CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 151019, VA Radiology performed CCTA. ref SDS 3 NV5I The report
040902 - interpreting the test merely states all bypass grafts are patent.
040903 - ref SDS 3 JW8O The VA also reported a finding that calcium score was
040904 - not calculated. ref SDS 3 8Q6I
040906 - ..
040907 - On 151203, met with Bret Elicker in the Radiology Department of the VA
040908 - Medical Center in San Francisco. Doctor Elicker advised that he read
040909 - the CCTA scan file created on 151019, and found no evidence of any
040910 - lesions or blockages in the active circulatory system. ref SDS 6 SZ5F
040911 - The doctor also reported that a calcium score was generated and the
040912 - result was about 1200, ref SDS 6 4S6M, and that all of this calcium
040913 - was found in the bypassed blood vessels, and so none is present in the
040914 - active circulatory system. As a result, calcium found in the bypassed
040915 - blood vessels presents no risk to patient health, longevity, nor to
040916 - quality of life. ref SDS 6 QW4K
040918 - ..
040919 - On 151204, ordered 2nd opinion from SLDC to obtain written
040920 - confirmation of findings from CCTA, ref SDS 7 644K, performed at the
040921 - VA Medical Center in San Francisco on 151019.
040923 - ..
040924 - On 151215 1642 received 2nd opinion from SLDC. ref SDS 9 RV5F For
040925 - some reason, the letter does not present detailed findings to clarify
040926 - the VA's original report that "All bypass grafts are patent."
040927 - ref SDS 9 A88O
040929 - ..
040930 - On 151215 1642 at 2156 sent letter to Doctor Vernacchia at SLDC
040931 - requesting clarification of 2nd opinion letter. ref SDS 9 MZ5L
040933 - ..
040934 - On 151216 0915 received letter from Doctor Vernacchia saying SLDC does
040935 - not have "equipment" to render a medical opinion of amount of
040936 - stenosis,lesions and blockages in active circulatory system.
040937 - ref SDS 10 5O4H
040939 - ..
040940 - On 151217 submitted letter to Doctor Elicker requesting amendment to
040941 - clarify findings for CCTA, 151217 2052, ref SDS 11 Y630, performed on
040942 - 151019 that says simply all bypass grafts are patent. ref SDS 3 8Q6I
040944 - ..
040945 - On 151223 0921 called Doctor Elicker, and he recommending meeting with
040946 - the attending physician, Doctor Priyanka Jha, to file an addendum that
040947 - clafifies the radiology report for CCTA on 151019. ref SDS 12 A46I
040948 -
040949 -
040950 -
040951 -
040953 - ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - After meeting with Lana in Wound Care Clinic in Module 2 on Ground
041302 - Floor, ref SDS 13 LX7H, went to Radiology on 2nd floor of building
041303 - 200.
041305 - ..
041306 - Asked the nurses in Radiology Preparation, for Doctor Jha. While they
041307 - were trying to figure out how to find out if the doctor is on staff
041308 - today, Haine, came into the room. He said Doctor Jha is scheduled for
041309 - work today, but has not yet come in. She is scheduled to arrive OA
041310 - 0900, and when she arrives, Haine will ask if she can do another
041311 - meeting, like Doctor Elicker did on 151203 1014. ref SDS 6 DF5J
041313 - ..
041314 - Waited in the hallway near the CT scan room.
041315 -
041317 - ..
0414 -
0415 -
0416 - 0911
0417 -
041701 - Haine brought Doctor Jha down the hall and introduced her.
041702 -
041703 - The doctor agreed to meet.
041705 - ..
041706 - We went to another CT scan room down the hall, and across from the CT
041707 - scan scheduling department. This is the same location, where Doctor
041708 - Elicker met on this issue on 151203 1014. ref SDS 6 U86J
041710 - ..
041711 - Met with...
041712 -
041713 - Priyanka Jha, MD
041714 - Associate Professor
041715 - UCSF School of Medicine
041716 - Radiology
041717 - 505 Parnassus Ave, Moffitt
041718 - San Francisco, CA 94143
041719 - 415 353 1958
041720 - priyanka.Jha@ucsf.edu
041721 -
041722 - http://profiles.ucsf.edu/priyanka.jha
041723 -
041724 - http://www.radiology.ucsf.edu/people/priyanka-jha
041726 - ..
041727 - Priyanka Jha, MBBS is an assistant professor of clinical
041728 - radiology in the Abdominal Imaging section at the Veterans
041729 - Affairs Medical Center in San Francisco and at the
041730 - University of California, San Francisco. She obtained her
041731 - medical degree from Mulana Azad Medical College, Delhi,
041732 - India in 2007. In 2010, she finished a one-year internship
041733 - from St Vincents Medical Center in Bridgeport, Conneticut,
041734 - and she completed her four-year Diagnostic Radiology
041735 - residency from the University of California, Davis in 2014,
041736 - followed by an abdominal imaging fellowship from UCSF in
041737 - 2015.
041739 - ..
041740 - Dr Jha has experience in crosssectional imaging, both CT
041741 - and MRI, ultrasound, fluoroscopic and radiographic
041742 - procedures. Her research interests include onclogic
041743 - imaging, focusing on imaging of hepatocellular carcinoma
041744 - and pancreatic malignancies. She is also interested in
041745 - women?s imaging, particularly MR applications
041747 - ..
041748 - Doctor Jha said she has not discussed this case with Doctor Elicker,
041749 - and so is unaware of the letter to Doctor Elicker on 151217 2052,
041750 - ref SDS 11 Y556, nor prior discussions with Doctor Elicker in this
041751 - matter on 151203 1014. ref SDS 6 SZ5F
041753 - ..
041754 - Doctor Jha recalled she was attending physician for CCTA scan test on
041755 - 151019, shown in the VA radiology report. ref SDS 3 LN5O
041757 - ..
041758 - The doctor advised that the statement in the radiology report finding
041759 - "All the bypass grafts are patent," ref SDS 3 JW8O, should be
041760 - interpretted through logical conclusion to mean that, since there are
041761 - no affirmative statements finding any blockages, stenosis, nor plaque
041762 - buildup of any kind, the Radiology report prepared by Doctor Colin
041763 - Burk, and herself, should be interpreted to mean that none can be
041764 - identified in the CCTA scan performed on 151019. She explained that
041765 - such interpretation is standard of care in radiology reporting.
041767 - ..
041768 - We did not discuss today, published guidance on radiology standard of
041769 - care using CCTA to both detect and exclude harmful coronary plaques,
041770 - reported on 151119 2141. ref SDS 5 7N6J and ref SDS 5 WP43 Nor did we
041771 - consider the record in the Welch case using radiology to expressly
041772 - exclude existence of harmful materials following CABG x4 heart surgery
041773 - on 091022, reported on 100928 0706. ref SDS 2 0W4O
041775 - ..
041776 - During the meeting today, Doctor Jha further advised the scan
041777 - performed on 151019, found substantial plaque buildup in the bypassed
041778 - blood vessels, yielding calcium score 1200+, and she explained that
041779 - this does not present a health risk to the patient.
041781 - ..
041782 - We briefly discussed that Doctor Jha's explanation today, aligns with
041783 - Doctor Elicker's report of his finding from the CCTA on 151019, when
041784 - we met on 151203 1014. ref SDS 6 SZ5F and ref SDS 6 4S6M
041786 - ..
041787 - We further reviewed today, research saying...
041788 -
041789 - Grafts can become diseased and may partially or completely
041790 - occlude - that is, lose their patency - in the months to
041791 - years after bypass surgery is performed. A graft is
041792 - considered patent if there is normal flow through the
041793 - graft: flow begins to diminish with around a 70 percent
041794 - stenosis in the graft.
041795 -
041796 - ...as reported on 091022 0700. ref SDS 1 RY6H Considered analysis of
041797 - the report on 151019, that merely finding blood vessels are patent,
041798 - seems to suggest there could be blockages up to 70%. ref SDS 3 JW8O
041800 - ..
041801 - Doctor Jha advised that if the radiology team observed plaque
041802 - blockages, i.e., blood vessel narrowing, of any size in the active
041803 - ciruculatory system included in the CT scan, they would be
041804 - affirmatively reported. Since none were reported, this establishes
041805 - nothing was observed.
041807 - ..
041808 - Today, Doctor Jha suggested going from the main CT scan room into the
041809 - adjacent Control room. She opened the file on the computer screen for
041810 - joint review of the CT scan performed in this case on 151019...
041811 -
041812 - F:\05\00003\SM\CC\GMPF\GFJ\20151019-093000\GEARView.exe
041814 - ..
041815 - Doctor Jha scrolled through what seemed to be the 2nd imaging
041816 - sequence, and stopped on an image that seemed about 3" long
041817 - positioned at an angle of about 30% with the top on the left and
041818 - bottom on the right.
041820 - ..
041821 - She explained that this is one of the 4 bypass grafts performed on
041822 - 091022. The doctor pointed out there is no narrowing anywhere along
041823 - the length of this arterial bypass graft blood vessel. She further
041824 - advised that the other blood vessels show similarly.
041826 - ..
041827 - Discussed prospects if filing an addendum to current findings to
041828 - affirmatively state what the Doctor just demonstrated that there is
041829 - no evidence in the CT scan test on 51019, that the active circulatory
041830 - system has any atherosclerotic plaques of any kind or amount.
041832 - ..
041833 - Doctor Jha again noted that this is implied by the report not finding
041834 - any.
041836 - ..
041837 - During the meeting with Doctor Simpson in Cardiology on 151028, the
041838 - doctor explained current findings are vauge, and that limitations of
041839 - CCTA testing that augurs for caution relying on test results for
041840 - guiding line of care. ref SDS 4 J69I
041842 - ..
041843 - Research indicates that CT testing, and standard of practice for CCTA
041844 - testing is performed to both detect and exclude critical obstructive
041845 - coronary artery disease (CAD), reported on 151119 2141. ref SDS 5 7N6J
041847 - ..
041848 - Where radiology testing is ordered to affirmatively exclude adverse
041849 - health conditions, here atherosclerosis, clarity requires affirmative
041850 - reporting, rather than rely on conclusion, conjecture or surmize from
041851 - mere silence alone.
041853 - ..
041854 - For example, Doctor Tseng and her cardiothoracic surgery team (Neil,
041855 - KC, Paula), performed CABG x4 on 091022. ref SDS 1 LO3G After the
041856 - surgical opening was closed, an inventory discovered a needle count
041857 - was one short. The doctor ordered an xray radiology study to verify a
041858 - needle was not inside the patient. In addition to reporting what was
041859 - found, the Radiology department affirmatively reported a finding that
041860 - a needle was not found (see report in the record, shown in the record
041861 - on 100928 0706. ref SDS 2 0W4O
041863 - ..
041864 - Doctor Jha agreed to consider filing an addendum to the report on
041865 - 151019. She reguested a proposed draft.
041866 -
041867 - [On 160107 2042 letter to Doctor Jha submits proposed
041868 - language for addendum to clarify findings on CCTA study,
041869 - ref SDS 14 8P70, originally performed on 151019.
041870 - ref SDS 3 JW8O
041872 - ..
041873 - Thanked Jha for her kindness taking time today clarifying the report
041874 - and demonstrating how analysis was performed for CCTA on 151019 0930.
041875 - ref SDS 3 JW8O
041876 -
041877 -
041878 -
041879 -
041880 -
041881 -
041882 -
041883 -
041884 -
041885 -
041886 -
041887 -
041888 -
0419 -