San Francisco, CA
S U M M A R Y
DIARY: July 13, 2010 00:07 AM Tuesday;
Millie requests Kaiser reconsider denial of her claim.
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Default Null Subject Account for Blank Record
0403 - ..
0404 - Summary/Objective
040501 - Follow up ref SDS D5 0000. ref SDS D4 0000.
040508 - ..
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 68
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 68 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 69 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 70 HH4I
040920 - ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 72 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 72 MZ4N
040926 - ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 73 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 74 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 75 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 76 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 77 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 78
040958 - L54I
040960 - ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 79 KE4K
040964 - ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 80 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 81 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 82 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 83 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 69 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 70
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 88 036C Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS 88 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 88 UN4M Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS 88 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 88 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 89 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 90 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 91 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 92 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 83 PE6P; today, Cherry did not have
041053 - time to return the call. ref SDS 93 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 94 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 94 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 95 036C
041068 - ..
041069 - On 100608 1521 called and talked to Cherry and Beth about expediting
041070 - Millie's claim at Kaiser. ref SDS 96 036C Developed work plan to have
041071 - a conference call with Kaiser tomorrow. ref SDS 96 C354 Submitted
041072 - letter to Kasier and CMS Medicare confirming work plan for tomorrow.
041073 - ref SDS 96 G84Q
041075 - ..
041076 - On 100609 1114 called CMS to expedite conference call on expediting
041077 - Millie's care. ref SDS 97 036C Cherry called and schedule telecon with
041078 - Kaiesr and CMS today 1300. ref SDS 97 8O4H Received letter from Cherry
041079 - at CMS confirming work plan for conference call at 1300. ref SDS 97
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 98 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 99 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 A0 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 A4 036C
041101 - Jennifer reported she reviewed 6-issues discussed on 100609, and will
041102 - address these issues responding to Millie's claim. ref SDS A4 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 A4 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 A5 CV4O, and further advising that issues Kaiser will determine
041111 - responding to Millie's claim for recovering from UCSF medical
041112 - mistakes, ref SDS A5 036C, are as set out in the record for telecon on
041113 - 100609. ref SDS A0 XK50 Jennifer will call on 100615, to report
041114 - progress on respnding to Millie's claim. ref SDS A5 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 A6 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 A7 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 A7 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 A7 OY4T She plans to call on Friday, 100618,
041130 - to report progress responding to Millie's claim. ref SDS A7 1K5J
041132 - ..
041133 - On 100618 0843 called Jennifer at Memeber Case Resolution Department
041134 - about progress responding to Millie's claim. ref SDS A8 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 A9 036C Recommends that delay communicating with medical team
041141 - that has delayed Millie starting treatment in time to be effective,
041142 - ref SDS A9 L59P, can be solved by hiring MD Anderson. ref SDS A9 L59X
041144 - ..
041145 - On 100621 0853 called for Jennifer and left several messages,
041146 - including for her team lead. ref SDS B1 036C Nobody had time today
041147 - for calling back. ref SDS B1 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 B3 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 B3 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 B4 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 B4 575U Millie's patient history
041167 - shows the doctor's only issue, ref SDS B4 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 B4 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 B4 584W Kaiser can
041174 - easily solve the time problem by hiring other people to do the work,
041175 - and charging UCSF. ref SDS B4 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 B5 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 B5 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 B5 EG73
041188 - Jennifer will submit her draft response, and call tomorrow for
041189 - discussing Kaiser's solution. ref SDS B5 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 B6 036C
041197 - ..
041198 - On 100626 0917 received letter from Cherry at Medicare, ref SDS B7
041199 - 036C, submitting CMS regulations, that control due date for Kaiser to
041200 - respond to Millie's claim. ref SDS B7 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 B8 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 C0 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 C1 036C Review of Grievance regulations show Kaiser required
041222 - to make timely response based on patient health. ref SDS C1 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 C2 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 C3 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 C4 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 C4 V83U Kaiser has
041241 - deferred responding to Millie's claim, ref SDS C4 V87S, and needs to
041242 - know how soon her health status requires Kaiser to make a response.
041243 - ref SDS C4 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 C4 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 C5 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 C5 PY4J
041256 - He asks if Millie wants to dis-enroll from Hospice. ref SDS C5 OY5G
041257 - Doctor Johnson further notes that public domain email conflicts with
041258 - HIPAA regulations. ref SDS C5 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 C6 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 C6 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 C6 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 C6 M84S Millie sent 44 letters to medical team requesting
041280 - targeted treatment to recover from UCSF medical mistakes, shown in
041281 - case study on 100622 1511, ref SDS B4 576S, and reporting pain and
041282 - suffering from chemotherapy; so, on 100601, Millie entered Hospice for
041283 - pain relief from chemotherapy. ref SDS C6 M84Y
041285 - ..
041286 - Millie cannot dis-enroll from Hospice providing pain medication until
041287 - Kaiser provides standard of care to recover from UCSF medical
041288 - mistakes. ref SDS C6 M93V Millie explains benefits to saving lives,
041289 - time, and money using public domain email. ref SDS C6 M94W Millie
041290 - notes Doctor Johnson's report today shows Kaiser has violated Medicare
041291 - regulations by delaying response to her claim longer than justified by
041292 - Millie's health status. ref SDS C6 M96P
041294 - ..
041295 - On 100701 0915 Carol called this morning saying she is the Chief of
041296 - Hospice and advised that she was told that Millie wants to dis-enroll
041297 - from Hospice. Millie sent a letter to the medical team, and claim
041298 - teams confirming understandings from the call with Carol. ref SDS C7
041299 - 036C Millie advised Carol that Millie entered Hospice for pain relief
041300 - for chemotherapy, and so she cannot dis-enroll from Hospice providing
041301 - pain medication until Kaiser provides standard of care to recover from
041302 - UCSF medical mistakes. ref SDS C7 Q85S Millie explains she wants a
041303 - written medical opinion on treatments lined up for her to recover from
041304 - UCSF medical mistakes that provides a "roadmap to a future worth
041305 - living." ref SDS C7 Q85Y
041307 - ..
041308 - On 100701 1140, meeting this morning scheduled during a prior meeting
041309 - at Kaiser on 100601, ref SDS 85 7E4S, was canceled because Doctor
041310 - Johnson's letter yesterday, said nothing about receiving instructions
041311 - from Kaiser's claims department on solving Millie's claim for care to
041312 - recover from UCSF medical mistakes, ref SDS C5 036C Since Doctor
041313 - Johnson was not authorized to provide care requested in Millie's claim
041314 - on 100527, ref SDS 81 IZ7N, meeting would jeperodize Millie's rights
041315 - in the case by adding or otherwise modifying her statement of claim.
041316 - ref SDS C8 036C
041318 - ..
041319 - On 100701 1213 Lois called and talked to Rod for explanation of
041320 - Millie's claim, and planned to talk with Doctor Johnson about a
041321 - resolution. ref SDS C9 036C
041323 - ..
041324 - On 100702 1424 Millie received letter from Doctor Johnson submitting
041325 - Kaiser's lab report on results of Millie's blood test on 100622, and
041326 - without comment except the doctor circled with ink CA 15-3 1116.
041327 - ref SDS D0 036C
041329 - ..
041330 - On 100702 1612 Lois called and reported discussing Millie's claim with
041331 - Doctor Johnson, who evidently indicated he cannot find on the Internet
041332 - a provider willing to treat Millie with PARP. ref SDS D1 036C Lois
041333 - asked to talk with Millie in order to verify what Millie wants in her
041334 - claim filed on 100527. Lois was referred to Millie's claim, and to
041335 - the letter to Kaiser on 100701, confirming Millie's telecon with
041336 - Carol, with the Kaiser Hospice program. ref SDS C7 036C
041338 - ..
041339 - On 100705 2050 planning letter to Kaiser and Medicare claim teams
041340 - asking for remedies for damanges caused by Kaiser delaying response to
041341 - Millie's request for urgent care. ref SDS D2 036C
041343 - ..
041344 - On 100708 0038 letter to Kaiser with copy to Medicare asking for
041345 - Millie's remedies for Kaiser delaying response to Millie's claim
041346 - requesting immedicate treatment to recover from UCSF medical mistakes.
041347 - ref SDS D4 036C
041349 - ..
041350 - On 100710 1343 Millie received a letter from Kaiser responding to her
041351 - claim. ref SDS D5 036C Kaiser says the office Millie was directed to
041352 - submit her claim to be held harmless from medical mistakes was
041353 - incorrect. ref SDS D5 X48S Kaiser advises that Doctor Johnson reports
041354 - Millie's patient hsitory makes getting treatment with PARP prescribed
041355 - by Doctor Rugo to recover from UCSF medical mistakes due to
041356 - "eligibility" issues. ref SDS D5 X45V The doctor feels Millie's cancer
041357 - is difficult to treat, and maintains nothing can help her recover from
041358 - UCSF medical mistakes without having tried a single treatment listed
041359 - in Millie's claim; Kaiser does not deny any request in Millie's claim,
041360 - but proposes she discuss her care directly with Doctor Johnson who
041361 - claims to have lost hope. ref SDS D5 X530 Kaiser apoligizes for taking
041362 - 44 days to respond to Millie's claim, because unnamed regulations give
041363 - Kaiser 30 days to respond. ref SDS D5 X547 Kaiser advises Millie can
041364 - dispute the determination through arbitration, but Kaiser does not
041365 - present a disputable issue. ref SDS D5 768G Kaiser advises that Millie
041366 - can appeal to Medicare. ref SDS D5 X54Q
041368 - ..
041369 - On 100713 0007 Millie requests reconsideration Kaiser's determination
041370 - on Millie's claim, ref SDS 0 036C, and appeals to Medicare for
041371 - compliance with CMS regulations. ref SDS 0 J74S
041377 - ..
0416 - Progress
041701 - Submitted following to Kaiser saying...
041703 - 1. Subject: Appeal Reconsideration Kaiser's Denial Millie's Claim
041704 - Date: Tue, 13 Jul 2010 22:32:33 -0700
041719 - ..
041720 - 2. Kaiser's letter dated 100708, and signed by you , was received
041721 - on 100710. Numerous errors of fact and conclusion require
041722 - immediate correction in order to save Millie's life.
041723 - ref SDS D5 036C
041725 - ..
041726 - 3. Here is a picture taken 2 days ago on Sunday July 11th, 2010
041727 - (the date on the picture says "2004," a camera glitch), and
041728 - showing Millie in top form (ECOG performance score 0 in Doctor
041729 - Johnson's medical chart for 100601), despite being denied
041730 - standard of care for a year to recover from UCSF medical
041731 - mistakes...
041733 - http://www.welchco.com/pic/buck/100711/
041735 - ...[here is a video of Millie 3-days later on 100714, modeling
041736 - her new dress to thank Peggy for help shopping on Sunday...
041738 - http://www.welchco.com/pic/buck/100714/100_1310.wmv
041740 - ..
041741 - 4. Kaiser's claim determination dated 100708, makes no express
041742 - denial of any request in Millie's claim. Neither does Kaiser
041743 - order relief. Rather Kaiser says Doctor Johnson will meet with
041744 - Millie and discuss "concerns." ref SDS D5 X530 [...Millie's
041745 - letter to Doctor Johnson on 100630, requested notice from
041746 - Kaiser that communication problems with UCSF are resolved, and
041747 - that Kaiser will hold Millie harmless from UCSF medical
041748 - mistakes, as a condition precedent to meeting with the doctor
041749 - again. ref SDS C4 V89X...]
041751 - [On 100719 0522 Millie's letter to Kaiser cited her claim
041752 - on 100527 demanding to be held harmless from UCSF medical
041753 - mistakes that occurred getting care on referral from
041754 - Kaiser. ref SDS D9 JH5Y and further at ref SDS D9 JH9U
041756 - ..
041757 - 5. This is therefore a denial, and Millie requests
041758 - reconsideration, as follows...
041760 - [On 100714 0742 received letter from Paula internal to
041761 - Kaiser notifying claim team, ref SDS D6 N34L, that Millie's
041762 - letter on 100713, ref SDS 0 036C, requests reconsideration
041763 - and appeals to Medicare Kaiser's denial dated 100708, and
041764 - received on 100710, ref SDS D5 036C, of Millie's claim
041765 - filed on 100527.
041767 - ..
041768 - [On 100715 1802 received securmail from Jennifer responding
041769 - to the letter today requesting reconsideration and
041770 - appealing Kaiser's denial on 100708, and received on
041771 - 100710, of Millie's claim filed on 100527, and Jennifer's
041772 - securemail letter could not be opened. ref SDS D7 036C
041774 - ..
041775 - [On 100715 1802 sent letter to Kaiser claim team with copy
041776 - to Medicare (CMS) team, reporting Jennifer's securemail
041777 - could not be opened, and requesting resubmission using
041778 - public domain email. ref SDS D7 PL5T
041780 - ..
041781 - 6. Millie met with the doctor for a year, and Kaiser failed to
041782 - perform, causing Millie's cancer to advance placing her life in
041783 - jeopardy [...cited in Millie's claim failed on 100527.
041784 - ref SDS 81 X553; case study shows 44 letters Millie filed
041785 - notifying Kaiser to provide prescribed care, reported on 100622
041786 - 1511. ref SDS B4 576S...] Doctor Johnson stated on 100601,
041787 - that he could not order care for Millie to recover from UCSF
041788 - medical mistakes, because he could not communicate with UCSF by
041789 - telephone nor by email. On 100606, Doctor Johnson reported
041790 - that UCSF still had not returned his calls. ref SDS 92 036C
041791 - Kaiser's letter on 100708, indicates the doctor has lost hope
041792 - ...[reported on 100710 1343, ref SDS D5 X45V...] Millie is
041793 - anxious to recover from UCSF medical mistakes. She will meet
041794 - with Doctor Johnson upon notice Kaiser has solved communication
041795 - problems with UCSF and authorized the doctor to provide
041796 - necessary and reasonable care that holds Millie harmless from
041797 - UCSF medical mistakes, as requested in Millie's claim filed on
041798 - 100527, ref SDS 81 X655 [...and as noted in Millie's letter to
041799 - Kaiser on 100630. ref SDS C4 V89X...]
041801 - [On 100716 0830 Paula recommends Millie offer to meet with
041802 - Doctor Johnson, because she believes the doctor may be
041803 - authorized to order work that holds Millie harmless from
041804 - UCSF medical mistakes, and so resolve Millie's claim.
041805 - ref SDS D8 6T3G
041807 - ..
041808 - [On 100719 0522 Millie submitted letter to primary care
041809 - physician with work plan to resolve Millie's claim, and
041810 - offered to meet with the doctor to discuss implementation
041811 - of demand to be held harmless from UCSF medical mistakes
041812 - that occurred getting care on referral from Kaiser.
041813 - ref SDS D9 JH5Y and further at ref SDS D9 JH9U
041815 - ..
041816 - [On 100719 1312 Kaiser proposes only another meeting to
041817 - "discuss next steps," and not to implement UCSF or any
041818 - alternate work plan for Millie to recover from UCSF
041819 - medical mistakes, and ignores Kaiser's fiduciary duty
041820 - to hold Millie harmless from UCSF medical mistakes
041821 - providing care on referral from Kaiser. ref SDS D0 036C
041823 - ..
041824 - [On 100729 0510 at 1700 Millie died due to lack of
041825 - treatment. ref SDS E3 EK4I
041827 - ..
041828 - [On 100803 1212 sympathy card of condolence and letter from
041829 - Arlette, and notes which why Millie died may never be fully
041830 - known what was done that should not have been done, and
041831 - what was not done that should have been done? ref SDS E4
041832 - 4R3G
041834 - ..
041835 - 7. Kaiser presents no opposing evidence nor dispute on facts
041836 - presented in Millie's claim filed on 100527. ref SDS 81 IZ7N
041838 - ..
041839 - 8. Kaiser's letter dated 100708 refuses to help Millie recover
041840 - from life-threatening injuries caused by medical mistakes under
041841 - Kaiser's care and authority because (1) Kaiser incorrectly
041842 - holds that the Case Resolution Department is not the proper
041843 - channel to hold Millie harmless from injuries Millie suffered
041844 - under Kaiser's referral order for treatment at UCSF,
041845 - ref SDS D5 X48S; and (2) Kaiser improperly holds that success
041846 - treating Millie makes her "ineligible" for treatment to recover
041847 - from medical mistakes, ref SDS D5 X45V; and (3) Kaiser
041848 - maintains without evidence trying any of 20 treatments
041849 - submitted by Millie at the request of Kaiser and UCSF and
041850 - targeted to Millie's patient profile, that none can be
041851 - effective, ref SDS D5 X530, and (4) Kaiser argues that "at this
041852 - time" having "run out the clock" giving incorrect treatment
041853 - with chemotherapy for a year, and ignoring Millie's 44 requests
041854 - for "targeted" care, which a breast care oncology expert
041855 - prescribed on 090616, citing agreement with Kaiser, that Kaiser
041856 - has no duty to correct this mistake by providing necessary and
041857 - reasonable care for Millie to attempt recovery from injuries
041858 - Millie suffered caused by medical mistakes getting radiation
041859 - treatment at UCSF on referral from Kaiser, thereby causing
041860 - wrongful death of an innocent party through negligence or for
041861 - the purpose of covering up medical mistakes and avoiding the
041862 - cost of Millie's care, ref SDS D5 X530, and (5) Kaiser
041863 - apologizes for violating Medicare regulations requiring timely
041864 - notice of claim determinations intended to prevent wrongful
041865 - death, and by such conduct strongly indicating complicity in
041866 - causing the wrongful death of an innocent and good woman.
041867 - ref SDS D5 X547
041869 - ..
041870 - 9. Millie is not afraid of death; she embraces life with courage
041871 - and dignity. She fears for others being denied standard of
041872 - care, and for doctors suffering the weight of organizational
041873 - pressure to ignore good practice, standard of care, and
041874 - regulations sliding down a slippery slope of denial that
041875 - transforms the examination room for "giving care" into a "death
041876 - panel" of one. She feels this needs quality improvement.
041878 - ..
041879 - 10. The only evidence Kaiser cites in its letter dated 100708,
041880 - denying life-saving treatment for Millie is alleged verbal
041881 - representations of "understandings" the primary care physician
041882 - ascribes to a single meeting on 100601, that occurred in a
041883 - closed-door, tiny examination room, contending Millie wanted to
041884 - end all attempts for treatment and die, ref SDS D5 X45V; while
041885 - Millie's claim filed on 100527 states, ref SDS 81 X65W; her
041886 - letter to Kaiser on 100601 states, ref SDS 84 1Q3V; and, Millie
041887 - requested again during the meeting on 100601 (and throughout
041888 - the year before that) to "end chemotherapy" causing torturous
041889 - pain and suffering, ref SDS 85 4H3K, and instead get "targeted"
041890 - treatment effective to recover from medical mistakes that
041891 - caused her cancer to spread, and which does not cause painful
041892 - side effects [...presented in Millie's claim on 100527 0217.
041893 - ref SDS 81 IZ7N and ref SDS 81 X66Y...]. Kaiser thus creates
041894 - an illusion of a disputable fact. This, however, is not a
041895 - relevant dispute, since Millie is entitled to choose whether to
041896 - pursue recovery from medical mistakes by getting necessary and
041897 - reasonable care without chemotherapy using any of 20 therapies
041898 - "targeted" to her cancer, but which Kaiser refuses to provide,
041899 - solely on grounds that Kaiser cannot communicate with UCSF by
041900 - telephone nor by email.
041902 - ..
041903 - 11. This case raises many puzzling questions, including...
041905 - (1) Why does an HMO paying $400,000 for referral care resist
041906 - correcting medical mistakes that severely injured the
041907 - patient? Millie's patient history (listed in her claim
041908 - filed on 100527) is replete with Doctor Johnson saying
041909 - "Hey, I tried my best. I don't have time. I called and
041910 - called, and sent email, but UCSF does not return calls."
041911 - (see for example the doctor's letter most recently on
041912 - 100606. ref SDS 92 036C
041914 - ..
041915 - However, none of this is in Kaiser's response letter dated
041916 - 100708. Instead, Kaiser immunizes the wrongdoer saying
041917 - "Gosh, "at this time" we delayed effective treatment
041918 - prescribed by UCSF (e.g., PARP) for so long that "at this
041919 - time" nothing can help Millie recover from UCSF medical
041920 - mistakes. "We tortured her with ineffective chemotherapy
041921 - for a year until she finally sought relief in hospice, so
041922 - it's over. UCSF is off the hook." Why though is it in
041923 - Kaiser's interest to refuse repair of a $400,000 mistake
041924 - made by a referral provider?
041926 - ...[why does Kaiser fight so hard to hold harmless the
041927 - guilty, and make the innocent pay, for UCSF's
041928 - mistakes...].
041930 - ..
041931 - (2) Standard of care requires the doctor to show the patient
041932 - evidence comparing treatment beneficial outcomes and costs
041933 - in terms of suffering painful side effects, time, and
041934 - money [...reported on 090725 2017. ref SDS 41 T58U, and
041935 - cited in Millie's claim on 100527 0217. ref SDS 81
041936 - X560...] The patient can then make a rational choice on
041937 - getting treatment, or not. Can an MA withhold evidence
041938 - and simply tell the patient nothing will work to recover
041939 - from medical mistakes; or, does, in this case, a woman
041940 - have the right to choose whether to try treatment or not
041941 - based on objective evidence and input from the doctor,
041942 - family, friends, second opinion? A patient injured by
041943 - medical mistake has the right to say, "Gosh, the evidence
041944 - doesn't look promising, but I would like to try." Can
041945 - she, also, say, "Gee, Doctor so and so, you present very
041946 - convincing evidence that treatment will help me recover
041947 - from medical mistakes, but after a year of being misled
041948 - and neglected I don't trust the health care system, and so
041949 - choose to avoid emotional trauma of false hope; I choose
041950 - Hospice, as you have been recommending for 6 years." What
041951 - standard of care protects a patient's human right to due
041952 - process choosing life or death?
041954 - ..
041955 - (3) Medicare regulations assiduously assuage the natural
041956 - tension between a surety who both pays and performs the
041957 - work, causing financial incentive to cut corners on care.
041958 - Medicare has exhaustive requirements for the MA to provide
041959 - written notice to the patient in time for ensuring
041960 - effective care [...e.g., on 100626 0917. ref SDS B7
041961 - 4U5G...]. Yet, in this case, Kaiser ignores all of the
041962 - regulations, ignores all written notices requesting
041963 - treatment for a year, and in a letter dated 100708,
041964 - defends withholding life-saving treatment solely on the
041965 - basis of an alleged verbal representation of a doctor
041966 - relating to claims professionals alleged verbal
041967 - representations of a patient [...see UCSF's letter dated
041968 - 100708, received on 100710 1343, ref SDS D5 X530...],
041969 - which are not supported by the medical chart [...reported
041970 - on 100601 0830. ref SDS 85 W28P...], nor by any of very
041971 - many [...44...] written notices in patient history [...
041972 - case study on 100622 1511. ref SDS B4 576S...], and result
041973 - in ending financial obligations to care for the patient.
041974 - Why bother to write regulations requiring written notice,
041975 - if there is no enforcement?
041977 - ..
041978 - 12. Accordingly, Millie requests reconsideration for favorable
041979 - determination on her claim requesting immediate life-saving
041980 - treatment; she further requests Kaiser's mitigation plan to
041981 - avoid future mistakes, as occurred here; and, Millie appeals to
041982 - Medicare for enforcement of applicable regulations, and review
041983 - of quality care in this case.
041985 - ..
041986 - [On 100716 0830 Paula recommends Millie offer to meet with
041987 - Doctor Johnson, because she believes the doctor may be
041988 - authorized to order work that holds Millie harmless from
041989 - UCSF medical mistakes, and so resolve Millie's claim.
041990 - ref SDS D8 6T3G
041992 - ..
041993 - [On 100719 0522 Millie submitted letter to primary care
041994 - physician with work plan to resolve Millie's claim, and
041995 - offered to meet with the doctor to discuss implementation.
041996 - ref SDS D9 JH5V
041998 - ..
041999 - [On 100719 1312 Kaiser proposes only another meeting to
042000 - "discuss next steps," and not to implement UCSF or any
042001 - alternate work plan for Millie to recover from UCSF medical
042002 - mistakes, and ignores Kaiser's fiduciary duty to hold
042003 - Millie harmless from UCSF medical mistakes providing care
042004 - on referral from Kaiser. ref SDS E0 036C
042006 - ..
042007 - [On 100720 0655 notified Medicare that, though not
042008 - required, Millie offered to meet the doctor, as requested
042009 - by Medicare for establishing denial of Millie's claim, and
042010 - the doctor repeated failure to perform for the past year by
042011 - offering only discussion of "next steps," rather than
042012 - implementing UCSF work plan for holding Millie harmless
042013 - from UCSF medical mistakes, and so Millie asked for
042014 - confirmation that Medicare is processing Millie's appeal
042015 - from Kaiser's adverse determination of her claim filed on
042016 - 100527. ref SDS E1 LB8U Millie further notified Medicare
042017 - that Kaiser (Paula) filed a 2nd claim for Millie in order
042018 - to take control of the case at Kaiser for the purpose of
042019 - settlement, and Millie objects to complicating resolution
042020 - that delays care for Millie, and requests that Medicare
042021 - process Millie's Medicare appeal filed today on 100713,
042022 - ref SDS 0 J74S, concurrent with any processing of a 2nd
042023 - claim filed internally for Millie at Kaiser. ref SDS E1
042024 - LB6T
042026 - ..
042027 - [On 100723 1323 Julie called for Patty, and advised that
042028 - Medicare will respond to Millie's appeal in writing,
042029 - ref SDS E2 036C; Julie indicated that Medicare holds that
042030 - documentation received from Kaiser shows Medicare is not
042031 - required to process Millie's appeal, because Kaiser
042032 - unilaterally reclassified the claim requesting medical
042033 - services, into a "grievance" filed by Rod on 100610, based
042034 - on Millie's filing a statement of authorized represenative
042035 - on 100610, which Medicare maintains allows Kaiser 30 days
042036 - to respond until 100710, rather than respond on 100610;
042037 - however, Kaiser and Medicare err, since Millie filed the
042038 - claim on 100527, and so filing statment of authorized
042039 - representative on 100610, was independent from Kaiser's
042040 - requirement to respond on that date, 100610, and does not
042041 - justify reclassifying Millie's claim to a "grievance."
042042 - ref SDS E2 HN8O
042044 - ..
042045 - 13. This appeal is based on the following facts evident from
042046 - Kaiser's letter dated 100708...
042048 - ..
042049 - 14. Kaiser does not dispute that Millie suffered injury to her
042050 - lungs and cancer spread due to medical mistakes caused by UCSF
042051 - providing radiation services on Kaiser's referral #A0231414
042052 - dated 090202, and compounded for a year by withholding
042053 - effective treatment, and providing instead ineffective
042054 - chemotherapy that caused torturous pain and suffering,
042055 - including near-fatal infections from side effects, as cited in
042056 - Millie's claim filed on 100527. ref SDS 81 IZ7N
042058 - ..
042059 - 15. Kaiser does not dispute that Millie's life is in grave danger
042060 - without immediate treatment requested in her claim. Doctor
042061 - Johnson's letter on 100624, reported that her cancer is
042062 - advancing exponentially [...received on 100702 1424,
042063 - ref SDS D0 L54I...], due to delay providing treatment since
042064 - ...[090716...], and shown in patient history listed on 090323.
042065 - ref SDS 22 J13O
042067 - ..
042068 - 16. Kaiser's reasoning that Millie cannot be held harmless from
042069 - injury caused by medical mistakes because medical mistakes are
042070 - not a "covered benefit" in her health plan is erroneous, and
042071 - conflicts with the record. [...on 100609, Irene Tsai and Susan
042072 - Morris stated to Medicare representatives Julie, Cherry, and
042073 - Beth that Millie's claim was submitted to Kaiser's office
042074 - responsible for processing payment requests. ref SDS 99
042075 - 6G82...] Kaiser is responsible for correct performance of work
042076 - under Kaiser's referral #A0231414 dated 090202. An injured
042077 - patient nearing death is not required to run from pillar to
042078 - post hoping someone will take responsibility to correct medical
042079 - mistakes. On 090609, Paula McPhail was notified in your office
042080 - at the Case Resolution Department that UCSF disclosed medical
042081 - mistakes that seriously injured Millie. Ms McPhail advised
042082 - that Kaiser would take immediate corrective action to hold
042083 - Millie harmless, and she did so, as presented in Millie's claim
042084 - submitted to Ms McPhail on 100527, shown beginning in para 44.
042085 - ref SDS 81 X94U
042087 - ..
042088 - 17. Kaiser does not dispute that UCSF notified Millie a week later
042089 - on 090616, that "everybody is on board" at Kaiser and UCSF for
042090 - a work plan to hold Millie harmless from UCSF medical mistakes,
042091 - ref SDS 37 D647, by providing treatment appropriate to her
042092 - medical history, and that Kaiser and UCSF entered into a letter
042093 - agreement to begin Millie's treatment with MPA and then PARP,
042094 - ref SDS 37 KD6L, and that Millie's care for oncology was
042095 - transferred to UCSF holding her, Kaiser, and Medicare harmless
042096 - from medical mistakes for which UCSF was solely responsible.
042097 - ref SDS 37 EE70
042099 - ..
042100 - 18. Accordingly, by copy I appeal to Medicare to enforce the usual
042101 - rule that MA must [...hold the patient harmless from medical
042102 - mistakes, and...] provide a single point of contact for timely
042103 - care, including dispute resolution, and that MA is responsible
042104 - to coordinate internal review, and this is not a duty of the
042105 - patient near wrongful death due to neglect aimed at covering up
042106 - mistakes and saving money by charging the patient and Medicare
042107 - for costs caused by others.
042109 - ..
042110 - 19. Kaiser's refusal to help Millie recover from UCSF medical
042111 - mistakes because one doctor allegedly "understands" Millie does
042112 - not meet "eligibility" requirements (see Kaiser's letter dated
042113 - 100708 para 7, ref SDS D5 X45V, conflicts with the record, and
042114 - with Kaiser's duty to provide necessary and reasonable care for
042115 - Millie to recover from medical mistakes.
042117 - ..
042118 - 20. Kaiser does not dispute that Kaiser and UCSF routinely exercise
042119 - doctor discretion for medical necessity waiving treatment
042120 - eligibility requirements so that Millie gets care in time to be
042121 - effective. On 081016, Millie did not meet eligibility
042122 - requirements for Sunitinib and cyclophosphamide, because
042123 - cyclophosphamide is "Cytoxan," which Doctor Johnson gave Millie
042124 - twice before in her complicated treatment history, and found
042125 - that her cancer resisted the treatment both times. Kaiser's
042126 - records show that Doctor Johnson ordered cyclophosphamide with
042127 - Adriamycin (commonly "AC") for Millie's first treatment on
042128 - 020423. ref SDS 1 0001
042130 - ..
042131 - 21. On 020603, the doctor ended AC because evidence from scans and
042132 - Millie's cancer marker that shot up to 117, showed her cancer
042133 - resisted AC and progressed. ref SDS 2 WO4O
042135 - ..
042136 - 22. Despite Millie's cancer resisting cyclophosphamide, Doctor
042137 - Johnson exercised discretion and waived protocol, including
042138 - risks of heart failure to prescribe it again, and for the
042139 - purpose of medical necessity to qualify Millie for a clinical
042140 - trial at Kaiser, which he believed would treat her cancer, even
042141 - if AC was ineffective again, reported on 041230. ref SDS 7
042142 - XQ41
042144 - ..
042145 - 23. The doctor later risked further heart damage by prescribing
042146 - additional AC that exceeded protocol requirements, and was
042147 - still ineffective causing Millie's cancer to progress, because
042148 - there was a mistake "understanding" the number of these
042149 - treatments needed for Millie to be "eligible" for a treatment,
042150 - which the doctor "understood" would help Millie, reported on
042151 - 050204. ref SDS 8 028N
042153 - ..
042154 - 24. Similarly, on 081016, Doctor Rugo waived eligibility protocol
042155 - to treat Millie with sunitinib that is "targeted" to cancer,
042156 - and combined with chemotherapy using cyclophosphamide and <W54J
042157 - Methotrexate. Despite Millie's patient history showing her
042158 - cancer resists cyclophosphamide, Doctor Rugo exercised
042159 - discretion because medical necessity for Millie to recover from
042160 - cancer required treatment with sunitinib targeted to cancer.
042161 - ref SDS 14 J38U Sunitinib was extremely effective [...
042162 - reported on 081202 0253. ref SDS 15 AS6X...], until Doctor Rugo
042163 - added chemotherapy with cyclophosphamide. Millie's cancer
042164 - resisted it again, and her blood counts went down, the doctor
042165 - was forced to pause sunitinib [...reported on 081218 1000.
042166 - ref SDS 16 WS8N, and the team lost control of the cancer [...
042167 - reported on 081224 0700. ref SDS 18 1Y4I...]
042169 - ..
042170 - 25. Lesson learned...after radiation, Doctor Rugo wrote a letter to
042171 - Doctor Johnson dated 090514, advising that she would treat
042172 - Millie with MPA even though the protocol, like sunitinib,
042173 - included cyclophosphamide and Methotrexate. Doctor Rugo
042174 - exercised discretion to avoid chemotherapy (cyclophosphamide
042175 - and Methotrexate) and order only "targeted" treatment for
042176 - Millie with with MPA alone. ref SDS 31 265I
042178 - ..
042179 - 26. This was implemented in the doctor's order issued a month later
042180 - on 090616. ref SDS 37 YO4J
042182 - ..
042183 - 27. There was concern leading up to the meeting at UCSF on 090616,
042184 - that Millie would not be "eligible" for MPA because she
042185 - suffered injury to her lungs from medical mistakes getting
042186 - radiation. When Doctor Hsu discovered medical mistakes on
042187 - 090609, he ordered treatment with MPA for Millie to recover.
042188 - He also ordered a CT test. ref SDS 34 1P3K
042190 - ..
042191 - 28. The next day, on 090610, Doctor Rugo's assistant called. He
042192 - said the doctor wanted files for Millie's CT test hand
042193 - delivered to UCSF for immediate review of radiation injury to
042194 - her lungs, because this would make Millie "ineligible" for MPA.
042195 - ref SDS 36 S537
042197 - ..
042198 - 29. With great effort by Doctor Johnson, and all hands in Radiology
042199 - the CT test was performed at Kaiser in Walnut Creek on 090612,
042200 - and, as requested, a CD with the scan files was immediately
042201 - hand-delivered to UCSF in the city. However, as shown in the
042202 - record on 090706, nobody ever looked at the files. ref SDS 39
042203 - 1L6N
042205 - ..
042206 - 30. Clearly, Doctor Hsu determined that Millie needed MPA to
042207 - recover from medical mistakes for which UCSF is liable, and
042208 - Doctor Rugo exercised discretion to order it for medical
042209 - necessity.
042211 - ..
042212 - 31. This record demonstrates that failure to help Millie recover
042213 - from UCSF medical mistakes is not justified on grounds that
042214 - successful care makes her "not eligible" for PARP or anything
042215 - else, as incorrectly alleged in Kaiser's letter dated 100708
042216 - ...[reported on 100710 1343. ref SDS D5 X45V...]
042218 - ..
042219 - 32. UCSF and Kaiser have at all times balanced "eligibility" with
042220 - medical necessity. There can be no greater necessity than the
042221 - life of the patient. Doctor Johnson's letter on 100624,
042222 - showing Millie's cancer marker increasing exponentially [...
042223 - received on 100702 1424. ref SDS D0 L54I...] shows Millie's
042224 - life requires immediate treatment. Kaiser and UCSF have over
042225 - 20 treatments "targeted" to Millie's cancer, shown in her claim
042226 - filed on 100527. ref SDS 81 X77U
042228 - ..
042229 - 33. Millie's claim [...filed on 100527...] requests standard of
042230 - care called out in Kaiser's contract based on best evidence for
042231 - her patient profile that requires treatment "targeted" to her
042232 - patient profile. ref SDS 81 IZ7N
042234 - ..
042235 - 34. Kaiser's letter dated 100708 represents that...
042237 - ..
042238 - 35. "Doctor Johnson stated that, at this point in time, [...
042239 - patient...] is exhibiting resistance to all forms of
042240 - chemotherapy, targeted therapy, and hormonal therapy. It was
042241 - for this reason that she decided not to pursue further
042242 - treatment, and enrolled in hospice. There are no further
042243 - beneficial treatments available at this time." ref SDS D5 X45V
042245 - ..
042246 - 36. This is a dangerous position for health care providers, saying
042247 - in effect...
042249 - ..
042250 - "Oops! Sorry we made a mistake. Fortunately, we don't have to
042251 - fix it because you "exhibit resistance" to everything."
042253 - ..
042254 - 37. The medical chart for meeting with Doctor Johnson on 100601
042255 - does not state Millie entered Hospice because nothing will
042256 - work. ref SDS 85 W28P
042258 - ..
042259 - 38. The medical chart states Abraxane chemotherapy was
042260 - discontinued.
042262 - ..
042263 - 39. This aligns with Millie's claim filed on 100527, requesting
042264 - treatment targeted to cancer beginning with PARP or equal
042265 - ref SDS 81 IZ7N, and saying chemotherapy could no longer be
042266 - tolerated. ref SDS 81 X65W Doctor Johnson received a copy of
042267 - the claim.
042269 - ..
042270 - 40. Millie's letter to Kaiser in the morning of 100601, notified
042271 - the doctor to implement UCSF's work plan for Millie to recover
042272 - from UCSF medical mistakes using treatment "targeted" to cancer
042273 - beginning with PARP, and that she cannot continue with
042274 - chemotherapy due to pain and suffering from side effects.
042275 - ref SDS 84 1Q3Y
042277 - ..
042278 - 41. Millie's letter on 100601, further cited Doctor Rugo's letter
042279 - on 100501, saying she would communicate with Doctor Johnson at
042280 - Kaiser on care for Millie to recover from UCSF medical
042281 - mistakes, ref SDS 70 456L, responding to Millie's letter
042282 - earlier in the day on 100501, requesting treatment with PARP or
042283 - equal. ref SDS 69 U47P
042285 - ..
042286 - 42. During the meeting at Kaiser Doctor Johnson told Millie that he
042287 - could not communicate with Doctor Rugo by telephone nor by
042288 - email for a month to implement the UCSF work plan for treating
042289 - Millie with PARP to recover from UCSF medical mistakes.
042290 - ref SDS 85 4F6I [...At that time...] On 100601, the doctor
042291 - opened a website on the computer in the examination room, and
042292 - said something to the effect that he could prescribe MPA for
042293 - Millie. ref SDS 85 WG7J When it was noted that Doctor Rugo
042294 - already treated Millie with MPA on 090616, and stopped on
042295 - 090716, due to concerns it caused breathing problems,
042296 - ref SDS 40 EE5W, the doctor advised that he could only provide
042297 - medication in Hospice to relieve Millie's pain from
042298 - chemotherapy. Millie's choice was to suffer a painful demise
042299 - to death, or get Hospice medication to ease her pain until
042300 - death, as reported on 100601. ref SDS 85 4H3K
042302 - ..
042303 - 43. Kaiser's representation in the letter on 100708, that Millie
042304 - cannot benefit from treatment is not supported by evidence.
042306 - ..
042307 - 44. Kaiser does not dispute that Kaiser and UCSF requested that
042308 - Millie submit a list of treatments. On 090326, Millie
042309 - submitted a list of 20 treatments targeted to her cancer, and
042310 - as set out in her claim filed on 100527... ref SDS 81 X77R
042312 - ..
042313 - 45. Millie requested standard of care for the doctor to investigate
042314 - and present trade-offs comparing positive outcomes with the
042315 - least cost in terms of suffering pain from side effects, time,
042316 - and money. [...see case study on 100622 1511. ref SDS B4
042317 - CJ5F...] Doctors have a fiduciary responsibility to provide
042318 - the best evidence available. During a meeting with Doctor
042319 - Johnson on 100112, the doctor reviewed evidence from a
042320 - professional article on PARP for treating Millie to recover
042321 - from UCSF medical mistakes. The doctor explained that evidence
042322 - shows PARP is targeted to Millie's rare triple negative status,
042323 - has shown positive outcomes, and causes no painful side
042324 - effects. ref SDS 60 1D4G
042326 - ..
042327 - 46. This independent evidence justifies Doctor Rugo's treatment
042328 - plan on 090616, citing a letter agreement with Kaiser to treat
042329 - Millie first with MPA, prescribed by Docthor Hsu, and then with
042330 - PARP for Millie to recover from UCSF medical mistakes.
042331 - ref SDS 37 KD6L
042333 - ..
042334 - 47. Kaiser's medical chart shows that on 100601, Kaiser failed to
042335 - provide standard of care for any of the 20 treatments
042336 - identified for Millie to recover from UCSF medical mistakes,
042337 - and so Millie's only choice was Hospice for pain relief to die,
042338 - or suffer a painful death.
042340 - ..
042341 - 48. Without independent corroborating evidence Kaiser may not rely
042342 - on mere verbal expressions that lead to financial gain for
042343 - Kaiser and loss of life of the patient. The patient's doctor
042344 - may certainly offer opinion with supporting evidence, as with
042345 - the PARP example, above. But, to the extent opinion of a
042346 - Kaiser doctor leads to financial gain for Kaiser, it may not be
042347 - relied upon as the sole evidence for denying patient requests
042348 - for urgent, life-saving care, since there is always risk that
042349 - uncorroborated opinion is slanted toward interests of the
042350 - employer out of "loyalty," being "team player" or simple error
042351 - due to fatigue, misunderstanding, and confusion from a hectic
042352 - schedule.
042354 - ..
042355 - 49. On 090213, Doctor Johnson met with Millie and told the story of
042356 - a "wise man" in India who invented chess. Millie was told
042357 - through this story that Kaiser did not want to pay more money
042358 - for her care. ref SDS 21 4N67
042360 - ..
042361 - 50. At this meeting on 090213, the doctor offered religious
042362 - counsel, and told Millie that she had less than a year to live,
042363 - and so she could end treatment and enter Hospice for pain
042364 - control until death. ref SDS 21 646L
042366 - ..
042367 - 51. Preparing the ground for "cutting the patient loose" was not
042368 - new. Case study in the record on 090213, shows Kaiser has told
042369 - Millie 11 times about twice a year since 2004, to get her
042370 - affairs in order because she had less than a year to live, and
042371 - her cancer could no longer be treated, ref SDS 21 L19H
042372 - precisely the reason presented in Kaiser's letter. dated
042373 - 100708, [...received on 100710 1343. ref SDS D5 X45V...]
042375 - ..
042376 - 52. Kaiser's conflict of interest desiring to move Millie from the
042377 - Oncology budget to Hospice and then "off the books," renders
042378 - Kaiser's opinion, unsupported by independent evidence,
042379 - unreliable and unjust for denying Millie's right to recover
042380 - from UCSF medical mistakes.
042382 - ..
042383 - 53. The only proof that Millie cannot respond to treatment is to
042384 - provide treatment. This is a very simple test that meets
042385 - standard of care for a patient to receive all necessary and
042386 - reasonable care to recover from medical mistakes.
042388 - ..
042389 - 54. Kaiser's sole reliance on a concept of "exhibiting resistance"
042390 - to all forms of treatment, as grounds to avoid trying even one
042391 - of 20 available "targeted" treatments, conflicts with Millie's
042392 - patient history. As stated above, after initial diagnosis of
042393 - cancer in March 2002, Kaiser prescribed chemotherapy with
042394 - Adriamycin Cytoxan (AC) as the "best treatment" for Millie's
042395 - cancer starting in April 2002. After 1 cycle, the doctor
042396 - determined Millie "exhibited resistance" to the top-of-the-line
042397 - "gold standard" for breast cancer. The doctor did not tell
042398 - Millie... "Sorry, since your cancer resists the best treatment,
042399 - nothing else will work." Indeed not! The doctor experimented.
042400 - He tried another treatment and it worked. Now, as then, Kaiser
042401 - has no evidence that the next treatment will not work to save
042402 - Millie's life. The doctor did not tell Millie in the meeting
042403 - at Kaiser on 100601, that her cancer would not respond to any
042404 - treatment. He said he could not communicate with Doctor Rugo
042405 - at Kaiser by telephone nor by email to arrange for "targeted"
042406 - treatment with PARP prescribed by Doctor Rugo on 090616, for
042407 - Millie to recover from UCSF medical mistakes. ref SDS 85 4F6I
042409 - ..
042410 - 55. Case study on 090213, shows that beginning on 080829, Doctor
042411 - Johnson asked Millie to have UCSF submit a list of therapies
042412 - "targeted" to cancer, so the medical team would have an
042413 - inventory of "targeted" and vaccine treatments UCSF could try,
042414 - as he did with chemotherapy in 2002, in order to find effective
042415 - care for Millie, since by 2008, Millie's cancer had mutated to
042416 - resist chemotherapy. ref SDS 21 PT3N
042418 - ..
042419 - 56. Later on 090121, Doctor Rugo's office said they lost their
042420 - list, and so asked Millie for a list. Millie submitted 20
042421 - treatments listed now in her claim filed on 100527, for Millie
042422 - to recover from UCSF medical mistakes. Kaiser and UCSF have
042423 - not tried even one. Unlike the first treatment Millie received
042424 - in 2002, there is no evidence of any kind showing Millie is
042425 - "exhibiting resistance" to any of the 20 treatments listed in
042426 - her claim, ref SDS 81 X77U, nor to any of the new treatments
042427 - being introduced everyday by cancer researchers.
042429 - ..
042430 - 57. Since UCSF presented a work plan on 090616, and commenced work
042431 - at that time taking responsibility for Millie's recovery from
042432 - UCSF medical mistakes, what is Kaiser's objection to UCSF doing
042433 - the work providing care with treatments submitted for that
042434 - purpose? Since UCSF reported delay on 090716, and asked Kaiser
042435 - provide interim care while UCSF organized Millie's next
042436 - treatment with PARP, why does Kaiser refuse to demand that UCSF
042437 - perform under referral?
042439 - ..
042440 - 58. Accordingly, by copy Millie appeals to Medicare to enforce the
042441 - usual rule that MA must offer patients reasonable and necessary
042442 - care to recover from medical mistakes, and that innocent
042443 - parties, here Millie and Medicare, are held harmless for costs
042444 - of recovery. It's between UCSF and Kaiser under referral
042445 - #A0231414 dated 090202.
042447 - ..
042448 - 59. Kaiser's delay responding to Millie's claim filed on 100527,
042449 - and requesting immediate life-saving treatment appears
042450 - conflicting with Medicare regulations, and the intent of
042451 - regulations to provide effective care in time for patient
042452 - health [...not withstanding Kaiser's apology for not
042453 - communicating clearly delayed response, in Kaiser's letter on
042454 - 100708, received on 100710 1343. ref SDS D5 X547...]
042456 - ..
042457 - 60. Millie filed a claim on 100527, requesting urgent treatment to
042458 - save her life. ref SDS 81 IZ7N
042460 - ..
042461 - 61. Kaiser's records show Millie's cancer marker is increasing
042462 - exponentially, shown in case study on 090323. ref SDS 22 J13O
042464 - ..
042465 - 62. Medicare section 422.568(a) says...
042467 - When a party has made a request for a service, the MA
042468 - organization must notify the enrollee of its determination as
042469 - expeditiously as the enrollee's health condition requires, but
042470 - no later than 14 calendar days after the date the organization
042471 - receives the request for a standard organization determination.
042472 - The MA organization may extend the timeframe by up to 14
042473 - calendar days if the enrollee requests the extension or if the
042474 - organization justifies a need for additional information and
042475 - how the delay is in the interest of the enrollee (for example,
042476 - the receipt of additional medical evidence from noncontract
042477 - providers may change an MA organization's decision to deny).
042478 - When the MA organization extends the timeframe, it must notify
042479 - the enrollee in writing of the reasons for the delay, and
042480 - inform the enrollee of the right to file an expedited grievance
042481 - if he or she disagrees with the MA organization's decision to
042482 - grant an extension.
042484 - ..
042485 - 63. Kaiser reported on 100609, that Kaiser would notify Millie of a
042486 - determination on Millie's claim requesting life-saving care the
042487 - next day on 100610. Kaiser stated that Medicare regulations
042488 - require response as expeditiously as Millie's declining health
042489 - condition requires. ref SDS 99 6F64 [...this was confirmed in
042490 - Millie's letter to Kaiser and Medicare the next day on 100610
042491 - 0352 ref SDS A1 036C...]
042493 - ..
042494 - 64. Later on 100609, Jennifer called and asked Millie to file a
042495 - statement of authorized representative to help Kaiser process
042496 - her claim. ref SDS A0 TV6R
042498 - ..
042499 - 65. The next day on 100610, Jennifer called and said she was having
042500 - difficulty communicating with the primary care physician, and
042501 - needed time to understand Millie's complex patient history.
042502 - She asked to extend Kaiser's response until 100624. This was
042503 - agreed. Kaiser's letter on 100611, confirms that on 100624,
042504 - Kaiser would notify Millie of a determination on her request
042505 - for life-saving care. ref SDS A5 6P53
042507 - ..
042508 - 66. The tenor of Kaiser's letter citing a "14-day" requirement
042509 - indicated compliance with Medicare regulations, but no citation
042510 - was given. On 100624, Jennifer called and said she had
042511 - completed response to Millie's claim, and needed another day
042512 - for her boss to review. This was again agreed. CMS was asked
042513 - for controlling authority [...in letter to Kaiser with copy to
042514 - CMS on 100625 0852. ref SDS B6 1X5W...] On 100626, the
042515 - following was received from CMS, saying...
042517 - ..
042518 - The exact citation for the 14-day timeframe is located at:
042520 - ..
042521 - 422.570 (d)(1) Expediting certain organization determinations:
042522 - Actions following denial. If an MA organization denied a
042523 - request for expedited determination, it must take the following
042524 - actions: (1) Automatically transfer a request to the standard
042525 - timeframe and make the determination within the 14-day
042526 - timeframe established in 422.568 for a standard determination.
042527 - The 14-day period begins with the day the MA organization
042528 - receives the request for expedited determination. ref SDS B7
042529 - 036C
042531 - ..
042532 - 67. The last sentence saying "The 14-day period begins with the day
042533 - the MA organization receives the request for expedited
042534 - determination" correlates to the date Millie filed the claim on
042535 - 100527, and the response date of 100610, presented by Kaiser in
042536 - the call on 100609.
042538 - ..
042539 - 68. There is no evident support for Kaiser delaying response to
042540 - Millie's claim to 100708, since Medicare regulations require
042541 - response expeditiously according to the enrollee's health
042542 - condition.
042544 - ..
042545 - 69. Accordingly, by copy Millie appeals to Medicare to enforce
042546 - regulations for quality care and order such relief as
042547 - appropriate to the case.