch.  IV (10-1-09 Edition) say in
042605 - part...
042606 -
042607 -        (f)  Effect of failure to provide timely notice.
042608 -
042609 -        If the MA organization fails to provide the enrollee with
042610 -        timely notice of an organization determination as specified in
042611 -        this section, this failure itself constitutes an adverse
042612 -        organization determination and may be appealed.
042613 -
042614 - ...shown in Cherry's letter received on 100626 0917. ref SDS 93 P38K
042616 -  ..
042617 - How does the patient exercise rights under this section?  What
042618 - remedies are available?
042620 -  ..
042621 - Thanked Beth, Cherry, and Julie for excellent support today, with work
042622 - plan to align Kaiser's compliance with requirements for providing
042623 - health care services to Millie in time to be effective.
042625 -  ..
042626 - Beth summarized the work plan for tomorrow...
042627 -
042628 -        1.  CMS will call and ask for Kaiser's reliance on regulatory
042629 -            authority that justifies re-classification to Grievance,
042630 -            delaying response until 100710, ref SDS 0 RO9X, to Millie's
042631 -            claim filed on 100527, requesting life-saving treatment,
042632 -            ref SDS 57 IZ7N, and after Kaiser had already determined on
042633 -            100609, under CMS regulation 422.570 (c)(2)(i) that
042634 -            Millie's case justifies expedited response? ref SDS 75 6F64
042635 -            Kaiser should submit documentation work product prepared on
042636 -            or about 100610, that switched Millie's claim to Grievance
042637 -            status, and which explains how this change enhances patient
042638 -            health.
042640 -             ..
042641 -        2.  CMS will ask Kaiser for justification extending Kaiser's
042642 -            response beyond the commitment in Kaiser's letter on
042643 -            100611, for Kaiser to respond on 100624, ref SDS 81 CV4O,
042644 -            to Millie'claim filed, on 100527, and will ask how CMS
042645 -            regulations requiring timely notice of Kaiser's
042646 -            determination, reported by Cherry on 100626 0917,
042647 -            ref SDS 93 05U2, should be resolved for delays determining
042648 -            Millie's claim now planned for 100710? ref SDS 0 RO9X  Why
042649 -            wasn't the patient notified to present evidence showing
042650 -            delaying Kaiser's determination will cause irreperable
042651 -            harm, as Kaiser was notified when the doctor refused to
042652 -            switch treatment requested on 100501, as shown in Millie's
042653 -            letter to the medical team on 100503? ref SDS 51 6X7V
042654 -
042655 -
042656 -
042657 -
042658 -
042659 -
042660 -
0427 -