THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rod@welchco.com
S U M M A R Y
DIARY: January 23, 2007 06:10 AM Tuesday;
Rod Welch
Millie went to Kaiser for more blood work to start treatment at UCSF.
1...Summary/Objective
2...Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare
3...Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix
4...Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix
5...UCSF Reports Kaiser Conflict with Medicare Subsidiary Not Resolved
6...Kaiser Authorization Office Coordinating with UCSF Resolve Problem
7...UCSF Frustrated Kaiser Has Not Submitted Authorization
8...Cascading Out of Control IBC Requires Treatment Authorization for UCSF
9...Treatment Needed Avoid IBC Cascading Out of Control Like Before
10...Doctor Notified Authorization for UCSF to Treat Millie Not Received
11...Doctor on Vacation Cannot Resolve Authorization Issue Until Next Week
12...UCSF Delays Treatment Pending Kaiser Authorization Account Number
13...CT Test Monitor Patient to Quickly Switch from Ineffective Treatment
14...Drug Trial Protocol Waiver Possible Use CT Test on 061227
15...Patient Better Served by Test Data Close to Treatment Start Date
16...Patient Help Expedite Kaiser Authorization Process
17...UCSF Suggests Patient Notify Kaiser Background Authorization Problem
18...Millie Implements Deferred Vacation Plans to Leave Town for Few Days
19...Laboratory Blood Test Performed Today Per Doctor's Order
20...CA 15-3 68 Cancer Marker Big Rise Elevates Need for Timely Treament
..............
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CONTACTS
SUBJECTS
Treatment Clinical Study Cetuximab Carboplatin Drug Trial Millie Rea
5303 -
5303 - ..
5304 - Summary/Objective
5305 -
530501 - Follow up ref SDS 27 0000. ref SDS 26 0000.
530502 -
530503 - Millie got blood drawn for tests to start treatment today, or
530504 - tomorrow. ref SDS 0 AS6M She wrote to Kaiser thanking Michelle for
530505 - coordinating resolution of treatment delays, ref SDS 0 C48M, and asked
530506 - UCSF about the time for treatment today or tomorrow. ref SDS 0 YF6Y
530507 - Jackie called in response to Millie letter and said that referral
530508 - authoriation has not been received from Kaiser, so there can be no
530509 - treatment today. ref SDS 0 4Q54 She was to call back later with the
530510 - time for Millie to get treatment tomorrow. ref SDS 0 4R31 Millie got
530511 - a letter from Michelle reporting Kaiser progress on submitting
530512 - authorization for Millie to get treatment at UCSF. ref SDS 0 PR3V
530513 - Millie thanked Michelle again for coordinating efforts at Kaiser to
530514 - solve the problem. ref SDS 0 EG7K Millie received a recent blood test
530515 - showing her cancer marker has increased significantly while waiting to
530516 - get treatment over the past 2 months. ref SDS 0 GK5B In the late
530517 - afternoon, Margaret called and said that UCSF has not been able to
530518 - obtain from Kaiser authorization documents for Millie's treatment.
530519 - This was a long explanation of significant efforts UCSF has made to
530520 - arrange for Millie's treatment. ref SDS 0 MW4H Margaret suggested
530521 - Millie ask her doctor at Kaiser for support to solve the problem.
530522 - ref SDS 0 LC7I Millie wrote a letter to her doctor asking for
530523 - assistance to end authorization delays so that cancer does not cascade
530524 - out of control. ref SDS 0 J94L Kaiser reported that Millie's doctor
530525 - is on vacation, and so there seems to be nobody who can take
530526 - responsibility. ref SDS 0 LP4L Jackie called and said that treatment
530527 - for tomorrow is now cancelled, and UCSF cannot schedule treatment
530528 - until referral authorization is received from Kaiser. ref SDS 0 J43I
530529 - Jackie further advised that delays to starting treatment will now
530530 - require Millie to get another CT test to meet clinical study
530531 - requirements, which will further delay treatment. ref SDS 0 J438
530532 - Jackie asked Millie to ask Kaiser again to submit authorization for
530533 - treatment at UCSF. ref SDS 0 FS33 Millie decided to take a short
530534 - vacation while Kaiser and UCSF resolve referall authorization issues.
530535 - ref SDS 0 PUPV
530536 -
530537 - [On 070124 Millie writes another letter requesting
530538 - Arlette to assist in resolving authorization issues,
530539 - ref SDS 30 YF8U, and then leaves town for short
530540 - vacation. ref SDS 30 KX9H
530542 - ..
530543 - [On 070125 UCSF schedules Millie for treatment on
530544 - 070131. ref SDS 31 YF8U
530545 -
530546 -
530547 -
530548 -
530549 -
530551 - ..
5306 -
5307 -
5308 - Discussion
5309 -
530901 - Treatment Delayed Not Enough Time Fix Kaiser Policy Conflict Medicare
530902 - Policy Conflict Kaiser Medicare Treatment Delayed Not Enough Time Fix
530903 - Medicare Policy Conflict Kaiser Treatment Delayed Not Enough Time Fix
530904 -
530905 - Follow up ref SDS 27 YF8U, ref SDS 26 YF8U.
530906 -
530907 - Millie submitted ref DIT 1 0001 to Michelle with copies to Arlette,
530908 - and to Jackie at UCSF confirming understandings from Michelle's call
530909 - yesterday, ref SDS 27 YF8U, and correspondence from the doctor,
530910 - ref DRP 6 0001, also received yesterday, ref SDS 27 LX8B, that Kaiser
530911 - has resolved problems which delayed treatment last week on Friday,
530912 - 070119. ref SDS 26 LW9N
530914 - ..
530915 - Millie's letter to Michelle at Kaiser says...
530916 -
530917 - 1. Thanks very much for your call yesterday explaining progress
530918 - resolving conflicts so I can get treatment at UCSF with the
530919 - drug trial that [my doctor] has prescribed. ref SDS 27 YF8U I
530920 - got a letter from the doctor last night saying he solved the
530921 - problem, ref SDS 27 LX8B, following up collaboration with
530922 - Doctor Rugo last Friday on 070119, ref SDS 26 4R4M, as related
530923 - by Jackie in our meeting at UCSF. ref SDS 26 AS96, ref DIT 1
530924 - 0001
530926 - ..
530927 - 2. By copy I am asking Jackie if I am supposed to come in this
530928 - morning to meet with Doctor Rugo, and then get my first
530929 - treatment. In our meeting at UCSF last Friday [on 070119],
530930 - Jackie indicated that Doctor Rugo wants treatment to start
530931 - today or at the latet tomorrow in order to comply with study
530932 - protocol. ref SDS 26 AS5H, ref DIT 1 UP6J
530934 - ..
530935 - Millie's letter to Arlette continues below explaining she got the
530936 - blood work done this morning requested by UCSF for getting treatment
530937 - today. ref SDS 0 AS6M
530938 -
530939 -
530941 - ..
5310 -
5311 -
5312 - 0842
5313 -
531301 - UCSF Reports Kaiser Conflict with Medicare Subsidiary Not Resolved
531302 -
531303 - Jackie at UCSF called.
531305 - ..
531306 - Jackie advised that insurance payment issues initially discussed
531307 - between the primary care physician and Doctor Rugo on 071230,
531308 - ref SDS 14 3X6K, have not been resolved between Kaiser and UCSF. This
531309 - clarifies understandings from Kaiser yesterday, ref SDS 27 PN4I, and
531310 - submitted to UCSF this morning; Jackie says Millie cannot start
531311 - treatment today, as discussed in Millie's letter, ref DIT 1 0001, to
531312 - Kaiser per shown above. ref SDS 0 YF8U
531314 - ..
531315 - Jackie understands that Kaiser and UCSF are working hard to resolve
531316 - policy conflict. Doctor Rugo expects this to occur today. Jackie
531317 - further indicated that Doctor Rugo expects to meet with Millie
531318 - tomorrow, and then Millie can start treatments also tomorrow after the
531319 - meeting, as originally planned for 070119. ref SDS 26 AS96
531321 - ..
531322 - Jackie will notify Millie later today confirming meeting and treatment
531323 - for tomorrow.
531324 -
531325 - [...below, Michelle reports that Pam at Kaiser is coordinating
531326 - with Lisa at UCSF to resolve policy conflicts and avoid
531327 - delaying Millie's treatment. ref SDS 0 575F
531329 - ..
531330 - [...below, Margaret reports UCSF has not received
531331 - authorization, and has been unable to make progress obtaining
531332 - required documentation from Kaiser. ref SDS 0 3S3J
531334 - ..
531335 - [...below, Jackie advises treatment scheduled for tomorrow on
531336 - 060124 delayed until further notice after Kaiser submits
531337 - authorization number for UCSF to get paid for treating Millie.
531338 - ref SDS 0 J43I
531340 - ..
531341 - [On 070124 Pam reported Kaiser eventually made contact with a
531342 - Medicare representative; after several hours of discussions
531343 - throughout the day, Kaiser submitted an authorization account
531344 - number to UCSF. ref SDS 30 6K3L
531345 -
531346 -
531347 -
531349 - ..
5314 -
5315 -
5316 - 1143
5317 -
531701 - Kaiser Authorization Office Coordinating with UCSF Resolve Problem
531702 -
531703 -
531704 - Millie received ref DRT 1 0001 from Michelle responding to Millie's
531705 - letter, ref DIT 1 0001, submitted to Kaiser earlier this morning, per
531706 - above. ref SDS 0 C48M
531708 - ..
531709 - Michelle at Kaiser says to Millie...
531710 -
531711 - 1. Someone from our authizoration dept was to call Lisa in the
531712 - billing dept of UCSF this am to straighten every thing out.
531713 - Pam in OA spoke with the medicare office yesterday, she was
531714 - going to explain everything to Lisa at UCSF. Medicare
531715 - should pay for all care at UCSF. (labs, xrays to be done at
531716 - Kaiser as ususal), ref DRT 1 S56F
531718 - ..
531719 - 2. Hope all goes well, ref DRT 1 P56M,
531721 - ..
531722 - The rest of Michelle's letter that relates to blood tests is reported
531723 - below. ref SDS 0 GK5B
531725 - ..
531726 - Michelle's explanation seems to align with communications on 061230,
531727 - when the primary care physician advised Doctor Rugo at UCSF that
531728 - Kaiser would pay for standard of care, and that labs and testing would
531729 - be done at Kaiser. ref SDS 14 3X6K
531730 -
531731 - [On 070124 Pam reported Kaiser eventually made contact
531732 - with a Medicare representative; after several hours of
531733 - discussions throughout the day, Kaiser was able to
531734 - submit an authorization account number to UCSF.
531735 - ref SDS 30 6K3L
531737 - ..
531738 - [On 070125 Jackie reported that UCSF did not receive an
531739 - authorization from Kaiser, and that Lisa in UCSF's
531740 - Business Office spent 6 hours talking to Medicare to
531741 - establish that UCSF would be paid for treating Millie.
531742 - ref SDS 31 4Y62
531743 -
531744 -
531745 -
531747 - ..
5318 -
5319 -
5320 - 1226
5321 -
532101 - Millie submitted ref DIT 2 0001 thanking Michelle for the update with
532102 - evident expectations of resolving policy conflicts in time to avoid
532103 - delaying treatment, per above. ref SDS 0 575F
532105 - ..
532106 - Millie's response to Michelle at Kaiser says...
532107 -
532108 - 1. Great work reported in your letter today that Kaiser
532109 - and UCSF are reaching agreement so that I can get
532110 - treatment. ref DIT 2 0001
532112 - ..
532113 - Millie's letter on blood work continues below. ref SDS 0 SY7N
532115 - ..
532116 - Concern about delaying treatment is elevated by blood test report
532117 - today that CA 15-3 has jumped back up again to 67, after falling to
532118 - 56, per below. ref SDS 0 GK5B
532119 -
532120 -
532122 - ..
5322 -
5323 -
5324 - 1633
5325 -
532501 - UCSF Frustrated Kaiser Has Not Submitted Authorization
532502 -
532503 - Margaret called from UCSF Medical Center.
532504 -
532505 - Thanked Margaret again for excellent work facilitating Millie's
532506 - meetings with Doctor Benz, most recently on 060821. ref SDS 11 SM6M
532508 - ..
532509 - Margaret said that she has been assisting Jackie today trying to get
532510 - Millie's account set up for treatment tomorrow at UCSF. The work plan
532511 - is for treatment on a clinical study with cetuximab and carboplatin,
532512 - which was prescribed by Millie's primary care physician at Kaiser as
532513 - the best treatment for Millie's condition of advancing IBC metastatic
532514 - disease reported by Kaiser on....
532515 -
532516 - Kaiser examination................. 061201, ref SDS 12 025H
532517 - Kaiser examination................. 061208, ref SDS 13 025H
532518 - Kaiser examination................. 070105, ref SDS 17 025H
532520 - ..
532521 - Margaret explained that UCSF has still not received authorization
532522 - documentation signed by Millie's primary care physician on 070119.
532523 - She said the discussions between UCSF and Kaiser reported by the
532524 - primary care physician at Kaiser in a letter on 070122, ref SDS 27
532525 - PN4I, and further cited by Michelle this morning, per above,
532526 - ref SDS 0 PR3V, have not been successful.
532528 - ..
532529 - Margaret seemed to explain that either she, or someone in Doctor
532530 - Rugo's office called Medicare today to attempt in good faith to carry
532531 - out suggestions developed from discussions with Kaiser for
532532 - establishing entitlement to payment through Medicare for USCF to
532533 - provide Millie's treatment prescribed by the primary care physician in
532534 - the meeting at Kaiser on 070105. Margaret related that the UCSF
532535 - person was on hold waiting to speak with someone at Medicare in the
532536 - manner requested by Kaiser for about 20 minutes, then the line was
532537 - dropped, and the standard phone company message was given to call
532538 - back. UCSF called Medicare back, and the same thing happened. As a
532539 - result, UCSF has nothing that establishes the revenue stream on this
532540 - transaction.
532541 -
532542 - [On 070124 Pam reported Kaiser had similar experience, but
532543 - eventually made contact with a Medicare representative, and after
532544 - several hours of discussions, Kaiser submitted an authorization
532545 - account number to UCSF. ref SDS 30 6K3L
532547 - ..
532548 - [On 070125 Jackie reported UCSF did not receive an authorization
532549 - from Kaiser, and that Lisa in UCSF's Business Office spent 6 hours
532550 - talking to Medicare to establish that UCSF would be paid for
532551 - treating Millie. ref SDS 31 4Y62
532553 - ..
532554 - Margaret was frustrated. She asked if Kaiser has a Patient Advocate
532555 - that Millie could notify for assistance, since UCSF has been unable
532556 - to make progress.
532558 - ..
532559 - Kaiser has several "assistant" roles...
532560 -
532561 - 1. Physician Assistant...... 050215, ref SDS 7 DL6J
532562 - 2. Medical Assistant........
532563 - 3. Patient Advocate......... 990913, ref SDS 2 N48H
532564 - 4. Records Assistant........
532565 - 5. Technical Assistant......
532566 - 6. Engineering Assistant....
532568 - ..
532569 - Margaret advised that UCSF has not written a letter to Kaiser stating
532570 - what they require to treat Millie. She seemed to indicate that
532571 - normally everything is handled by conversation.
532573 - ..
532574 - Margaret advised that UCSF has scheduled Millie for treatment
532575 - tomorrow. If UCSF writes a letter stating treatment is delayed until
532576 - UCSF receives a particular document from Kaiser, then Millie can
532577 - notify her doctor precisely what is needed to resolve the problem.
532579 - ..
532580 - Margaret wants Millie to write the letters coordinating with Kaiser,
532581 - and seemed to indicate that nobody at UCSF has time to write a letter
532582 - on this, because Kaiser already knows what is needed. She feels
532583 - Millie can contact her doctor without anything from UCSF, and say she
532584 - heard in a telephone call that treatment is denied because UCSF needs
532585 - something from Kaiser, but the patient does not know what it is except
532586 - for the general phrase, "authorization number."
532588 - ..
532589 - There was discussion that UCSF has spent about 20 minutes in this
532590 - telephone call with Millie. Writing a letter to Millie confirming the
532591 - problem, which Millie can then submit to Kaiser would take 5 mintues.
532593 - ..
532594 - Margaret feels that writing a letter telling the patient why treatment
532595 - is refuesed and what UCSF requires to proceed is either not necessary
532596 - or is otherwise objectionable for some reason.
532598 - ..
532599 - Thanked Margaret for the call, and advised a letter will be sent to
532600 - the doctor at Kaiser to report understandings Margaret has presented.
532601 -
532602 -
532603 -
532604 -
5327 -
SUBJECTS
Treatment Delay IBC Cascading Out of Control CA 15-3 Rising Kaiser D
5903 -
5904 - 1702
590501 - ..
590502 - Cascading Out of Control IBC Requires Treatment Authorization for UCSF
590503 - Treatment Needed Avoid IBC Cascading Out of Control Like Before
590504 - Doctor Notified Authorization for UCSF to Treat Millie Not Received
590505 -
590506 - Millie submitted ref DIT 3 0001 to the primary care physician at
590507 - Kaiser explaining the problem Margaret presented, per above.
590508 - ref SDS 0 3S3J, and clarifying the favorable understanding set out in
590509 - Millie's earlier letter to Michelle, earlier today, also, per above.
590510 - ref SDS 0 EG7K
590511 -
590512 - 1. I just got a call from Margaret Rubino, who
590513 - works for Doctor Rugo at UCSF. ref DIT 3 0001
590515 - ..
590516 - 2. Margaret said UCSF has not received the
590517 - authorization you signed on January 19th, and
590518 - that UCSF requires an authorization account
590519 - number from Kaiser. Margaret said
590520 - collaboration between Kaiser and UCSF admin
590521 - staff on these matters has not been successful,
590522 - and so my doctor needs to facilitate Kaiser's
590523 - referral to UCSF. ref SDS 0 3S3J, ref DIT 3
590524 - AK5N
590526 - ..
590527 - 3. I am concerned that CA 15-3 is rising without
590528 - treatment since 061201, similar to before.
590529 - Missing the current window for treatment at
590530 - UCSF will require another PET/CT test causing
590531 - increased costs and further delay. ref DIT 3
590532 - NK6L
590534 - ..
590535 - Michelle at Kaiser reports in a letter today that CA 15-3 increased
590536 - again, now to 68, per below. ref SDS 0 GK5B This eliminates prior
590537 - improvement reported on 070110. ref SDS 19 087J
590539 - ..
590540 - Citation "...similar to before." references treatment ended on 041021,
590541 - and was denied on 041104 because Kaiser discovered pulmonary embolism
590542 - in Millie's CT test the day before. Rather than continue treatment
590543 - with Taxol, which posed no evident risk, ref SDS 4 LP7F, there were
590544 - various delays for over 2 months, until treatment was resumed on
590545 - 050105. ref SDS 6 0001 By then IBC was cascading out of control, as
590546 - discussed in the case study on patient history listed on 041230.
590547 - ref SDS 5 P19O At that time, CA 15-3 continued to rise above 100
590548 - while being treated with AC until treatment was switched on 050329.
590549 - ref SDS 8 0001 A few weeks after starting treatment with Taxotere and
590550 - capecitabine (Xeloda), IBC rash dramatically subsided, and CA 15-3
590551 - dropped back to 67. ref SDS 9 0001
590553 - ..
590554 - High medical costs from mistakes reported on 990912, ref SDS 1 0001,
590555 - occur from delaying authorization that requires another medical test,
590556 - because treatment delayed from 061230 when primary care physician and
590557 - Doctor Rugo agreed Millie would get treatment at UCSF, ref SDS 14
590558 - 3X6K, and planning began on 070101 for Millie seeing Doctor Rugo.
590559 - ref SDS 15 E23P There was plenty of time then to work on
590560 - authorization and use the PET/CT test on 061227.
590562 - ..
590563 - Millie's letter to primary care physician continues...
590564 -
590565 - 4. Can you please complete these arrangements, or
590566 - let me know what I can do to provide the
590567 - authorization number to UCSF? ref DIT 3 LK7H
590569 - ..
590570 - [On 070124 Millie writes another letter requesting
590571 - Arlette to assist in resolving authorization issues,
590572 - ref SDS 30 YF8U, and then leaves town for short
590573 - vacation. ref SDS 30 KX9H
590575 - ..
590576 - [On 070124 Jackie called and left message for Millie
590577 - indicating problem has been resolved; UCSF wants Millie
590578 - to have another PET/CT test before starting treatment.
590579 - ref SDS 30 PQ4Q
590581 - ..
590582 - [On 070124 Pam reported Kaiser had difficulty contacting
590583 - Medicare, similar to Margaret's report today, per above,
590584 - ref SDS 0 MW5Y, but eventually made contact with a
590585 - Medicare representative, and after several hours of
590586 - discussions, Kaiser was able to submit an authorization
590587 - account number to UCSF. ref SDS 30 6K3L
590588 -
590589 -
590590 -
590592 - ..
5906 -
5907 -
5908 - 1717
5909 -
590901 - Doctor on Vacation Cannot Resolve Authorization Issue Until Next Week
590902 -
590903 - Margaret at UCSF asked Millie to send a letter to the doctor on
590904 - coordinating referral, per above. ref SDS 0 L43U After Millie sent a
590905 - letter to the doctor, also, per above, ref SDS 0 J94L, Kaiser reported
590906 - that the primary care physician is on vacation until 070129.
590908 - ..
590909 - Evidently, UCSF planning for Millie to start treatment tomorrow cannot
590910 - be achieved, and so treatment of progressing disease is delayed at
590911 - this time indefinetly.
590913 - ..
590914 - [On 070124 Millie sent a letter to Arlette at Kaiser explaining
590915 - background ref SDS 30 YF8U, and asking for assistance.
590916 - ref SDS 30 BA9Y
590918 - ..
590919 - [On 070124 Arlette expedited coordination of resolution.
590920 - ref SDS 30 UE4O
590922 - ..
590923 - [On 070124 UCSF notifies Millie referral problem solved; orders
590924 - another CT test because treatment has been delayed too long to
590925 - use the last CT test on 061227. ref SDS 30 PQ4Q
590927 - ..
590928 - [On 070126 substitute doctor orders CT test requested by UCSF
590929 - for Millie's treatment. ref SDS 32 Z24H
590930 -
590931 -
590932 -
590933 -
590935 - ..
5910 -
5911 -
5912 - 1722
5913 -
591301 - UCSF Delays Treatment Pending Kaiser Authorization Account Number
591302 -
591303 - Jackie called.
591304 -
591305 - Jackie explained that she and others at UCSF have spent a lot of time
591306 - and effort to make arrangements for Millie to get treatment tomorrow,
591307 - but this has not worked out. She asked Margaret to call earlier and
591308 - explore possible ways to assist Kaiser with pending authorization.
591310 - ..
591311 - Commended Margaret's past work helping Millie get a 2nd opinion from
591312 - Doctor Benz, and that her call today was professional and helpful in
591313 - all respects, per above. ref SDS 0 MW4H
591315 - ..
591316 - Jackie explained that normally patients arrive at UCSF with a document
591317 - that authorizes payment for treatment. Dealing with Kaiser works
591318 - differently, and this causes delays and frustrations all around.
591320 - ..
591321 - Asked about getting the name of the document UCSF wants so that Millie
591322 - can asked her doctor about it? Considered prospects again of Jackie,
591323 - Doctor Rugo, or someone at UCSF writing a letter explaining treatment
591324 - is denied and what is required to provide treatment, as discussed with
591325 - Margaret earlier. ref SDS 0 J96N
591327 - ..
591328 - Jackie feels that UCSF should not have to explain the problem in
591329 - writing. She asked if Millie has contacted Kaiser following the call
591330 - from Margaret earlier today, per above? ref SDS 0 J98F
591332 - ..
591333 - Reviewed Millie's letter to the primary care physician, ref SDS 0
591334 - J94L, submitted to Kaiser after Margaret's call about 40 minutes ago,
591335 - per above. ref SDS 0 J94L
591337 - ..
591338 - Jackie explained that under the circumstances with no authorization
591339 - from Kaiser and Medicare, Millie cannot get treatment tomorrow at
591340 - UCSF, as planned originally on 070117, ref SDS 23 5S85, and then
591341 - revised during the meeting at UCSF on 070119. ref SDS 26 AS5H Doctor
591342 - Rugo wants to establish with documentation from Kaiser and Medicare
591343 - that neither UCSF nor Millie will get stuck with the bill, which is
591344 - covered by Millie's health care entitlements and insurance premiums.
591345 - We considered prospects of getting treatment on Thursday or Friday if
591346 - by some miracle difficult issues presented today are resolved in time?
591348 - ..
591349 - [On 070124 Pam reported Kaiser eventually made contact with a
591350 - Medicare representative, and after several hours of
591351 - discussions, Kaiser was able to submit an authorization account
591352 - number to UCSF. ref SDS 30 6K3L
591353 -
591354 -
591355 -
591356 -
591357 -
5914 -
SUBJECTS
Default Null Subject Account for Blank Record
6003 -
600401 - ..
600402 - CT Test Monitor Patient to Quickly Switch from Ineffective Treatment
600403 - Drug Trial Protocol Waiver Possible Use CT Test on 061227
600404 - Patient Better Served by Test Data Close to Treatment Start Date
600405 -
600406 - Jackie seemed to indicate having discussed Millie's case with Doctor
600407 - Rugo today.
600409 - ..
600410 - The doctor apparently gave the impression to Jackie that UCSF could
600411 - probably obtain a protocol waiver for Millie to get treatment this
600412 - week under the PET/CT test on 061227, since the requirements would
600413 - only be exceeded by a few days. However, the doctor feels Millie
600414 - would be better served by having another PET/CT test if treatment is
600415 - delayed until next week. Jackie understands from Doctor Rugo that
600416 - besides drug trial study requirements, tests closer in time to the
600417 - date of starting treatments provide better diagnostics on patient
600418 - benefits; so that, if treatment is not effective, the doctor can
600419 - switch the patient to another regimen in time to prevent disease from
600420 - cascading out of control.
600422 - ..
600423 - The primary care physician has cautioned strongly throughout Millie's
600424 - care for breast cancer, and particularly with respect to IBC, that
600425 - accurate data to take action in time to avoid cancer from spinning out
600426 - of control is a critical criteria of treatment strategy, shown by case
600427 - study on 041230. ref SDS 5 P19O
600428 -
600429 - [On 070124 Jackie leaves message that the doctor wants Millie
600430 - have another CT test. ref SDS 30 PQ4Q
600432 - ..
600433 - [On 070125 Doctor Rugo orders updated CT test to begin new
600434 - treatments at UCSF; request CT test for pulmonary embolism.
600435 - ref SDS 31 Z24H
600436 -
600437 -
600438 -
600440 - ..
600441 - Patient Help Expedite Kaiser Authorization Process
600442 - UCSF Suggests Patient Notify Kaiser Background Authorization Problem
600443 -
600444 - Jackie suggested that Millie submit a more detailed account of
600445 - background on the scope and urgency of the authorization problem for
600446 - getting Millie into treatment.
600448 - ..
600449 - Explained that Millie got a response to her letter 10 minutes ago
600450 - after talking to Margaret, per above. ref SDS 0 MW4H Kaiser reports
600451 - that Millie's doctor is on vacation until next week. ref SDS 0 LP4L
600452 - There may be nothing more that can be done until Millie's primary care
600453 - physician returns from vacation.
600455 - ..
600456 - Jackie said she will work the problem further tomorrow, and let Millie
600457 - know about progress.
600459 - ..
600460 - Millie will consider asking Arlette to get involved. She has been a
600461 - strong support for good management at Kaiser, illustrated by the
600462 - record on 060809. ref SDS 10 3J4O
600463 -
600464 - [On 070124 Millie sent a letter to Arlette at Kaiser explaining
600465 - background ref SDS 30 YF8U, and asking for assistance.
600466 - ref SDS 30 BA9Y
600468 - ..
600469 - [On 070124 Arlette expedited resolution with Kaiser's
600470 - Authorization Department. ref SDS 30 UE4O
600472 - ..
600473 - [On 070124 Pam reported Kaiser eventually made contact with a
600474 - Medicare representative; after many hours of discussion a
600475 - solution was arranged; Kaiser submitted an authorization
600476 - account number to UCSF. ref SDS 30 6K3L
600477 -
600478 -
600479 -
600481 - ..
6005 -
6006 -
6007 - 1801
6008 -
600801 - Millie Implements Deferred Vacation Plans to Leave Town for Few Days
600802 -
600803 - After Jackie's call explaining UCSF demand for administrative details
600804 - from Kaiser, per above, ref SDS 0 J94O, Millie was very disappointed
600805 - and despondent that all the work the past month to expedite treatment
600806 - has failed. She decided that to relieve emotional tension,
600807 - frustration and anger, rather than sit around the house waiting for
600808 - phone calls and hearing endless explanations of treatment delayed
600809 - because people in various departments at Kaiser, UCSF and Medicare
600810 - failed to perform, got mixed up, or lost documents, she might as well
600811 - take several days vacation previously planned, as reported on 070116,
600812 - ref SDS 22 VQ3G, but were then cancelled to accomodate cancer
600813 - treatments, which UCSF scheduled for tomorrow on 070124, as reported
600814 - on 070118, ref SDS 24 FA60, but are now on hold, or cancelled because
600815 - Kaiser and UCSF do not agree, as reported by Michelle, per above,
600816 - ref SDS 0 3S3J, and confirmed by Jackie. ref SDS 0 J43I It's another
600817 - mess.
600819 - ..
600820 - [On 070124 Millie travels to Seattle after treatment is delayed;
600821 - implements original plan. ref SDS 30 KX9H
600822 -
600823 -
600824 -
600825 -
6009 -
SUBJECTS
Blood Test Performed Treatment Clinical Study Cetuximab Carboplatin
7003 -
700401 - ..
700402 - Laboratory Blood Test Performed Today Per Doctor's Order
700403 -
700404 - Follow up ref SDS 27 AS6M, ref SDS 26 AS6M.
700406 - ..
700407 - Millie's letter from above, ref SDS 0 YF6Y, to Michelle at Kaiser
700408 - continues...
700409 -
700410 - 3. As well, per your call yesterday, I went to Kaiser at 0600 this
700411 - morning and got additional blood tests ordered by [my doctor]
700412 - yesterday that meet UCSF requirements for me to start
700413 - treatment. ref SDS 27 LX6V, ref DIT 1 CQ6F
700415 - ..
700416 - 4. When time permits, I need the report on the blood test which
700417 - Kaiser submitted to UCSF OA 070119. It should now show CA 15-3
700418 - diagnostic, as noted in the letter last week to Kaiser.
700419 - ref SDS 26 0Z9P, ref DIT 1 XQ7I
700421 - ..
700422 - Michelle did not have time to discuss submitting blood test reports,
700423 - during the call yesterday. ref SDS 27 Z73H
700424 -
700425 - [On 070130 Millie scheduled for treatment at UCSF on
700426 - 070201. ref SDS 33 MP4H
700427 -
700428 - [On 070131 UCSF requests another blood test before starting
700429 - treatment on 070201. ref SDS 34 NZ4N
700431 - ..
700432 - The test today corrects mistakes in the test on 070118, ref SDS 24
700433 - HZ41, which were reported the next day on 070119 during a meeting at
700434 - UCSF.
700436 - ..
700437 - Millie's letter to Michelle at Kaiser concludes...
700438 -
700439 - 5. Thanks also to Arlette for coordinating everything.
700440 -
700441 -
700443 - ..
7005 -
7006 -
7007 - 1143
7008 -
700801 - CA 15-3 68 Cancer Marker Big Rise Elevates Need for Timely Treament
700802 -
700803 -
700804 - Michelle at Kaiser letter to Millie continues...
700805 -
700806 - 3. I am putting in the mail today (which will go out tomorrow)
700807 - a copy of the labs from 1/18. The CA 15-3 was 68. UCSF
700808 - already has these results. I will check the computer this
700809 - afternoon to see if your results from today are back yet.
700810 - If they are I will fax to UCSF. If not Arlette will fax
700811 - them tomorrow am. ref DRT 1 0001
700813 - ..
700814 - CA 15-3 rising from 56 to 68 loses most of the improvement reported on
700815 - 070110. ref SDS 19 087J Rising cancer marker underscores urgency of
700816 - starting treatment, ended on 061201. Millie cited rising CA 15-3 in
700817 - letter to primary care physician on authorizing treatment at UCSF, per
700818 - above. ref SDS 0 SX5W
700820 - ..
700821 - Millie responded to Michelle at Kaiser....
700823 - ..
700824 - This letter continues from the section on delayed treatment.
700825 - ref SDS 0 EG8T
700826 -
700827 - 2. If it is not too much touble, rather than mail
700828 - documents to me, can you cut and past the lab report on
700829 - blood tests (both today and last week) in an email so I
700830 - don't have to type everything over again? If you send
700831 - me a printed document, then I have to key it in.
700832 - ref DIT 2 2W5M
700834 - ..
700835 - 3. Arlette and [my doctor] for example use cut and past to
700836 - send the Medical Chart report on meetings, CT test
700837 - reports, ect., via email. ref DIT 2 HW6I
700839 - ..
700840 - 4. I realize that sometimes tasks which sound fast and
700841 - easy turn out to be difficult and time consuming, and I
700842 - don't want to add to your work. But, if it is just as
700843 - fast for you to send the blood test results by return
700844 - email that would save me a lot of time and effort to
700845 - manage the record. ref DIT 2 TW6N
700847 - ..
700848 - Michelle submitted the blood test report in a follow up letter.
700849 - During this time the email program failed. ref SDS 29 6180 Various
700850 - solutions were attempted, resulting in using a Netscape upgrade called
700851 - variously Mozilla or Thunderbird. ref SDS 29 L49K
700853 - ..
700854 - Eventually, email functionality was restored.
700856 - ..
700857 - This process resulted in losing some correspondence. One was
700858 - Michelle's letter that submitted the blood test report.
700860 - ..
700861 - Since UCSF ordered another blood test, and blood was drawn this
700862 - morning, per above, ref SDS 0 AS6M, will try to avoid asking Michelle
700863 - to resubmit the blood test, since it was incomplete. If the test
700864 - today is complete, rather than just supplementing the prior test, then
700865 - the report the test today will be adequate for patient history.
700866 -
700867 -
700868 -
700869 -
700870 -
700871 -
700872 -
7009 -