CONTACTS 

SUBJECTS
Cetuximab Carboplatin Clinical Study Drug Trial Consent Forms Signed

1903 -
1903 -    ..
1904 - Summary/Objective
1905 -
190501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
190502 -
190503 - Mil signed consent forms for the clinical study on Cetuximab and
190504 - Carboplatin drug trial.  The primary care physician signed
190505 - authorization for Kaiser to pay for treatment under the insurance
190506 - agreement with Millie.  Treatment was delayed because after submitting
190507 - authorization, Kaiser management encountered a policy conflict with
190508 - its Medicare subsidiary. ref SDS 0 AS96  Delayed authorization for two
190509 - weeks until today, resulted in not enough time for Kaiser to resolve
190510 - policy conflicts in time for Millie to get treatment today.
190511 - ref SDS 0 AS9L  UCSF is assisting Kaiser in resolving the problem so
190512 - that Millie can get treatment next Tuesday or Wednesday. ref SDS 0
190513 - AS5H  Blood work reports submitted by Kaiser to UCSF are incomplete.
190514 - ref SDS 0 AS6M  Millie sent a letter asking Arlette to make a review
190515 - and notify Millie about getting another blood test if necessary to
190516 - meet protocol requirements for Millie to get treatment next week.
190517 - ref SDS 0 PK6M
190518 -
190519 -            [On 070122 primary care physician reports work resolving
190520 -            confusing Medicare regulations, so that Millie's treatment
190521 -            can proceed as prescribed. ref SDS 16 LX8B
190523 -             ..
190524 -            [On 070122 Kaiser ordered additional blood tests; still
190525 -            need report from Kaiser on test results, including CA 15-3.
190526 -            ref SDS 16 AS6M
190528 -             ..
190529 -            [On 070123 Margaret notifies Millie that UCSF has not
190530 -            received authorization for treating Millie, and invested
190531 -            many hours attempting to contact Medicare, but was not
190532 -            successful; requests patient to ask her doctor at Kaiser
190533 -            for assistance to expedite authorization. ref SDS 17 3S3J
190535 -             ..
190536 -            [On 070123 Millie notifies primary care physician at Kaiser
190537 -            that treatment is delayed because authorization signed by
190538 -            the doctor on 070119 has not been submitted by Kaiser to
190539 -            UCSF, causing risk of cancer cascading out of control, and
190540 -            escalating costs, ref SDS 17 J94L; Kaiser reportes that the
190541 -            doctor is on vacation. ref SDS 17 LP4L
190543 -             ..
190544 -            [On 070123 Jackie advises treatment scheduled for 060124
190545 -            delayed until Kaiser submits authorization number for UCSF
190546 -            to get paid for treating Millie, ref SDS 17 J43I; asks
190547 -            patient to notify Kaiser about detailed history of problem
190548 -            in order to resolve impasse. ref SDS 17 FS33
190550 -             ..
190551 -            [On 070124 Pam reported Kaiser eventually made contact with
190552 -            Medicare representative; after 8 hours of discussions
190553 -            Kaiser submitted an authorization account number to UCSF.
190554 -            ref SDS 18 6K3L
190556 -             ..
190557 -            [On 070125 Jackie reported that UCSF did not receive an
190558 -            authorization from Kaiser, and that Lisa in UCSF's Business
190559 -            Office spent 6 hours talking to Medicare for authorization
190560 -            that UCSF would be paid for treating Millie. ref SDS 19
190561 -            4Y62
190562 -
190563 -
190564 -
190565 -
190567 -  ..
1906 -
1907 -
1908 - Progress
1909 -
190901 - Clinical Study Consent Forms Signed
190902 -
190903 - Follow up ref SDS 13 QM7I, ref SDS 12 RT7K.
190904 -
190905 - Jackie said she finally received Millie's letter, ref DIP 1 0001,
190906 - submitted to UCSF on 070117. ref SDS 13 1G3K, but was not received at
190907 - that time via transmission through the Internet. ref SDS 13 Y25Q
190909 -  ..
190910 - During the meeting this morning, Jackie reviewed consent forms for the
190911 - clinical study initially submitted with her letter received on 070116,
190912 - ref SDS 12 RT7K, and discussed with Jackie by telephone the next day
190913 - on 070117. ref SDS 13 QM7I
190915 -  ..
190916 - After brief discussion, Millie signed the forms, and initialled
190917 - authorization for UCSF and associated organizations to use tissue and
190918 - diagnostics for study purposes, as called out in the confidentiality
190919 - section of the consent document. ref DRP 1 6O53
190920 -
190921 -     [On 070130 Millie signed supplemental authorization for UCSF to
190922 -     share biopsy tissue with clinical study personnel. ref SDS 21 2O3L
190923 -
190924 -
190925 -
190926 -
190927 -
1910 -

SUBJECTS
Payment Authorization Kaiser Signed Authorization for Millie's Treat

6403 -
640401 -  ..
640402 - Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare
640403 - Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix
640404 - Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix
640405 -
640406 - Follow up ref SDS 14 YF8U.
640407 -
640408 - Jackie commended Arlette's work at Kaiser this morning coordinating
640409 - communications with UCSF on getting the doctor's authorization signed,
640410 - and submitting patient history to UCSF on meeting with the primary
640411 - care physician, and on recent blood work.
640412 -
640413 -     [On 070126 Arlette facilitated resoution of problem that delayed
640414 -     Kaiser submitting payment authorization for Millie to get
640415 -     treatment at UCSF. ref SDS 20 F184
640417 -  ..
640418 - Jackie said that Doctor Rugo cannot meet with Millie today, and Millie
640419 - cannot get treatment today, as planned yesterday, ref SDS 14 1B5F,
640420 - because there was not enough time to resolve the mixup getting
640421 - documentation on referral authorization from Kaiser, reported
640422 - yesterday, ref SDS 14 YF8U, to implement agreement on 061230 for
640423 - Kaiser to pay costs for Standard of Care. ref SDS 4 3X6K  This delay
640424 - appears to conflict with reports on 070105 that Kaiser ignored other
640425 - issues in order to focus on referral to UCSF. ref SDS 7 794K
640427 -  ..
640428 - Jackie advised that Millie's primary care physician at Kaiser signed
640429 - authorization this morning for UCSF to start treatment today,
640430 - following Millie's letter last night notifying Kaiser of the problem.
640431 - ref SDS 14 PK6M  Kaiser then encountered another problem resolving
640432 - internal policy and practices between Kaiser insurance obligations and
640433 - Medicare rule changes because Millie has coverage under Medicare that
640434 - is also a business unit of Kaiser, or something like that.
640436 -             ..
640437 -            [On 070122 primary care physician reports resolving
640438 -            authorization policy confusion so that Millie can get
640439 -            prescribed treatment. ref SDS 16 LX8B
640441 -             ..
640442 -            [On 070123 UCSF reports authorization not received from
640443 -            Kaiser, treatment deferred. ref SDS 17 4Q54
640445 -             ..
640446 -            [On 070130 treatment delayed for referral coordination,
640447 -            ref SDS 22 2X6L; UCSF schedules new tests so Millie can
640448 -            start treatment on 070201. ref SDS 21 N96O
640450 -             ..
640451 -            [On 081031 Glenna reported the primary care physician at
640452 -            Kaiser signed authorization for Millie's treatment with the
640453 -            sunitinib clinical study to recover from Millie's 5th
640454 -            relapse of IBC. ref SDS 32 J28K
640456 -  ..
640457 - Jackie said that Doctor Rugo has encountered this problem previously,
640458 - and is working closely by telephone with Millie's primary care
640459 - physician to resolve the administrative conflict at Kaiser.  She
640460 - described a concentrated effort by both doctors, but so far there has
640461 - not been enough time to solve the problem, because work only started
640462 - today rather than on 070101 when Kaiser and UCSF agreed to make
640463 - arrangements for Millie to get treatment at the UCSF Cancer Center.
640464 - ref SDS 5 E23W  Proactive case management to avoid delays was
640465 - discussed at Kaiser on 070105.
640467 -  ..
640468 - Doctor Rugo wants Millie to come back next Tuesday or Wednesday to
640469 - meet for examination, and then get treatment after authorization
640470 - documentation has been received from Kaiser.  Jackie advised that
640471 - 070124 (next Wednesday) is a target date in order to meet standards
640472 - for treatment within 4 weeks of testing.  Since Millie had a PET/CT
640473 - test on 061227, the end of 4 weeks occurs on 070124.  Delay beyond
640474 - 070124 will cause further delay for Millie to have another CT test.
640475 -
640476 -
640477 -
640479 -  ..
6405 -
6406 -
6407 - 1552
6408 -
640801 - Notify Doctor Treatment Delayed at UCSF
640802 - Primary Care Physician Reports Referral Authorization Signed
640803 - Authorization Submitted by Doctor for Referral Treatment at UCSF
640804 -
640805 - Follow up ref SDS 14 PK6M.
640806 -
640807 - Millie received ref DRT 1 0001 from the primary care physician
640808 - responding to Millie's letter, ref DIP 5 0001, yesterday on 070118
640809 - reporting UCSF needs authorization for treatment, ref SDS 14 NR7V, to
640810 - perform work in clinical trial referral made by Kaiser on 070105,
640811 - ref SDS 7 PK68, and implementing arrangements Kaiser made with UCSF in
640812 - correspondence on 061230. ref SDS 4 3X6K
640814 -  ..
640815 - The primary care physician at Kaiser says...
640816 -
640817 -        Authorization was submitted ...but, new Medicare regulations
640818 -        around this are confusing.  Dr Rugo and I are working on it
640819 -        from both ends. ref DRT 1 0001
640820 -
640821 -            [On 070829 Arlette seemed to advise the Millie is the first
640822 -            patient referred for treatment under the new Medicare
640823 -            regulations, and this is causing confusion about handling
640824 -            payments. ref SDS 23 EG4N
640826 -             ..
640827 -            [On 070906 UCSF Clinical Trial Director confirms Kaiser
640828 -            made referral for Millie's treatment, ref SDS 25 UK5M, and
640829 -            the patient was not notified of extra charges for
640830 -            coinsurance, because nobody knew anything about this issue
640831 -            when treatment was started on 070202. ref SDS 25 I49K
640833 -             ..
640834 -            [On 070917 UCSF reports errors in billings; reduces charges
640835 -            from about $10K to only $2K per year for coinsurance,
640836 -            ref SDS 26 595P; no evident justification for coinsurance
640837 -            charges. ref SDS 26 596Q
640839 -             ..
640840 -            [On 071002 Mark Manfriede seems to indicate Millie is the
640841 -            first patient who has been processed by CMS under new
640842 -            Medicare rules for clinical trials. ref SDS 28 GJ6M
640844 -             ..
640845 -            [On 070927 Kaiser Senior Advantage EOC presents 16 grounds
640846 -            for Kaiser liability to pay for Millie's treatment on
640847 -            referral to UCSF. ref SDS 27 WU6M
640849 -             ..
640850 -            [On 071006 Paula in Kaiser's MCRC unit asks why the doctor
640851 -            prescribed treatment with cetuximab and carboplatin at
640852 -            UCSF. ref SDS 29 Q969
640854 -             ..
640855 -            [On 071031 Millie receives notice dated 071026 UCSF plans
640856 -            referral to collection agency for payment of $202.65 on
640857 -            Kaiser referral account 12493370, ref SDS 30 KK4I, revised
640858 -            070830, ref SDS 24 4P8K, and revised again on 070917,
640859 -            ref SDS 26 MK4H; no indication of UCSF collection efforts
640860 -            against Kaiser; separate notice dated 071027 and also
640861 -            received 071031 UCSF says Millie's treatment for cancer
640862 -            ordered by Kaiser will be terminated if UCSF does not
640863 -            receive payment of $202.65. ref SDS 30 KM8J
640865 -             ..
640866 -            [On 071128 Kaiser Appeals Committee approved payment for
640867 -            Millie's care on referral to UCSF. ref SDS 31 JZ5R
640869 -  ..
640870 - Millie submitted ref DIT 2 0001 responding to the primary care
640871 - physician at Kaiser saying...
640872 -
640873 -    1.  I met with Jackie at UCSF this morning, and signed the consent
640874 -        forms. ref SDS 0 1G3K  Jackie said that you and Doctor Rugo are
640875 -        working on authorization, but there may not be enough time for
640876 -        me to get treatment today, so it was deferred to next week,
640877 -        which is still within the window for using the last PET/CT
640878 -        test. ref SDS 0 AS96, ref DIT 2 0001
640879 -
640880 -            [On 070122 primary care physician reports work resolving
640881 -            authorization issues, so that Millie's treatment can
640882 -            proceed as prescribed. ref SDS 16 LX8B
640884 -         ..
640885 -    2.  Jackie said the lab report Kaiser faxed to UCSF was missing
640886 -        diagnostics on a "liver panel," and maybe something else.  I
640887 -        told her that you specified a complete work up for starting
640888 -        treatment, so some pages of the report may not have been sent
640889 -        over to UCSF. ref SDS 0 AS6M, ref DIT 2 OE6G
640891 -         ..
640892 -    3.  I wrote to Arlette and asked her to coordinate with Jackie on
640893 -        getting the complete lab in time for treatment next week, and
640894 -        to let me know if I need to rush over to Martinez for more
640895 -        blood work.  I requested a copy of the report via email.
640896 -        Wondering about CA 15-3?  If it has not jumped up again, I
640897 -        won't feel so rushed about everything. ref SDS 0 Q95H,
640898 -        ref DIT 2 HF6N
640899 -
640900 -            [On 070122 primary care physician orders additional blood
640901 -            tests; still need report from Kaiser on test results,
640902 -            including CA 15-3. ref SDS 16 AS6M
640904 -         ..
640905 -    4.  Thanks for following up. ref DIT 2 TF7M
640906 -
640907 -
640908 -
640909 -
6410 -

SUBJECTS
Laboratory Blood Test Report Received from Kaiser Incomplete Bumblin

8403 -
840401 -  ..
840402 - Laboratory Blood Test Report Received from Kaiser Incomplete
840403 -
840404 - Follow up ref SDS 14 5S6L.
840405 -
840406 - Jackie advised that the report received from Kaiser this morning on
840407 - Millie's blood test from yesterday, ref SDS 14 5S6L, is missing a
840408 - "liver panel," and possibly something else.
840410 -  ..
840411 - Millie examined the document Jackie received from Kaiser, and noted
840412 - there is a single page for the blood test report.
840414 -  ..
840415 - Millie explained that the scope of the blood test is ordered by the
840416 - primary care physician, and is prescribed to meet requirements for
840417 - establishing a baseline to begin chemotherapy treatments.
840418 -
840419 -            [On 070122 Kaiser primary care physician ordered additional
840420 -            blood tests; still need report from Kaiser on test results,
840421 -            including CA 15-3. ref SDS 16 AS6M
840423 -             ..
840424 -            [On 070123 Millie went to Kaiser to get blood tests needed
840425 -            to start treatment at UCSF. ref SDS 17 AS6M
840427 -             ..
840428 -            [On 070122 additional blood testing ordered by Kaiser
840429 -            primary care physician. ref SDS 16 LX6V
840431 -             ..
840432 -            [On 070123 Millie went to Kaiser to get blood tests needed
840433 -            to start treatment at UCSF. ref SDS 17 AS6M
840435 -             ..
840436 -            [On 070123 treatment delayed at UCSF need referral
840437 -            authorization for payment from Kaiser. ref SDS 17 J43I
840439 -             ..
840440 -            [On 070130 Millie scheduled for treatment at UCSF on
840441 -            070201. ref SDS 21 MP4H
840443 -  ..
840444 - We reviewed patient history showing that often blood test reports are
840445 - printed by Kaiser in multiple pages with different log identification
840446 - numbers, even though everything can be fit on a single page.
840447 - Sometimes multiple logs are printed on the same page, and pages get
840448 - separated by multiple handling.  There is no evident pattern.  Most
840449 - likely, 1 or 2 pages are missing from the documents transmitted to
840450 - UCSF via FAX this morning.
840452 -  ..
840453 - Jackie explained this happens a lot at UCSF using FAX to send test
840454 - reports, because machines breakdown, run out of paper, transmissions
840455 - are fuzzy and have to be done over, papers get separated because the
840456 - bin fills up and spills on the floor.  Nobody notices the problem.
840457 - People make mistakes collating documents into the correct order.
840458 - Multiple handling by multiple people gets the documents mixed up and
840459 - separated.  Many problems occur, when people have a hectic schedule.
840460 - Hurrying to catch up at the last minute causes more mistakes.  Growing
840461 - medical mistakes was reported nationally on 990912. ref SDS 1 QP3N
840463 -  ..
840464 - Jackie will contact Arlette at Kaiser to request submission of the
840465 - complete blood test report.
840466 -
840467 -
840469 -  ..
8405 -
8406 -
8407 - 1348
8408 -
840801 - Notify Arlette about Submitting Blood Test Lab Report to UCSF
840802 -
840803 - Follow up ref SDS 14 PK6M.
840804 -
840805 - Millie submitted ref DIT 1 0001 to Arlette at Kaiser and with a copy
840806 - to Jackie at UCSF, confirming understandings and requesting notice if
840807 - another blood test is needed to meet UCSF requirements, per above.
840808 - ref SDS 0 AS6M
840810 -  ..
840811 - Millie's letter to Kaiser says...
840812 -
840813 -    1.  I met with Jackie this morning on starting treatments at UCSF.
840814 -        ref SDS 0 1G3K, ref DIT 1 0001
840816 -         ..
840817 -    2.  She said you were terrific providing documentation and working
840818 -        through Kaiser's systems to facilitate my case setup at UCSF.
840819 -        ref SDS 0 YF8U, ref DIT 1 HH5L
840821 -         ..
840822 -    3.  Jackie asked about the scope of blood work received from Kaiser
840823 -        this morning.  She said a "liver panel" was missing, and
840824 -        possibly something else.  [My doctor] prescribes the scope of
840825 -        lab work. ref SDS 0 AS6M  I am pretty sure he ordered
840826 -        everything required by UCSF, since it is seems to be same that
840827 -        I always get. ref DIT 1 LH6F
840829 -         ..
840830 -    4.  My treatment has been deferred a few days to give [my doctor]
840831 -        and Doctor Rugo time to arrange authorizations, ref SDS 0 AS96,
840832 -        discussed initially on 070101, and again on 070105. ref SDS 0
840833 -        AS4K  Jackie asked me to check on getting the complete lab
840834 -        submitted.  Typically, I get these from the doctor via email or
840835 -        from the nurses in the Chemotherapy clinic on the day of
840836 -        treatment.  There are usually several pages.  Jackie only
840837 -        seemed to have a single page in the documents she showed me
840838 -        this morning, so I suspect that the complete lab was performed,
840839 -        and presented in multiple pages. ref DIT 1 TH6M
840841 -         ..
840842 -    5.  Please coordinate with Jackie on what she needs (415 353 7857
840843 -        page 415 443 2057). ref DIT 1 HI7M
840845 -         ..
840846 -    6.  Let me know if I have to get more blood work done in time for
840847 -        treatment now scheduled for either Tuesday or Wednesday of next
840848 -        week.  I am off work today, and so can run over to Martinez if
840849 -        needed. ref DIT 1 KI8G
840851 -         ..
840852 -    7.  Please further send me a copy of the lab report.  I expect by
840853 -        now the CA 15-3 is available.  It has been on a roller coaster
840854 -        lately, so I am anxious about rates of change with respect to
840855 -        urgency starting treatment. ref DIT 1 AJ8L
840856 -
840857 -            [On 070122 Kaiser ordered additional blood tests,
840858 -            ref SDS 16 AS6M; still need report from Kaiser on test
840859 -            results, including CA 15-3. ref SDS 16 Z73H
840861 -             ..
840862 -            [On 070123 Millie went to Kaiser to get blood tests needed
840863 -            to start treatment at UCSF. ref SDS 17 AS6M
840865 -             ..
840866 -            [On 070130 Millie scheduled for treatment at UCSF on
840867 -            070201. ref SDS 21 MP4H
840869 -         ..
840870 -    8.  By copy I am pleased to thank you and Jackie for expediting
840871 -        these matters. ref DIT 1 KJ9G
840872 -
840873 -
840874 -
840875 -
840876 -
840877 -
840878 -
8409 -