CONTACTS 
0201 - Medical Offices Lisa Bailey                                                                                                                                        O-00000850 0605
020101 - Ms. Roberta Bennett                                                                                                                                              O-00000850 0605
020103 - Administration Department                                                                                                                                        O-00000850 0605

SUBJECTS
2nd Opinion #2 Surgical Oncologist 3rd Referral by UCSF on Criteria
2nd Opinion #2 Schedule Meeting 3rd Referral 050909 Notify of Scope

0904 -
0904 -    ..
0905 - Summary/Objective
0906 -
090601 - Follow up ref SDS 35 0000. ref SDS 34 0000.
090602 -
090603 - Doctor Bailey's operator said everyone has left for the weekend; so,
090604 - submitted a letter to the doctor with a copy to Roberta, in case she
090605 - sees the doctor, before the doctor reads her email....
090606 -
090607 -    1.  Subject: **** 2nd Opinion Meeting Surgeon on Sep 23
090608 -        Date: Fri, 16 Sep 2005 17:21:59 -0700
090618 -         ..
090619 -    3.  Millie had a treatment at Kaiser this morning, per your
090620 -        recommendation on 050909.
090622 -         ..
090623 -    4.  **************, the primary care physician, and oncologist
090624 -        stopped by briefly in the clinic and reported he has talked to
090625 -        the surgeon, ******************, following up a phone message
090626 -        on 050913 when he asked her to schedule surgery. ref SDS 36
090627 -        T646 The doctor did not say what was discussed; he might have
090628 -        discussed additional diagnostics which Doctor Grissom proposed
090629 -        to take 2 sliver skin biopsies on the left breast for
090630 -        evaluating IBC, per your examination on 050909 finding possible
090631 -        remaining IBC.  He may also have urged immediate surgery, which
090632 -        was done previously on 050913, per my letter to you (see
090633 -        below).
090635 -         ..
090636 -    5.  Millie now has a meeting scheduled with the surgeon on 050923,
090637 -        a week from today on Friday.  Would like your 2nd opinion to be
090638 -        on file to support that meeting, so it needs to be mailed OB
090639 -        050921.  I would also like to see a draft prior to submission,
090640 -        but, if time is short, we can forego draft review and comment.
090641 -
090642 -            [On 050918 received doctor's 1s draft 2nd opinion.
090643 -            ref SDS 38 LW3O
090645 -             ..
090646 -            [On 050918 submitted comments on 1st draft. ref SDS 38 YP7U
090648 -         ..
090649 -    6.  Mail 2nd opinion to...
090650 -
090663 -        Surgeon
090664 -        Kaiser Permanente
090665 -        Permanente Medical Group, Inc
090666 -        1425 South Main Street
090667 -        Walnut Creek, CA  94596
090669 -         ..
090670 -   10.  We would like a signed copy of the final draft, but also the
090671 -        computer file, so we don't have to key everything in again.
090673 -         ..
090674 -   11.  Doctor Grissom is finalizing a 2nd opinion.  Key points she
090675 -        makes in a 1st draft on prospects for surgery and details for
090676 -        performing surgery, in this case, are listed in the record on
090677 -        050914. ref SDS 37 K85X
090679 -         ..
090680 -   12.  Notice the doctor is cautious about surgery, and states that
090681 -        surgery in this case would require a "very wide mastectomy"
090682 -        supported by a plastic surgeon to close the wound with skin
090683 -        grafts.  I have asked the doctor in comments to her 1st draft
090684 -        how such surgery would advance the primary care physician's
090685 -        goal to achieve "local control," and alternatively, what risks
090686 -        threaten local control by having such an operation; your
090687 -        comments on this would likewise be very helpful.
090689 -         ..
090690 -   13.  Could you please include in your remarks the scope of any
090691 -        surgery that might be done in Millie's case, keeping in mind we
090692 -        realize you recommend against surgery.  In other words, if
090693 -        Kaiser insists the patient have surgery, which is currently the
090694 -        case, what then are the mechanics that govern how that work
090695 -        should be performed?  At the present time, Kaiser is proposing
090696 -        a simple mastectomy to achieve "local control." Grissom is
090697 -        proposing a 10 hour operation with a plastic surgeon, etc.,  If
090698 -        you were to do it, what would you do to best serve the patient
090699 -        with surgery?  How, for example, would you establish the
090700 -        boundaries of surgery absent photographs, diagrams, etc.,
090701 -        showing the spread of IBC this past March?  Grissom says this
090702 -        is a major factor.  Shim does not mention this in her opinion,
090703 -        and does not mention a plastic surgeon, suggesting a routine
090704 -        mastectomy is contemplated.  I think Grissom is on the right
090705 -        track.  My opinion, however, is irrelevant, but your opinion is
090706 -        critical on this point.
090708 -         ..
090714 -         ..
090715 -   14.  Having laid out a plan for surgery, please then explain what
090716 -        benefits this might achieve relative to "local control" sought
090717 -        by PCP.  Then explain why this is illusory, or very high risk
090718 -        for doing more harm than good, which makes systemic treatment
090719 -        the default choice in your opinion.
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0908 -