CONTACTS 

SUBJECTS
2nd Opinion Metastatic Cancer Treatment Chemotherapy New Trial Drug
600 Dollars Patients Must Pay for 2nd Opinion Metastatic Cancer Trea
Medical Records Transfer Authorize from Kaiser to UCSF Breast Care C
2nd Opinion Requested from UCSF, Stanford, UC Davis Cancer Centers
Medical Records Mistake Business Office Failed Follow Procedure Not

1207 -
1207 -    ..
1208 - Summary/Objective
1209 -
120901 - Follow up ref SDS 21 0000. ref SDS 20 0000.
120902 -
120903 - Picked up Millie's medical records from Kaiser, per Millie's request
120904 - on 041007. ref SDS 20 GI9F  Corrected errors and omissions in the
120905 - record while at Kaiser.  Reviewed medical records, and added
120906 - organization requested by UCSF. ref SDS 0 PF7I  Found more errors and
120907 - omissions. ref SDS 0 T49J
120908 -
120909 -     [On 041018 Doctor Benz at UCSF did not examine imaging scan films,
120910 -     ref SDS 26 L246, and the doctor did not review meeting notes and
120911 -     other handwritings by Kaiser professional staff. ref SDS 26 EN63
120913 -      ..
120914 -     [On 050826 applied experience from using medical records for the
120915 -     1st 2nd opinion to order a reduced set of medical records for the
120916 -     2nd opinion #2. ref SDS 30 668F
120918 -      ..
120919 -     [On 050907 picked up medical records from Kaiser; problems getting
120920 -     submittals, ref SDS 31 FA98, in organization and getting wrong
120921 -     records. ref SDS 31 028E
120923 -      ..
120924 -     [On 060810 head nurse in Oncology ordered and assembled packet
120925 -     of documents for 2nd opinion #3. ref SDS 32 U76O
120927 -      ..
120928 -     [On 060810 head nurse in Oncology ordered and assembled packed
120929 -     of documents for 2nd opinion #3. ref SDS 32 U76O
120931 -      ..
120932 -     [On 061011 commend Kaiser and Arlette for extra work providing a
120933 -     packet of documents to facilitate 2nd opinion #3 review by UCSF,
120934 -     reducing the cost by 30%. ref SDS 34 QY4I
120935 -
120936 -
120937 -
120939 -  ..
1210 -
1211 - 1136 Visited Business Office.............. 925 295 4935
1212 -
121201 - Received two packets of documents, per request on 041007 for
121202 - assembling medical records to get a 2nd opinion. ref SDS 20 GI9F
121203 -
121204 - Today, Tangi was not in the Business Office.  There were two (2) other
121205 - attendants.  They advised that only the patient can pick up the
121206 - records, unless the patient calls ahead and designates someone to
121207 - pickup medical records.  This means the plan for me to pick up the
121208 - medical records while Millie is getting chemotherapy would have
121209 - failed, or encountered delays.  Since we had time this morning to
121210 - visit the Business Office prior to starting chemotherapy, Millie was
121211 - able to visit the Business Office to pick up the medical records, so
121212 - another problem was averted.
121213 -
121214 -
121215 -
121217 -  ..
1213 -
1214 -
1215 - Visited Pathology Department...... 925 295 4789
1216 -
121601 - Talked to Nancy.
121602 -
121603 - She submitted two packets of pathology slides, per telecon on 041011.
121604 - ref SDS 21 RR3O, per planning on 041007 when Millie signed the
121605 - authorization. ref SDS 20 GI9F
121606 -
121607 -     [On 041021 Millie returned pathology slides to Patty. ref SDS 27
121608 -     RR3O
121609 -
121610 -
121611 -
121612 -
121614 -  ..
1217 -
1218 -
1219 - Visited Imaging (Xray) Department........ 925 295 4789
1220 -
122001 - Talked to receptionist.  She took Millie's Kaiser account number, and
122002 - then went and got two packets of films, per discussion with Nicole on
122003 - 041012. ref SDS 23 TC6X
122005 -  ..
122006 - The receptionist handed us two packets, one each for UCSF and for
122007 - Stanford.  The packets were closed, and there was no inventory
122008 - submitted.
122010 -  ..
122011 - I took all the medical records to the car in the garage, and Millie
122012 - went to get blood drawn at the Infusion Clinic.
122014 -  ..
122015 - Based on prior difficulties, decided we need to verify that Nicole has
122016 - included films for Nuclear Medicine on PET and Bone scans, per
122017 - planning on 041012. ref SDS 23 7Z64
122018 -
122019 -     [...below PET scans were missing, and so were added by Nuclear
122020 -     Medicine. ref SDS 0 0254
122021 -
122022 -
122023 -
122025 -  ..
1221 -
1222 -
1223 - 1237 Visited Nuclear Medicine.
1224 -
122401 - After Millie finished getting blood drawn for treatment today,
122402 - reported in another record, ref SDS 25 407N, we took the samples to
122403 - the lab for processing.  After submitting the samples, we walked down
122404 - the hall and took the elevator to the basement level, and visited
122405 - Nuclear Medicine.
122407 -  ..
122408 - The receptionist, Jessica, checked Kaiser's computer and found no
122409 - record that Nicole, or anyone else, has checked out PET and Bone scans
122410 - on Millie's account, contrary to planning yesterday. ref SDS 23 7Z73
122411 - She called the Xray Department and asked for Nicole, however she was
122412 - at lunch, and no one else in the Xray Department knew anything about
122413 - work on assembling records for Millie.
122415 -  ..
122416 - Jessica went to another room across the hall.  She came back in about
122417 - 5 minutes and said that the PET scans are still in the file folder,
122418 - and there are no notes in the file folder that shows anyone has ever
122419 - checked anything out, which aligns with the record in the computer.
122420 - Jessica held up a PET scan to show the general size and appearance
122421 - with a notice on the film saying "PET."
122423 -  ..
122424 - We decided to go to lunch, and after that will bring the film
122425 - packages back to Nuclear Medicine, where an inventory can be made to
122426 - verify status, and correct any problems.
122427 -
122429 -  ..
1225 -
1226 -
1227 - 1309
1228 -
122801 - After lunch, Millie went to the Chemotherapy Clinic to wait for
122802 - treatment.
122804 -  ..
122805 - I walked back to the car in the garage on the 4th floor.
122807 -  ..
122808 - Looked in one of the two packets received earlier from the Medical
122809 - Imaging (Xray) Department, received earlier, per above. ref SDS 0 UR4K
122810 - There was no transmittal listing what is included.  There did not
122811 - appear to be any films like Jessica showed for PET scans, earlier in
122812 - the afternoon.
122814 -  ..
122815 - Took the two (2) sets of films, received from the Imaging Department,
122816 - back to the Nuclear Medicine Department.
122817 -
122819 -  ..
1229 -
1230 -
1231 - 1318 Visited Nuclear Medicine
1232 -
123201 - Jessica was at lunch.
123202 -
123203 - There was a nurse or administrator working at a desk inside a room
123204 - leading from the reception area.  Jessica had briefed this person on
123205 - the the film problem matter.
123207 -  ..
123208 - The attendant prepared a film transmittal envelope and marked on it
123209 - that contents are two (2) PET scans, with the dates.
123210 -
123211 -     [On 041021 Millie returned two PET scans to Jessica. ref SDS 27
123212 -     ZE3J
123214 -  ..
123215 - The attendant could not determine from examining the scans in the
123216 - envelopes prepared by the Xray Department, if the contents were Xrays
123217 - or CT tests.
123218 -
123220 -  ..
1233 -
1234 -
1235 - 1340 Visited Xray Department
1236 -
123601 - Talked to Daniello Romero................ 925 295 4789
123602 -
123603 - She opened one of the packages received earlier, per above,
123604 - ref SDS 0 TC6X, and confirmed that we have CT tests.  She looked
123605 - through the stack, and could not find the most recent test done in
123606 - late September 2004, a few weeks ago.  Daniello further noticed that
123607 - the CT test films seemed to out of date order.
123609 -  ..
123610 - Daniello took the stack of films back into a room behind the
123611 - receptionist area to collate.
123613 -  ..
123614 - About 15 minutes later Nichole came out to the receptionist area and
123615 - introduced herself.  She explained that because of the error by the
123616 - Business Department, cited by Tina on 041011, ref SDS 21 PQUP, there
123617 - wasn't enough time to collate the films, so they are in chronological
123618 - order.  Nicole said that Daniello has collated the 1st set, and Nicole
123619 - demonstrated how to read the films to determine the date so that the
123620 - patient can collate the 2nd set.
123621 -
123623 -  ..
1237 -
1238 -
1239 - 1356
1240 -
124001 - Daniello completed collating the first set of films.
124002 -
124003 - Thanked her and Nicole for extra effort.
124004 -
124005 -
124006 -
124007 -
1241 -

SUBJECTS
Medical Chart Illegible Sparse Handwritten Notes Cryptic Unreadable
2nd Opinion Medical Records Review Organize to Facilitate 2nd Opinio

2204 -
2205 - 1930
220601 -  ..
220602 - Organized Medical Records for Submission to UCSF
220603 - Doctor's Notes on Meeting with Patient Sparse, Illegible, No Planning
220604 -
220605 - Review Medical Records
220606 -
220607 - Medical Legal.
220609 -  ..
220610 - This appears to be primarily test results in chronological order, but
220611 - without separation by category, requested by UCSF, reported on 041006,
220612 - ref SDS 17 WL4Q, submitting an oncology check list. ref DRP 2 7R8Y
220614 -  ..
220615 - After the section with test results, Doctor notes with the patient are
220616 - generally in chronological order; some are out of order, and some are
220617 - upside down, not fully copied.
220619 -  ..
220620 - Added tabs with notes that index biopsys, CT and PET tests, and
220621 - identify doctor visits with the patient, per Sheridan's request on
220622 - 041012. ref SDS 22 HW4R
220623 -
220624 -     [On 041018 Doctor Benz at UCSF used the tabs to prepare a patient
220625 -     time line. ref SDS 26 QZ4F
220627 -      ..
220628 -     [On 060819 2nd opinion #3 has fewer documents to organize, so
220629 -     fewer problems. ref SDS 33 PL6M
220631 -  ..
220632 - The doctor's notes on meeting with the patient, consulting, and
220633 - performing examinations are handwritten, illegible, cursory, and
220634 - disconnected from chronology, and context, which aligns with the
220635 - reporting on 990912, ref SDS 2 4T4H, citing failed communication as a
220636 - major cause of medical mistakes. ref SDS 2 0960  On 020402 Michele
220637 - reported there is not enough time for legible communications.
220638 - ref SDS 4 C24N  On 040614 the doctor confirmed that limited time
220639 - prevents receiving legible writings from the patient using email.
220640 - ref SDS 13 9E8O
220642 -  ..
220643 - This conflicts with Kaiser's Healthwise Handbook calling for review of
220644 - the Medical Chart for effective analysis to diagnose and prescribe
220645 - treatment. ref SDS 1 TD5S
220646 -
220647 -        [On 041018 Doctor Benz at UCSF reported that notes on patient
220648 -        history in the medical chart are often difficult to read.
220649 -        ref SDS 26 EN63
220651 -         ..
220652 -        [On 041130 written work plan submitted by Kaiser illigible,
220653 -        conflicts with Breast Cancer Treatment Guidelines for Patients
220654 -        on page 52. ref SDS 28 9V71
220656 -         ..
220657 -        [On 041130 written "work ups" for treatment plans called out by
220658 -        Kaiser Breast Cancer Treatment Guidelines. ref SDS 28 UB4H
220660 -         ..
220661 -        [On 050819 handwritten record of patient report on side effects
220662 -        illegible, incomplete. ref SDS 29 A15O
220664 -  ..
220665 - There is one (1) type written document on starting treatment with a
220666 - new patient three (3) years ago on 040321.  This report was not
220667 - previously submitted to the patient for feedback to verify patient
220668 - understandings, and to expand span of attention by the doctor, which
220669 - conflicts with Kaiser policy on using a "ping pong" model to verify
220670 - accuracy, reviewed on 990625. ref SDS 1 3960
220672 -  ..
220673 - The surgeon has a record dated 040429 that seems to discuss surgery to
220674 - install a port, however, this work was done on 040419. ref SDS 8 0001
220675 - On 040429 the surgeon met with the patient and disclosed the biopsy
220676 - taken on 040419 showed cancer, ref SDS 9 F66N, and did not disclose
220677 - the type of cancer.
220678 -
220679 -
220680 -
2207 -

SUBJECTS
Case Study Medical Chart Missing Incorrect Reporting Patient History
Case Study Medical Chart Errors Omissions Reporting Patient History
2nd Opinion Medical Records Review Mistakes Omissions Errors

2905 -
290601 -  ..
290602 - Records Missing and Incorrect from Kaiser's Submission
290603 - Case Study Medical Chart Missing Incorrect Reporting Patient History
290604 - Patient History Medical Chart Missing Incorrect Reporting Case Study
290605 -
290606 - On 041013 Woody at Boeing cited Kaiser for advanced Knowledge
290607 - Management support. ref SDS 24 W14V
290609 -  ..
290610 - Kaiser's Healthwise Handbook calls out review of the Medical Chart for
290611 - effective analysis to diagnose and prescribe treatment. ref SDS 1 TD5S
290613 -  ..
290614 - Today, reviewing Kaiser's medical chart to prepare a chronology that
290615 - will help UCSF and Stanford develop 2nd opinions, found legibility
290616 - issues, per above, ref SDS 0 W78K, and the following records are
290617 - missing...
290618 -
290619 -            [On 061024 case study medical practice computer access
290620 -            limited even with everything on the computer, people can't
290621 -            find details stored in parts of the computer (software
290622 -            modules) that are not frequently used. ref SDS 35 JD9L
290624 -         ..
290625 -    1.  There is no evident comment nor report showing patient notified
290626 -        of stage IIA treatment status, which occurred on 020321.
290627 -        ref SDS 3 6Q4U
290629 -         ..
290630 -    2.  There no evidence in the medical chart of analysis on pathology
290631 -        reports for PET scan, CT scan, MRI, xray, blood, nor on any
290632 -        testing of any kind over the three (3) year history of the
290633 -        case.  Most likely, the doctor relies on the analyst to perform
290634 -        analysis, and so there is no practice for the doctor to comment
290635 -        further.  This overlooks requirements to "correlate clinically"
290636 -        between a report, and what is observed during examination, what
290637 -        the patient reports, and what is shown by other diagnostics.
290638 -        Therefore testing requires intrepretation by doctors with
290639 -        analysis to synthesize all input into diagnosis and treatment
290640 -        decisions.  This may exist in another part of the medical
290641 -        chart, which is withheld from patients and from providers
290642 -        performing 2nd opinions.  Lack of analysis aligns with case
290643 -        study on 040416 showing mistakes interpreting the meaning of
290644 -        PET and CT tests which identified IBC symptoms a year prior to
290645 -        diagnosis on 040614. ref SDS 7 PTSX
290647 -         ..
290648 -    3.  Meeting on 020726 the oncologist reported counting on
290649 -        radiologist for 2nd opinion, backup analysis on diagnosis and
290650 -        treatment, ref SDS 5 YO6K, there is no evidence in doctor's
290651 -        notes of consultations with radiologist.
290653 -         ..
290654 -    4.  Surgery on 040419 when the port was installed by the surgeon,
290655 -        ref SDS 8 PPSW, and a biopsy was taken to evaluate redness
290656 -        problem. ref SDS 8 1572  Pathology report on biopsy is missing
290657 -        from the record.
290659 -         ..
290660 -    5.  Meeting on 040429 when the surgeon advised patient that biopsy
290661 -        taken on 040419 was positive, will require surgery for a
290662 -        masectomy in 4 - 6 months.  Pathology report on the biopsy was
290663 -        not submitted nor shown to the patient.
290665 -         ..
290666 -    6.  Meeting on 040504 the primary care physician in the Oncology
290667 -        Department came into the chemo clinic and apologized for not
290668 -        telling the patient earlier about findings from biopsy taken on
290669 -        040419, advised that findings of cancer related to redness of
290670 -        breast were unexpected because when biopsys were done to
290671 -        evaluate redness of breast on prior occassions, results were
290672 -        invariably negative.  Doctor discussed need for surgery in 4 -
290673 -        6 months.  Biopsy was not submitted nor shown to the patient.
290674 -        ref SDS 10 WI8F
290676 -         ..
290677 -    7.  Meeting on 040517 Tumor Board report submitted by the doctor is
290678 -        not in the medical records. ref SDS 11 4R59
290680 -         ..
290681 -    8.  Meeting on 040517 biopys submitted by Doctor Johnson to the
290682 -        patient, no explantation of IBC. ref SDS 11 6T5G
290684 -         ..
290685 -    9.  Meeting on 040614 patient diagnosed with IBC. ref SDS 13 6T5G
290687 -         ..
290688 -        There is no disclosure to the patient of IBC by anyone in
290689 -        Kaiser's medical records.
290691 -         ..
290692 -   10.  Meeting on 040614 Stage IV cancer treatment assigned,
290693 -        ref SDS 13 6M9H, increased level from stage IIa reported on
290694 -        020321. ref SDS 3 6Q4U
290696 -         ..
290697 -        No formal written analysis changing evaluation of patient and
290698 -        setting treatment for cancer at stage IV.
290700 -         ..
290701 -   11.  Meeting on 040614 patient faces dilemma on deciding to remain
290702 -        with Avastin trial or have surgery to treat IBC. ref SDS 13 JK8L
290704 -         ..
290705 -        There is no mention of this discussion in Kaiser's records.
290707 -         ..
290708 -   12.  The Authorization for Use and/or Disclosure form that Millie
290709 -        signed at the Business Office on 040710, ref SDS 20 GI9F, is
290710 -        the first document in the set of documents, which are stapled
290711 -        together, and received from the Business Office today.  The
290712 -        "attached" list that specifies records to be disclosed is not
290713 -        included, indicating the scope requested by the patient was
290714 -        ignored. ref SDS 20 VN9O
290716 -         ..
290717 -   13.  CA 15-3 39 best result ever for Millie's cancer marker showing
290718 -        response to treatment, and from a blood test on 041007; but it
290719 -        is missing from Kaiser's report in the documents prepared for
290720 -        2nd opinion consultation.  This occurred because of a lag in
290721 -        reporting on CA 15-3 diagnostics prepared by an outside
290722 -        contractor that takes an extra few days for processing compared
290723 -        to same day processsing of all the other diagnostics by the
290724 -        Kaiser laboratory, as explained on 041007. ref SDS 19 5K6K
290725 -        During treatment today, Millie obtained from the nurse an
290726 -        updated report for the blood test on 041007 that shows CA 15-3
290727 -        39, which can be hand delivered to doctors for 2nd opinion
290728 -        consultations on 041018 and 041019. ref SDS 25 2N5J
290729 -
290730 -            [On 041018 Doctor Benz requested blood test report for
290731 -            041007 showing results for CA 15-3 39 to authenticate
290732 -            conversation that conveys the gist of patient history
290733 -            during 2nd opinion consultation, and to verify accuracy for
290734 -            a written analysis issued by UCSF. ref SDS 26 L16Q
290735 -
290736 -
290737 -
290738 -
290739 -
290740 -
290741 -
2908 -