THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: July 10, 2010 01:43 PM Saturday;
Kaiser denies Millie claim to recover from medical mistakes.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS C4 0000. ref SDS C2 0000.
040507 - ..
0408 - Background
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 58
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 58 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 59 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 60 HH4I
040920 - ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 62 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 62 MZ4N
040926 - ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 63 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 64 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 65 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 66 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 67 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 68
040958 - L54I
040960 - ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 69 KE4K
040964 - ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 70 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 71 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 72 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 73 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 59 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 60
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 78 036C Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 78 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 78 UN4M Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 78 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 78 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 79 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 80 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 81 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 82 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 73 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 83 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 84 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 84 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 85 036C
041068 - ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 86 036C Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 86 C354 Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 86 G84Q
041075 - ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 87 036C Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 87 8O4H Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 87
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 88 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 89 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 90 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 94 036C
041101 - Jennifer reported she reviewed 6-issues discussed on 100609, and will
041102 - address these issues responding to Millie's claim. ref SDS 94 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 94 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 95 CV4O, and further advising that issues Kaiser will determine
041111 - responding to Millie's claim for recovering from UCSF medical
041112 - mistakes, ref SDS 95 036C, are as set out in the record for telecon on
041113 - 100609. ref SDS 90 XK50 Jennifer will call on 100615, to report
041114 - progress on respnding to Millie's claim. ref SDS 95 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 96 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 97 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 97 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 97 OY4T She plans to call on Friday, 100618,
041130 - to report progress responding to Millie's claim. ref SDS 97 1K5J
041132 - ..
041133 - On 100618 0843 called Jennifer at Memeber Case Resolution Department
041134 - about progress responding to Millie's claim. ref SDS 98 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 99 036C Recommends that delay communicating with medical team
041141 - that has delayed Millie starting treatment in time to be effective,
041142 - ref SDS 99 L59P, can be solved by hiring MD Anderson. ref SDS 99 L59X
041144 - ..
041145 - On 100621 0853 called for Jennifer and left several messages,
041146 - including for her team lead. ref SDS A1 036C Nobody had time today
041147 - for calling back. ref SDS A1 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 A3 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 A3 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 A4 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 A4 575U Millie's patient history
041167 - shows the doctor's only issue, ref SDS A4 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 A4 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 A4 584W Kaiser can
041174 - easily solve the time problem by hiring other people to do the work,
041175 - and charging UCSF. ref SDS A4 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 A5 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 A5 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 A5 EG73
041188 - Jennifer will submit her draft response, and call tomorrow for
041189 - discussing Kaiser's solution. ref SDS A5 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 A6 036C
041197 - ..
041198 - On 100626 0917 received letter from Cherry at Medicare, ref SDS A7
041199 - 036C, submitting CMS regulations, that control due date for Kaiser to
041200 - respond to Millie's claim. ref SDS A7 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 A8 036C
041207 - ..
041208 - On 100628 1033 called CMS Medicare for Beth Simone on regulations for
041209 - Kaiser to respond to Millie's claim.
041211 - ..
041212 - On 100628 2318 submitted record of telecon with CMS, ref SDS B0 036C,
041213 - and that CMS learned today that Kaiser changed Millie's claim to a
041214 - Grievance, and notified CMS that Kaiser intends to delay response
041215 - until 100710, to Millie's claim filed on 100527.
041217 - ..
041218 - On 100629 00003 received letter from Cherry transmitting Grievance
041219 - procedures, cited in the telecon yesterday as a change Kaiser made to
041220 - delay responding until 100710, to Millie's claim filed on 100527.
041221 - ref SDS B1 036C Review of Grievance regulations show Kaiser required
041222 - to make timely response based on patient health. ref SDS B1 PN5S
041224 - ..
041225 - On 100629 0013 letter thanks CMS for submitting regulations on
041226 - Grievance procedures, and notes requirements for Kaiser to respond
041227 - prior to maximum allowed of 30 days, based on patient health.
041228 - ref SDS B2 036C
041230 - ..
041231 - On 100629 1631 called Medicare (CMS) on results of their
041232 - teleconference with Kaiser on expediting response to Millie's claim.
041233 - ref SDS B3 036C
041235 - ..
041236 - On 100630 0027 Millie thanks Doctor Johnson for reporting on 100606,
041237 - that UCSF did not call Kaiser to provide care for Millie to recover
041238 - from UCSF medical mistakes. ref SDS B4 036C; she reports blood counts
041239 - are good, but cancer progressing because treatment was stopped on
041240 - 100601, for pain relief from chemotherapy. ref SDS B4 V83U Kaiser has
041241 - deferred responding to Millie's claim, ref SDS B4 V87S, and needs to
041242 - know how soon her health status requires Kaiser to make a response.
041243 - ref SDS B4 V88T Millie asks about deferring the meeting with Doctor
041244 - Johnson tomorrow, until Kaiser responds to Millie's claim, or, Millie
041245 - would love to meet, if Doctor Johnson has communicated with Doctor
041246 - Rugo on a work plan for Millie to recover from UCSF medical mistakes.
041247 - ref SDS B4 V89X
041249 - ..
041250 - On 100630 1148 Doctor Johnson notfies Millie, and the Kaiser claim
041251 - team that he is confused about Millie's case, because Kaiser has
041252 - deferred determination on urgent requirement for care. ref SDS B5 036C
041253 - Doctor Johnson notes Millie is in Hospice and states that Millie's
041254 - disease is resistant to all forms of therapy, and that entering
041255 - Hospice is based on patient desire to forego therapy. ref SDS B5 PY4J
041256 - He asks if Millie wants to dis-enroll from Hospice. ref SDS B5 OY5G
041257 - Doctor Johnson further notes that public domain email conflicts with
041258 - HIPAA regulations. ref SDS B5 0W5U
041260 - ..
041261 - On 100630 1537 Millie notified medical team and claim team, thanking
041262 - Doctor Johnson for his letter commenting on Millie feeling better
041263 - after ending chemotherap. Confirms Doctor Johnson's intent to defer
041264 - meeting scheduled for tomorrow until after Kaiser responds to Millie's
041265 - claim, and further confirms Doctor Johnson has still not communicated
041266 - with Doctor Rugo on UCSF providing care for Millie to recover from
041267 - UCSF medical mistakes. ref SDS B6 M86X Advises that Doctor Johnson's
041268 - assertion that Millie's cancer now resists all forms of therapy
041269 - conflicts with the record; Doctor Johnson advised that finding
041270 - effective treatment requires experimentation; Millie's first treatment
041271 - failed, and had to be switched. ref SDS B6 M87Q When UCSF discovered
041272 - medical mistakes, UCSF failed to provide necessary and reasonable care
041273 - for Millie to recover, and instead prescribed chemotherapy, which was
041274 - not effective and caused unbearable pain and suffering, causing Millie
041275 - to enter Hospice. ref SDS B6 M84P The only evident purpose for
041276 - Millie's death is to avoid accountability from medical mistakes and
041277 - avoid cost of recovery, by making Millie suffer, and making Medicare
041278 - pay, while Millie is actually innocent, and Medicare is innocent.
041279 - ref SDS B6 M84S Millie sent 44 letters to medical team requesting
041280 - targeted treatment to recover from UCSF medical mistakes, and
041281 - reporting pain and suffering from chemotherapy; so, on 100601, Millie
041282 - entered Hospice for pain relief for chemotherapy. ref SDS B6 M84Y
041283 - Millie cannot dis-enroll from Hospice providing pain medication until
041284 - Kaiser provides standard of care to recover from UCSF medical
041285 - mistakes. ref SDS B6 M93V Millie explains benefits to saving lives,
041286 - time, and money using public domain email. ref SDS B6 M94W Millie
041287 - notes Doctor Johnson's report today shows Kaiser has violated Medicare
041288 - regulations by delaying response to her claim longer than justified by
041289 - Millie's health status. ref SDS B6 M96P
041291 - ..
041292 - On 100701 0915 Carol called this morning saying she is the Chief of
041293 - Hospice and advised that she was told that Millie wants to dis-enroll
041294 - from Hospice. Millie sent a letter to the medical team, and claim
041295 - teams confirming understandings from the call with Carol. ref SDS B7
041296 - 036C Millie advised Carol that Millie entered Hospice for pain relief
041297 - for chemotherapy, and so she cannot dis-enroll from Hospice providing
041298 - pain medication until Kaiser provides standard of care to recover from
041299 - UCSF medical mistakes. ref SDS B7 Q85S Millie explains she wants a
041300 - written medical opinion on treatments lined up for her to recover from
041301 - UCSF medical mistakes that provides a "roadmap to a future worth
041302 - living." ref SDS B7 Q85Y
041304 - ..
041305 - On 100701 1140, meeting this morning scheduled during a prior meeting
041306 - at Kaiser on 100601, ref SDS 75 7E4S, was canceled because Doctor
041307 - Johnson's letter yesterday, said nothing about receiving instructions
041308 - from Kaiser's claims department on solving Millie's claim for care to
041309 - recover from UCSF medical mistakes, ref SDS B5 036C Since Doctor
041310 - Johnson was not authorized to provide care requested in Millie's claim
041311 - on 100527, ref SDS 71 IZ7N, meeting would jeperodize Millie's rights
041312 - in the case by adding or otherwise modifying her statement of claim.
041313 - ref SDS B8 036C
041315 - ..
041316 - On 100701 1213 Lois called and talked to Rod for explanation of
041317 - Millie's claim, and planned to talk with Doctor Johnson about a
041318 - resolution. ref SDS B9 036C
041320 - ..
041321 - On 100702 1424 Millie received letter from Doctor Johnson submitting
041322 - Kaiser's lab report on results of Millie's blood test on 100622, and
041323 - without comment except the doctor circled with ink CA 15-3 1116.
041324 - ref SDS C0 036C
041326 - ..
041327 - On 100702 1612 Lois called and reported discussing Millie's claim with
041328 - Doctor Johnson, who evidently indicated he cannot find on the Internet
041329 - a provider willing to treat Millie with PARP. ref SDS C1 036C Lois
041330 - asked to talk with Millie in order to verify what Millie wants in her
041331 - claim filed on 100527. Lois was referred to Millie's claim, and to
041332 - the letter to Kaiser on 100701, confirming Millie's telecon with
041333 - Carol, with the Kaiser Hospice program. ref SDS B7 036C
041335 - ..
041336 - On 100705 2050 planning letter to Kaiser and Medicare claim teams
041337 - asking for remedies for damanges caused by Kaiser delaying response to
041338 - Millie's request for urgent care. ref SDS C2 036C
041340 - ..
041341 - On 100708 0038 letter to Kaiser with copy to Medicare asking for
041342 - Millie's remedies for Kaiser delaying response to Millie's claim
041343 - requesting immedicate treatment to recover from UCSF medical mistakes.
041344 - ref SDS C4 036C
041346 - ..
041347 - On 100710 1343 Millie received a letter from Kaiser responding to her
041348 - claim. ref SDS 0 036C Kaiser says the office Millie was directed to
041349 - submit her claim to be held harmless from medical mistakes was
041350 - incorrect. ref SDS 0 X48S Kaiser advises that Doctor Johnson reports
041351 - Millie's patient hsitory makes getting treatment with PARP prescribed
041352 - by Doctor Rugo to recover from UCSF medical mistakes due to
041353 - "eligibility" issues. ref SDS 0 X45V The doctor feels Millie's cancer
041354 - is difficult to treat, and maintains nothing can help her recover from
041355 - UCSF medical mistakes without having tried a single treatment listed
041356 - in Millie's claim; Kaiser does not deny any request in Millie's claim,
041357 - but proposes she discuss her care directly with Doctor Johnson who
041358 - claims to have lost hope. ref SDS 0 X530 Kaiser apoligizes for taking
041359 - 44 days to respond to Millie's claim, because unnamed regulations give
041360 - Kaiser 30 days to respond. ref SDS 0 X547 Kaiser advises Millie can
041361 - dispute the determination through arbitration, but Kaiser does not
041362 - present a disputable issue. ref SDS 0 768G Kaiser advises that Millie
041363 - can appeal to Medicare. ref SDS 0 X54Q
041369 - ..
0416 - Progress
041701 - Received in the US mail today the following from Jennifer, responding
041702 - to Millie's claim filed on 100527, ref SDS 71 IZ7N, and says...
041704 - 1. Subject: Claim Recovery Medical Mistakes Need Immediate Treatment 11th Relapse Cancer CA 15-3 520
041706 - H0524/H6050/H6052 001599 (08 25 2009
041707 - CGA1910 Medicare Grievance Standrd Unfavorable Resolution
041708 - Date: Thu, 8 July 2010
041709 - From: Kaiser Permanente
041723 - ..
041724 - 2. Your grievance regarding reimbursement of charges for all
041725 - srevices including medications related to treatment provided to
041726 - the Kaiser Permanente Walnut Creek Medical Cneter Oncology
041727 - Department from March 2009, to June 1, 2010, as compensation
041728 - for medical mistakes that you state were made by the University
041729 - of California San Francisco (UCSF) during authorized treatment
041730 - for inflammatory Breast Cancer, amount unspecified, has been
041731 - reviewed by a Kaiser Permanente Member Caser Resolutoin Center
041732 - Assistant Director. After carefully reviewing your records and
041733 - other information, Kaiser Permanente Senior Advantage (HMO)
041734 - regrets to inform you that we are unable to accomodate your
041735 - request.
041737 - ..
041738 - Millie filed a claim on 100517, requesting immediate life-saving
041739 - treatment. ref SDS 71 IZ7N
041741 - [On 100713 0007 file request for reconsideration by Kaiser,
041742 - ref SDS C5 J69Q, and appeal to Medicare. ref SDS C5 J74S
041744 - ..
041745 - Medicare section 422.570 (c)(2) required Kaiser to expedite
041746 - determining Millie's claim in order to prevent seriously jeopardizing
041747 - Millie's life or health, and ability to regain maximum function,
041748 - reported on 100626 0917, ref SDS A7 1U33
041750 - ..
041751 - Kaiser complied with Medicare regulations by determining a response to
041752 - Millie's claim was required on 100610, in order for Millie to recover
041753 - from rapidly deteriorating health, reported by Kaiser on 100609,
041754 - ref SDS 89 6F64 This determination was reported to at least 5
041755 - witnesses, and confirmed by CMS representatives.
041757 - ..
041758 - Kaiser delaying determination of Millie's claim violated her human
041759 - rights to life and liberty by delaying treatment with knowledge that
041760 - delay causes her cancer to progress rapidly beyond a point of no
041761 - return and with intent to cause wrongful death without due process,
041762 - and for the purpose of saving money.
041764 - ..
041765 - Kaiser converting Millie's claim to a "grievance" cited in Kaiser's
041766 - letter dated 100708, per above, ref SDS 0 036C, violates Millie's
041767 - human rights to life and liberty by delaying treatment with knowledge
041768 - that delay causes her cancer to progress rapidly beyond a point of no
041769 - return and with intent to cause wrongful death without due process,
041770 - and for the purpose of saving money.
041772 - [On 100723 1323 Julie called for Patty, and advised that
041773 - Medicare will respond to Millie's appeal in writing,
041774 - ref SDS C0 036C; Julie indicated that Medicare holds that
041775 - documentation received from Kaiser shows Medicare is not
041776 - required to process Millie's appeal, because Kaiser
041777 - unilaterally reclassified the claim requesting medical
041778 - services, into a "grievance" filed by Rod on 100610, based
041779 - on Millie's filing a statement of authorized represenative
041780 - on 100610, which Medicare maintains allows Kaiser 30 days
041781 - to respond from 100610, until 100610, rather than respond
041782 - on 100610; however, Kaiser and Medicare err, since Millie
041783 - filed the claim on 100527, and so filing statment of
041784 - authorized representative on 100610, was independent from
041785 - Kaiser's requirement to respond on that date, 100610, and
041786 - does not justify reclassifying Millie's claim to a
041787 - "grievance." ref SDS C0 HN8O
041789 - ..
041790 - Medicare section 422.568(a) required Kaiser to make a determination
041791 - on Millie's claim requesting life-saving care within a time frame to
041792 - prevent seriously jeopardizing Millie's life or health, and ability to
041793 - regain maximum function, reported 100626 0917. ref SDS A7 JG5Q
041795 - ..
041796 - Medicare section 422.564(b) required Kaiser to promptly determine and
041797 - inform the enrollee whether the complaint is subject to its grievance
041798 - procedures or its appeal procedures, reported on 100629 0003,
041799 - ref SDS B1 TP5T
041801 - ..
041802 - Medicare section 422.568(f) requires that failure to provide timely
041803 - notice of determination on Millie's claim may be appealed, reported on
041804 - 100626 0917. ref SDS A7 05U2
041806 - ..
041807 - Kaiser has not complied with Medicare requirements, and so its
041808 - determination is without standing nor effect. As a result, Kaiser
041809 - must immediately implement Millie's request for life-saving treatment
041810 - in her claim filed on 100527 0217. ref SDS 71 IZ7N
041812 - ..
041813 - Kaiser's response dated 100708 continues...
041815 - 3. Your request for compensation in the form of a refund for
041816 - copayments paid for services including medicaiton related to
041817 - threatment through the Kaiesr Permenante Walnut Creek Medical
041818 - Center Oncology department is a financial resolution that is
041819 - not a benefit included in your Health Plan Evidence of Coverage
041820 - (EOC). Compensation for the above stated services cannot be
041821 - provided through the grievance process. In order to best
041822 - address your specific requests, you must pursue them through
041823 - our Legal Department.
041825 - ..
041826 - 4. You may contact the Legal Department by sending your request
041827 - in writing to...
041829 - Kaiser Permanente
041830 - Legal Department - PPL
041831 - 1950 Franklin Street
041832 - Oakland, CA 94612
041834 - ..
041835 - 5. Your issue will be given prompt attention.
041837 - ..
041838 - Kaiser's letter dated 100708, received today saying claims for
041839 - compensation are "not covered benefits" and so should be sent to
041840 - another office, ref SDS 0 X48S, conflicts with Irene's report on
041841 - 100609. She said that Kaiser delayed responding to Millie's claim on
041842 - 100527, requesting treatment to recover from medical mistakes, until
041843 - 100609, because the office only processes "claims" for money.
041844 - ref SDS 89 6G82
041846 - ..
041847 - Millie is entitled to be held harmless from UCSF medical mistakes
041848 - performing radiation services on referral from Kaiser, admitted by
041849 - Doctor Hsu on 090609. ref SDS 26 W65W, and confirmed in Millie's
041850 - letter to UCSF and Kaiesr, reported on 090610 0043. ref SDS 27 W65S
041851 - The response from Kaiser dated 100708, and received today cites no
041852 - opposing evidence that UCSF committed medical mistakes. Recovery from
041853 - medical mistakes is separate from benefits of Millie's Medicare Health
041854 - Plan, as presented in Millie's claim filed on 100527 0217. ref SDS 71
041855 - IZ7N
041857 - ..
041858 - Kaiser's response dated 100708 continues...
041860 - 6. Your concern regarding your perception of a lack of treatment,
041861 - negligence and medical mistakes made by Doctor Hope Rugo and
041862 - her staff at UCSF, during the time that you were under her
041863 - care, were forwarded to [...patient's...] physician, Doctor
041864 - Robert Johnson of the Kaiser Permanente Walnut Creek Medical
041865 - Center Oncology Department, as well as the Chief of the Kaiser
041866 - Permanente Walnut Creek Medical Center Oncology Department for
041867 - review and action as appropriate.
041869 - ..
041870 - 7. Doctor Johnson responded that [...patient...] has stage IV
041871 - Inflammatory Breast Cancer and has been on at least 11
041872 - different regimens [...Millie's patient history shows 16
041873 - treatments listed on 090213 1140. ref SDS 13 AC6G...]. Some of
041874 - these were clinical trials, and other treatment protocols
041875 - (including chest wall radiation). His understanding is that
041876 - because of the many different types of treatments that she has
041877 - had, that she is not eligible for any PARP Clinical Trial, at
041878 - UCSF, or any other insititutions. Doctor Johnson further
041879 - states that [...patient...] is currently enrolled in Hospice,
041880 - and therefore is no longer seeking any "aggressive" care.
041881 - Doctor Michael P Russin, Chief of the Kaiser Permanente Diablo
041882 - Service Area Oncology Departments, concurs with Doctor
041883 - Johnson's response.
041885 - ..
041886 - Kaiser's evidence-based medical practice requires that medical
041887 - "understandings" cited in Kaiser's determination dated 100708, per
041888 - above, ref SDS 0 X45V, be based on evidence. Kaiser submits no
041889 - evidence showing Millie cannot get treatment to recover from UCSF
041890 - medical mistakes. Who was called; what necessary and reasonable
041891 - inducments were offered for Millie to recover from UCSF medical
041892 - mistakes? Doctor Johnson reported on 100601, that he was unable to
041893 - communicate with UCSF by telephone nor by email for an entire month.
041894 - ref SDS 75 4F6I The doctor's letter on 100606, reported he had still
041895 - not communicated with Doctor Rugo. ref SDS 82 036C
041897 - ..
041898 - Kaiser's failure to order treatment for Millie on grounds that patient
041899 - history prevents eligibility conflicts with the record. Doctor Rugo's
041900 - letter to Kaiser on 090514, proposed treatment with MPA protocol,
041901 - ref SDS 23 DI63, that included cyclophosphamide (Cytoxan), and so
041902 - conflicted with Millie's treatment history of getting cyclophosphamide
041903 - twice prescribed by Doctor Johnosn in April 2002, and again in January
041904 - 2005, shown in the record on 090213. ref SDS 13 AC6G At that time on
041905 - 090514, Doctor Rugo exercised doctor discretion for medical necessity
041906 - to save the life of the patient by planning to treat Millie only with
041907 - MPA. ref SDS 23 265I
041909 - ..
041910 - On 090616, Doctor Rugo ordered treatment for Millie with MPA alone, as
041911 - planned in the letter to Kaiser on 090514. ref SDS 28 YO4J
041913 - ..
041914 - On 090514, Doctor Rugo further reported UCSF had other treatments for
041915 - Millie after MPA. ref SDS 23 3F7M A month later on 090616, Doctor
041916 - Rugo reported that UCSF and Kaiser had a letter agreement to treatment
041917 - Millie to recover from UCSF medical mistakes, first with MPA and then
041918 - with PARP, part of a list of 20 protocols which Millie submitted to
041919 - Kaiser and UCSF at their request. ref SDS 28 KD6L
041921 - ..
041922 - This evidence shows there are many treatments available to treat
041923 - Millie's patient profile to recover from UCSF medical mistakes, and
041924 - that Kaiser has a fiduciary responsiblity to fairly represent Millie's
041925 - interests in recovering from injuries caused by UCSF medical mistakes
041926 - providing radiation services on referral from Kaiser.
041928 - ..
041929 - Kaiser's response dated 100708 continues...
041931 - 8. Doctor Johnson stated that, at this point in time, [...
041932 - patient...] is exhibiting resistance to all forms of
041933 - chemotherapy, targeted therapy, and hormonal therapy. It was
041934 - for this reason that she decided not to pursue further
041935 - treatment, and enrolled in hospice. There are no further
041936 - beneficial treatments available at this time. He also stated
041937 - that if [...patient...] would like to discuss this with him in
041938 - person, she is certainly welcome to do so, as he remains her
041939 - attending physician. In fact, an appointment for [...
041940 - patient...] to discuss her care with Doctor Johnson was
041941 - arranged for July 1, 2010, but [...patient...] declined, citing
041942 - that she wanted to receive a written response to her concerns
041943 - before attending such an appointment. If I can be of any
041944 - assistance in scheduling such an appointment, please contact me
041945 - at... 925 924 6859.
041947 - ..
041948 - Doctor Johnson proposing another open ended meeting with no work plan
041949 - to justify "discussion" on holding Millie harmless from UCSF medical
041950 - mistakes is the cause of Millie's claim filed on 100527, ref SDS 71
041951 - X67R and ref SDS 71 X553, and so cannot be the remedy without evidence
041952 - showing progress can result, otherwise this is an endless loop that
041953 - violates notice requirements for finality that enables legal
041954 - intervention.
041956 - [On 100713 0007 responded to Kaiser's letter denying
041957 - Millie's claim requesting implementation of UCSF work plan
041958 - to hold Millie harmless from UCSF medical mistakes,
041959 - ref SDS C5 036C, request reconsideration at Kaiser, and
041960 - appeal to Medicare, ref SDS C5 J74S, on grounds that Millie
041961 - met many times with Doctor Johnson over the past year, and
041962 - Kaiser persistentlly refused to provide effective care,
041963 - causing Millie's cancer to worsen, and endangering her
041964 - life. ref SDS C5 J64Y
041966 - ..
041967 - [100716 0830 received response from Jullin, saying nothing
041968 - further is required for Medicare to process Millie's
041969 - appeal. ref SDS C6 LY3M
041971 - ..
041972 - [On 100716 0830 Paula recommends Millie offer to meet with
041973 - Doctor Johnson, because she believes the doctor may be
041974 - authorized to order work that holds Millie harmless from
041975 - UCSF medical mistakes, and so resolve Millie's claim.
041976 - ref SDS C6 6T3G
041978 - ..
041979 - [On 100719 0522 Millie submitted letter to primary care
041980 - physician with work plan to resolve Millie's claim, and
041981 - offered to meet with the doctor to discuss implementation.
041982 - ref SDS C7 JH5V
041984 - ..
041985 - [On 100719 1312 Kaiser proposes only another meeting to
041986 - "discuss next steps," and not to implement UCSF or any
041987 - alternate work plan for Millie to recover from UCSF
041988 - medical mistakes, and ignores Kaiser's fiduciary duty
041989 - to hold Millie harmless from UCSF medical mistakes
041990 - providing care on referral from Kaiser. ref SDS C8 036C
041992 - ..
041993 - [On 100720 0655 2nd letter to Medicare requesting
041994 - confirmation that Millie's appeal on 100713, is being
041995 - processed by Medicare. ref SDS C9 LB8U
041997 - ..
041998 - Kaiser offering "discussion" to resolve Millie's claim filed on
041999 - 100527, requesting relief from injuries caused by UCSF medical
042000 - mistakes, conflicts with Medicare regulations that require written
042001 - notification on claims, reviewed on 100626, ref SDS A7 4U5G, and
042002 - further violates Millie's right to due process for equitable relief
042003 - from medical mistakes, which at minimum requires transparency of
042004 - written commitments. Kaiser violates required claim response
042005 - timeframes by extending determination to a yet to be determined
042006 - meeting date.
042008 - ..
042009 - Kaiser grounding unfavorable determination of Millie's claim filed on
042010 - 100527, requesting for life-saving treatment, ref SDS 71 IZ7N, on a
042011 - doctor's evaluation of Millie's health status "...at this point in
042012 - time..." ref SDS 0 X530, is not responsive to the claim that Kaiser
042013 - provided the wrong treatment and withheld life-saviing treatment by
042014 - failing to provide standard of care for over a year, beginning on
042015 - 090716, reported in the claim filed on 100527 0217. ref SDS 71 X592
042017 - ..
042018 - Kaiser's representation that Millie decided not to pursue further
042019 - treatment, and enrolled in hospice because her cancer resists all
042020 - forms of chemotherapy, targeted therapy, and hormonol therapy
042021 - conflicts with the record. On 100601, Doctor Johnson advised Millie
042022 - that Kaiser was unable to contact UCSF by telephone nor by email for
042023 - an entire month, and so could not arrange for UCSF to provide care for
042024 - Millie to recover from medical mistakes. ref SDS 75 4F6I This was
042025 - confirmed by Doctor Johnson's letter on 100606, reporting that UCSF
042026 - had still not contacted him about Millie's treatment. ref SDS 82 036C
042028 - ..
042029 - Millie notified Kaiser in a letter on 100630, that she will meet with
042030 - Doctor Johnson at Kaier after Kaiser submits a work plan for providing
042031 - standard of care to recover from UCSF medical mistakes beginning with
042032 - PARP or equal, ref SDS B4 V89X, as called out in Millie's claim on
042033 - 100527, ref SDS 71 IZ7N, requesting the medcal team implement Doctor
042034 - Rugo's prescription when "everybody at Kaiser and UCSF was on board"
042035 - to fix problems providing radiation services at UCSF on referral from
042036 - Kaiser, reported on 090616. ref SDS 28 D647 Millie asked Doctor
042037 - Johnson in her letter on 100630, if anything has changed since
042038 - Kaiser's letter on 100606, ref SDS 82 036C, that would justify another
042039 - meeting? ref SDS B4 V89X
042041 - ..
042042 - Kaiser's response dated 100708 continues...
042044 - 9. You also expressed concerns surrounding the processing of this
042045 - case. Specifically, you indicated that extensions were taken.
042046 - Although we received your concerns on May 27, 2010, ref SDS 71
042047 - IZ7N, we could not begin processing the case until receipt of
042048 - the completed Statment of Authorized Representative on June 10,
042049 - 2010. Medicare regulations allow up to 30 calendar days for
042050 - processing of a grievance, resulting in a July 10, 2010, due
042051 - date. We sincerely apologize that this was not communicated to
042052 - you clearly.
042054 - [On 100713 0007 resonse complains Kaiser violated Medicare
042055 - regulations causing Millie to suffer increased exposure to
042056 - wrongful death, ref SDS C5 J94Y, and appeals to Medicare
042057 - for appropriate remedy. ref SDS C5 J94T
042059 - ..
042060 - 10. Although it is never our intention to provide our members with
042061 - less than a satisfactory experience, we appreciate the time you
042062 - have taken to tell us of your concerns and allowing us the
042063 - opportunity to review the way we deliver health care services
042064 - to our valued members.
042066 - ..
042067 - 11. Please be assured that we take your concerns seriously, and the
042068 - issue you hae raised will be addressed by the appropriate
042069 - department(s) within the Kaiser Permanente Medical Care
042070 - Program. We at Kaiser Permanente continually strive to meet
042071 - the expectation of our members for high standards in all
042072 - aspects of their health care. All members concerns are
042073 - carefully reviewed and handled, with the goal of preventing
042074 - similar concerns and ensuring that we continue to provide
042075 - quality health care and service to all our members, consistent
042076 - with both the laws governing health care service plans and our
042077 - own internal policies and procedures. Please understand,
042078 - however, that all such reviews are subject to statutory
042079 - confidentiality and privacy considerations, and results cannot
042080 - be disclosed.
042082 - ..
042083 - 12. How to Dispute this Determnation
042085 - Binding Arbitration
042087 - ..
042088 - The following description of binding arbitration applies to the
042089 - following members:
042091 - a. All members enrolled in Kaiser Permanente's Senior
042092 - Advantage Individual Plan (HMO) who enrolled with an
042093 - effective date prior to 1/1/2008, and
042095 - ..
042096 - b. All members enrolled in Kaiser Permanente's Senior
042097 - Advantage Individual Plan (HMO) with an effective date
042098 - 01/01/08 or after who have not expressly opted out of the
042099 - binding arbitration process by submitting the Arbitration
042100 - Opt-Out Notice mailed to you with your identification card.
042102 - ..
042103 - Kaiser's presentation on Millie's rights conflicts with Medicare
042104 - section 422.568 (e)(4)(i) requiring Kaiser to describe for service
042105 - denials standard and expedited reconsideration processes including
042106 - conditions for appeal, reported on 100626 0917. ref SDS A7 L37O
042108 - ..
042109 - Kaiser's response dated 100708 continues...
042111 - 13. Except for Small Claims Court cases, claims subject to Medicare
042112 - appeals procedure, and if your Group must comply with ERISA
042113 - regarding certain benefit-related disputes, any dispute between
042114 - memmbers and their heirs, or other associated parties on the
042115 - one hand and Health Plan, its health care providers or other
042116 - associated parties on the other hand, for alleged violation of
042117 - any duty arising out of or related to membership in Health
042118 - Plan, including any claim for medical or hospital malpractice,
042119 - for premises liability, or relating to the coverage for, or
042120 - delivery of services of items, irrespective of legal theory,
042121 - must be decided by binding arbitration under California law and
042122 - not by lawsuit or resort to court process, except as applicable
042123 - law provides for judicial review of arbitration proceedings.
042124 - Both sides give up the right to a jury trial and accept the use
042125 - of binding arbitration. This is a summary, please refer to
042126 - your Evidence of Coverage for the complete arbitration
042127 - provision.
042129 - ..
042130 - 14. Please be advised that whether your arbitration provisions are
042131 - enforceable or are unenforceable will be determined by the
042132 - application and interpretation of various laws. These include
042133 - the Health & Safety Code section 1361.1, which pertains to
042134 - required disclosures of arbitration provisions. Additional
042135 - information regarding the California laws pertaining to
042136 - arbitration of healthcare claim(s) can be accessed on the
042137 - Internet at...
042139 - http://www.hmohelp.ca.gov
042141 - ..
042142 - 15. What if you have a quality care complaint?
042144 - If you are concnerned about the quality of care you have
042145 - received you may also file a complaint with the local Quality
042146 - Improvement Organization, by writing to...
042148 - Health Services Avisory Group, Inc
042149 - Attn: Beneficiary Protection
042150 - 5201 West Kennedy Boulevart, Suite #900
042151 - Tampa, FL 33609-1822
042153 - ...or by calling 1 800 841 1602 (TTY 1 800 991 5980 Quality
042154 - Improvement Organizations are groups of doctors and health
042155 - professionals that monitor the quality of care provided to
042156 - Medicare beneficiaries. The Quality Improvmeent Organization
042157 - review process is designed to stop any improper practice.
042159 - ..
042160 - 16. You may also file a quality complaint with Kaiser Permanente
042161 - Senior Advantage by calling 1 800 443 0815 or for the hearing
042162 - or speech impaired TTY 1 800 777 1370 8 am to 8 pm seven days a
042163 - week. We will review your complaint and notify you in writing
042164 - of our conclusion within 30 days, unless we notify you that
042165 - additional time is necessary. The process is separate from the
042166 - appeal process.
042168 - ..
042169 - 17. If you have any further questions, please feel free to contact
042170 - me at 925 924 6859, Monday through Friday between 0700 am and
042171 - 0330 pm. If you are hearing or speech impaired, you may
042172 - contact me by calling the California Relay Service at 711. You
042173 - may also contact Member Serivces by calling toll free 1 800 443
042174 - 0815, or for the hearing or speech impaired, TTY # 1 800 777
042175 - 1370 0800 am to 0800 pm seven days a week.
042177 - ..
042178 - Kaiser Permanente is a health plan with a Medicare contract.