CONTACTS 

SUBJECTS
CT Test Scheduled 070520 Comparison Test 060930 Lung Heart Disorders

4603 -
4603 -    ..
4604 - Summary/Objective
4605 -
460501 - Follow up ref SDS 22 Y76G.
460502 -
460503 - Physicians at Kaiser seem to have lost control of medical decisions
460504 - for testing, illustrated by failure to perform doctor's orders for
460505 - tests to evaluate pulmonary embolism and enlarged right ventricle in
460506 - Millie's case. ref SDS 0 KV3F  Failure to perform essential diagnostic
460507 - tests of life-threatening maladies cannot be excused with assumptions
460508 - that omissions imply comparisons found "stability." ref SDS 0 KV3O
460509 - Case management requires affirmative statements of comparison for
460510 - effective care. ref SDS 0 KV9G  Kaiser has implemented cost/benefit
460511 - policy in Millie's case without consideration of patient history.
460512 - ref SDS 0 WX8I  The doctor explains today that Kaiser and UCSF use
460513 - different methods for assessing CA 15-3 cancer biomarkers, like apples
460514 - and oranges, and that consideration of correlations requires analysis,
460515 - i.e., test results do not compare 1 to 1 directly. ref SDS 0 NT3O
460516 - Kaiser's failure to address issues presented on patient care
460517 - illustrates that omissions in test reporting do not justify
460518 - assumptions on test results. ref SDS 0 H39G  Millie responded to
460519 - questions presented by the primary care physician on patient history
460520 - for evaluating recent CA 15-3 56 cancer marker tests. ref SDS 0 SR3I
460521 - Communication between Kaiser and UCSF has not been effective to
460522 - coordinate Millie's referral for treatment in the cetuximab clinical
460523 - study. ref SDS 0 4T4L  UCSF reported today that coordination of
460524 - Laboratory work to manage test results is always difficult with
460525 - divided responsibilities that occur with referrals. ref SDS 0 466H
460526 - UCSF proposals to limit cross-checking laboratory test results appears
460527 - conflicting with requirements for accuracy. ref SDS 0 IN5L
460528 -
460529 -
460530 -
460531 -
460532 -
460533 -
460535 -  ..
4606 -
4607 -
4608 - Progress
4609 -
460901 - 20 80 Management Practice Giving Up on Finding Critical Details
460902 - Omission Does Not Imply Work Performed Nothing to Report
460903 - Kaiser Heart Lung Disorder Severity Does Not Affect Case Management
460904 -
460905 - Follow up ref SDS 22 Y76G, ref SDS 21 405I.
460906 -
460907 - On 070510 UCSF reported that coordinating Kaiser to meet requirements
460908 - of the clinical study, ref SDS 19 VP4H, on monitoring lung and heart
460909 - preconditions of pulmonary emobolism and enlarged right ventricle (Cor
460910 - Pulmonale) was too stressful. ref SDS 19 TK8H
460912 -  ..
460913 - Yesterday, on 070516 Millie coordinated with Kaiser in a letter asking
460914 - that the next CT test scheduled for 070520 use thin slice spiral
460915 - technology that can compare with pior testing on 060930 to assess
460916 - progression or recovery from pulmonary embolism, and enlarged right
460917 - ventricle, ref SDS 22 Y76G, which helps assess continuing on the
460918 - cetuximab clincial study that has been associated with lung and heart
460919 - disorders, reported on 070116. ref SDS 11 I75I  The doctor responded
460920 - that all CT tests at Kaiser use thin slice spiral technology that
460921 - produce 1 mm scans, but Kaiser chooses to review only 20% of the data.
460922 - ref SDS 22 GP3L
460924 -  ..
460925 - Millie submitted a letter asking Kaiser to make a thorough review of
460926 - all the data that scanned the locations where lung and heart disorders
460927 - were previously found in the CT test on 060930, and report comparision
460928 - to assess progression of pulmonary embolism and enlarged right
460929 - ventricle. ref SDS 22 Y76G
460931 -  ..
460932 - After returning from getting treating in San Francisco at UCSF today,
460933 - ref SDS 23 0001, Millie received ref DRT 1 0001 from the primary care
460934 - physician responding to Millie's letter, and saying...
460935 -
460936 -        I can have them do this, but the "omission" is probably
460937 -        indicative of stability and no increase in clot.  Again, it's
460938 -        important to understand the value of information....you[r]
460939 -        management at this time will not change based on your requested
460940 -        inquiry.  So this information is more of an inquisitive nature.
460942 -         ..
460943 -        If we did this with every study, very few studies, for you or
460944 -        other patients, would be completed. ref DRT 1 0001
460945 -
460946 -            [...below Millie responds to Kaiser citing following
460947 -            analysis. ref SDS 0 616M
460949 -  ..
460950 - Representation that Kaiser will perform the scope of testing and
460951 - comparisons ordered by the doctor does not align with patient history.
460952 - Case study on 061012 shows the doctor has ordered comparisions many
460953 - times and the Medical Imaging Department has consistently failed to
460954 - perform, ref SDS 9 A55J, including the most recent test on 070326,
460955 - reported on 070329. ref SDS 17 0136  This presents a significant
460956 - question of whether doctors can perform case management.  For example,
460957 - on 060126 the analyst reported that comparisons could not be performed
460958 - because Kaiser could not find the record for prior tests in
460959 - organizational memory. ref SDS 7 XF3K
460961 -  ..
460962 - Kaiser's position that the patient should not worry about progression
460963 - of lung and heart disorders because failure to present findings, i.e.,
460964 - silence by omission, probably indicates stability, ref SDS 0 OS5G, is
460965 - incorrect, illustrated by Kaiser's follow up letter today shown below.
460966 - Omission in the 2nd letter verifying accuracy of a test, and reporting
460967 - submission of data to UCSF does not establish that these tasks were
460968 - actually performed, but rather that most likely no action was taken.
460969 - ref SDS 0 H39G
460971 -  ..
460972 - Faith not to worry that "omission" in a report probably indicates
460973 - "stability," overlooks management practice of traceability to original
460974 - sources called out in ISO requirements, reviewed on 950721.
460975 - ref SDS 1 1740  ISO standards rest on the locality principle that
460976 - accuracy derives from the power of knowledge with connections back to
460977 - original sources, which Kaiser has consistently failed to do this
460978 - case, shown in the case study on 061012. ref SDS 9 A55J
460980 -  ..
460981 - There are many reasons representations are omitted besides finding
460982 - nothing changed to report, i.e., stability....
460983 -
460984 -        1.  Finding prior related work for investigation and comparison
460985 -            is not fast and easy, causing frustrations, stress, and
460986 -            anger that drives good people to omit critical work, by
460987 -            assuming that if it was important it would not have been
460988 -            omitted, illustrated by common scenario in NWO. ref OF 1
460989 -            VP7L
460991 -             ..
460992 -        2.  Analyst cannot find prior report to compare with current
460993 -            work for trend analysis, and so says nothing, because there
460994 -            is no baseline for recognizing changes in condition.
460996 -             ..
460997 -        3.  Analyst finds prior report, but performing comparison is a
460998 -            lot of hard work that takes extra time, which people avoid.
461000 -             ..
461001 -        4.  Management policy avoids investing time and expense
461002 -            performing hard work to find prior relevant records, and
461003 -            make comparisons that save lives, time, and money, in
461004 -            mistaken belief that proactive management is not cost
461005 -            effective.
461007 -             ..
461008 -            Kaiser's formulation today justifies failure to perform on
461009 -            cost/benefit basis. ref SDS 0 KV3H
461011 -             ..
461012 -            This overlooks the record showing Kaiser has already
461013 -            invested time to make comparisons.  The analyst need not
461014 -            compare every image in the scan, but only at locations
461015 -            where prior maladies have already been identified.  Kaiser
461016 -            did this on 041217, as reported by the doctor during the
461017 -            meeting on 041230. ref SDS 4 PW3K
461019 -             ..
461020 -        5.  Analyst gets distracted and forgets to make comparisons.
461022 -             ..
461023 -        6.  Analyst gets tired and makes mistakes in comparisons that
461024 -            miss significant differences showing changes in patient
461025 -            conditions.
461027 -  ..
461028 - Assurances not to worry about testing only 20% of the data because
461029 - case management is not affected by findings of comparisions for trend
461030 - analysis of lung and heart disorders appears conflicting....
461031 -
461032 -        1.  Kaiser told Millie "not to worry" on 051005 about safety of
461033 -            chemotherapy treatments, because many CT tests had shown no
461034 -            explanation for persistent and rising symptoms, and so the
461035 -            patient must tolerate symptoms as side effects of treatment
461036 -            for cancer. ref SDS 2 OG4J
461038 -             ..
461039 -        2.  Millie's case management was severly affected on 041104
461040 -            when a test of the kind requested at this time, and so far
461041 -            not performed nor analysed at the appropriate level by
461042 -            Kaiser, was in fact performed, evidently at urging of UCSF
461043 -            to investigate serious lung disorders. ref SDS 3 0001
461044 -            Kaiser advised on 041104 that representations on 041005
461045 -            were a mistake, because there was a lot to worry about
461046 -            continuing the treatment at that time.
461047 -
461048 -               [...below Millie responds to Kaiser citing following
461049 -               analysis. ref SDS 0 616M
461051 -             ..
461052 -            Findings resulted in removing Millie from treatment that
461053 -            was yielding favorable response for a very serious form of
461054 -            cancer, ref SDS 3 N438, treatment was interrupted for a
461055 -            long period, and the patient suffered significant relapse,
461056 -            leading to mastectomy surgery, with continuing
461057 -            complications of lymphedema and Cellulitis.
461059 -             ..
461060 -            Findings further resuled in lifetime disruption by daily
461061 -            treatments for pulmonary embolism.
461063 -             ..
461064 -        3.  Millie's peace of mind and lifestyle was partially restored
461065 -            on 041230 when follow up testing, which Kaiser maintains
461066 -            today is not cost effective, reported that treatment
461067 -            resulted in prior pulmonary embolism no longer being
461068 -            visualized. ref SDS 4 PW3K
461069 -
461070 -               [...below Millie responds to Kaiser citing following
461071 -               analysis. ref SDS 0 743O
461073 -             ..
461074 -        4.  On 051007 the primary care physician was able to end
461075 -            treatment for pulmonary embolism in advance of mastectomy
461076 -            surgery.
461078 -             ..
461079 -        5.  Similarly, findings from annual or bi-annual investigation
461080 -            with CT scans at 1 mm intervals for the few locations where
461081 -            prior problems were reported may show no visualizations of
461082 -            problems, as occurred previously on 041230. ref SDS 4 PW3K
461083 -            In that case, patient and care givers are signaled to
461084 -            maintain the current course, including training to increase
461085 -            fitness for quality of life, and to resist cancer.  If
461086 -            conditions are unchanged from prior scans, people are on
461087 -            notice of continuing risk, which may be manageable at
461088 -            current levels of treatment and activity.  If conditions
461089 -            have worsened, then, as on 041130, there may be further
461090 -            drastic change to avoid life threatening risks by ending
461091 -            treatment with cetuximab, and reducing the level of effort
461092 -            working out, with consequent loss of fitness and quality of
461093 -            life.
461094 -
461095 -               [...below Millie responds to Kaiser citing following
461096 -               analysis. ref SDS 0 744V
461098 -  ..
461099 - Policy to avoid comparisons for trend analysis to evaluate progression
461100 - of disease may reflect challenge of managing the record to find
461101 - critical details in organizational memory from daily working
461102 - information.  For example, on 060126 the analyst reported that
461103 - comparisons could not be performed because Kaiser could not find the
461104 - record for prior tests. ref SDS 7 XF3K
461106 -  ..
461107 - Policy objectives to save time and money by (1^]reviewing only 20% of
461108 - the data, i.e., examining 1 mm scans at 5 mm intervals, ref SDS 0
461109 - D66M, and (2) by avoiding comparisons to assess progression of disease
461110 - will divert resources from caring for patients, ref SDS 0 KV3H,
461111 - conflicts with requirements for standard of care in this case...
461113 -             ..
461114 -        1.  All patients have not been diagnosed with pulmonary
461115 -            embolism and enlarged right ventricle with 1 mm scans as
461116 -            Millie has been diagnosed on 2 occassions, see patient
461117 -            history on 060722. ref SDS 8 6G6O
461119 -             ..
461120 -        2.  All patients do not have a history of life-threatening
461121 -            symptoms for 6 months, with negtive findings from numerous
461122 -            5 mm CT scan reviews, and then discovery of lung and heart
461123 -            disorders in time for treatment to be effective only with 1
461124 -            mm CT scan review, as discussed at UCSF on 070510.
461125 -            ref SDS 19 HW5I
461127 -             ..
461128 -        3.  All patients are not being treated with an unusual triple
461129 -            negative clinical study to discover treatments that are
461130 -            effective for breast cancer, but which presents risks of
461131 -            lung and heart disorders that require increased scrutiny,
461132 -            reported on 070116. ref SDS 11 I75I
461134 -             ..
461135 -        4.  All CT tests for Millie need not make 1 mm review; annual
461136 -            or bi-annual 1 mm review seems adequate to assess critical
461137 -            changes in life threatening maladies; failure to review
461138 -            previously diagnosed lung and heart disorders with the same
461139 -            method used for original diagnosis appears negligent.
461141 -             ..
461142 -        5.  All scans in Millie's CT tests need not be reviewed for
461143 -            progression of previously diagnosed lung and heart disease;
461144 -            analysis can compare the few locations where prior findings
461145 -            diagnosed pulmonary embolism and enlarged right ventricle,
461146 -            as was done with the CT test on 041217, reported on 041230.
461147 -            ref SDS 4 PW3K  Failure to perform comparison of known
461148 -            problems and report changes appears negligent.
461150 -             ..
461151 -        6.  Far more time time and money can be saved by coordinating
461152 -            referral work to avoid duplication of laboratory work for
461153 -            hundreds of blood tests, as occurred on 070511, ref SDS 20
461154 -            T76M, rather than avoiding essential review of a few scan
461155 -            films.
461157 -             ..
461158 -        7.  On 061230 UCSF invested time and expense to review Millie's
461159 -            chances of surviving risks of lung and heart damage from
461160 -            treatment on the cetuximab carboplatin study, ref SDS 10
461161 -            PN6R, and in order to benefit from treating a rare form of
461162 -            cancer, with a rare patient history of triple negative,
461163 -            also, noted by the primary care physician on 061230.
461164 -            ref SDS 10 PO3Q  A month later, on 070130 UCSF invested more
461165 -            time and expense to assess complications compounding
461166 -            Millie's pulmonary embolism and enlarged right ventricle
461167 -            from treatment on the cetuximab carboplatin study.
461168 -            ref SDS 12 MO7K  Having invested time and expense to place
461169 -            the patient at risk for a study on which only 100 patients
461170 -            in the country are participating, the occassional minor
461171 -            expense to assess impacts of known complications seems to
461172 -            represent the cost of the study, rather than a threat to
461173 -            policy for treating all patients.  By definition and
461174 -            design, patients in a study are treated differently.  They
461175 -            incur increased risks and require increased expense in
461176 -            order to achieve benefits for all patients.
461178 -             ..
461179 -        8.  Saving time and money by checking only 20% of test data,
461180 -            and failing to compare with prior tests where lung and
461181 -            heart disorders were found to assess progression of
461182 -            disease, and complications from treatments known to cause
461183 -            lung and heart disorders appears conflicting with standard
461184 -            of care requirements.  Kaiser can treat a lot more patients
461185 -            by reducing treatments to only 20%, doing 20% of required
461186 -            surgeries, blood tests, treating 20% of emergency patients,
461187 -            etc,, etc., would leave more time and money to treat other
461188 -            patients under Kaiser's new policy. ref SDS 0 KV3H
461189 -
461190 -
461191 -
461192 -
461193 -
4612 -

SUBJECTS
CA 15-3 Blood Tests Kaiser Cancer Marker UCSF Different Metholology

5903 -
5904 - 1610
590501 -  ..
590502 - Apples Oranges CA 15-3 Test Protocol Different Kaiser from UCSF
590503 - CA 15-3 Test Protocol Different Kaiser from UCSF Apples Oranges
590504 -
590505 - Follow up ref SDS 22 ZJ9N.
590506 -
590507 - Millie received ref DRT 2 0001 from primary care physician responding
590508 - to Millie's letter, ref DIP 1 0001, submitted to Kaiser yesterday,
590509 - ref SDS 22 ZJ9N, and saying to Millie today...
590510 -
590511 -        Was that "26" drawn at UCSF?  Because if it was, they probably
590512 -        were using a different methodology and we are comparing apples
590513 -        with oranges. ref DRT 2 0001
590515 -  ..
590516 - Millie's letter reports UCSF CA 15-3 test was 29, ref SDS 22 UG9M, not
590517 - 26, but that is a minor point.
590519 -  ..
590520 - Kaiser and UCSF CA 15-3 testing should track the same direction, i.e.,
590521 - up or down.  In this case, CA 15-3 56 at Kaiser remains substantially
590522 - above the benchmark of 39, and CA 15-3 29 at UCSF has dropped below
590523 - the benchmark of 31.
590524 -
590525 -        [On 070524 CA 15-3 37 makes dramatic reversal and begins to
590526 -        rise in the UCSF test method, ref SDS 25 EU4I; examination
590527 -        seems to show IBC at all sites continues to subside.
590528 -        ref SDS 25 EU6O
590530 -  ..
590531 - Kaiser's 2nd letter illustrates error in Kaiser's earlier letter today
590532 - proposing that omission from a test report implies work was performed
590533 - and found no problems to report, per above. ref SDS 0 KV3O  The letter
590534 - yesterday on 070516 asked Kaiser to verify test data that seems
590535 - inconsistent, and notify UCSF of new data. ref SDS 22 UH3R  Omission
590536 - reporting these tasks today, ref SDS 0 NT3O, does not establish nor
590537 - imply Kaiser took action.
590538 -
590539 -
590540 -
5906 -

SUBJECTS
CA 15-3 Blood Tests Kaiser Cancer Marker  USF Different Metholology

7503 -
7504 - 1618
750501 -  ..
750502 - CA 15-3 Cancer Marker Opposite Directions Requires Investigation
750503 -
750505 -  ..
750506 - Millie submitted ref DIT 1 0001 responding to Kaiser's letter asking
750507 - for identification of conficting CA 15-3 test data, per above,
750508 - ref SDS 0 NT3O, and cited in Millie's letter to Kaiser yesterday on
750509 - 070516. ref SDS 22 ZJ9N
750511 -  ..
750512 - Millie's letter says to Kaiser...
750513 -
750514 -    1.  CA 15-3 29 was reported in a meeting at UCSF for a test at UCSF
750515 -        on 070426, ref SDS 18 087J, as shown in my letter yesterday.
750516 -        ref SDS 22 ZJ9N, ref DIT 1 0001
750518 -         ..
750519 -    2.  Kaiser sets 39 as a benchmark, while UCSF uses 31.  Reporting
750520 -        on 070328 indicates the FDA sets strict standards for cancer
750521 -        biomarkers. ref SDS 16 0001, ref DIT 1 PV5O
750523 -         ..
750524 -    3.  While this is a new field, it has helped me guage progress
750525 -        along with your good counsel. ref DIT 1 LV6K
750527 -         ..
750528 -    4.  Has Kaiser changed the 39 benchmark, or does 56 still represent
750529 -        17 points high?  At UCSF, they use 31, which as you say
750530 -        suggests differences in methodolgy and calibration.  Still 29
750531 -        is below the benchmark, and 56 is well above Kaiser's
750532 -        benchmark. ref DIT 1 5W6O
750534 -         ..
750535 -    5.  Is there literature that sets out the "apples and oranges"
750536 -        point you make today?  It is hard to believe I am the only
750537 -        customer who has been confused by these technicalities.
750538 -        ref DIT 1 MW7K
750539 -
750540 -
7506 -

SUBJECTS
CA 15-3 56 Substantial Rise Blood Tests  00511 at Kaiser UCSF Plans

9303 -
9304 - 1637
930501 -  ..
930502 - Labs Accuracy UCSF Avoids Cross-check Coordination Referrals Difficult
930503 - Coordination Difficult Labs Referrals UCSF Avoids Cross-check Accuracy
930504 - Referrals Coordination Labs Difficult UCSF Avoids Cross-check Accuracy
930505 -
930506 - Follow up ref SDS 22 J55T.
930507 -
930508 - Yesterday, Millie received notice of CA 15-3 56 for a test performed
930509 - at Kaiser on 070511. ref SDS 22 RH9H  Millie asked Kaiser to verify
930510 - results in light of possible conficts with prior tests at UCSF, and to
930511 - notify UCSF for consideration changing treatments. ref SDS 22 UH3R
930513 -  ..
930514 - There is no indication in the record that Kaiser communicated with
930515 - UCSF to coordinate this issue, per Kaiser's letter today, shown above.
930516 - ref SDS 0 NT3O
930518 -  ..
930519 - Millie also sent a letter to UCSF explaining that CA 15-3 56 was
930520 - reported by Kaiser and was being investigated. ref SDS 22 J55T  Today,
930521 - UCSF responded to Millie's letter.
930523 -  ..
930524 - Millie received ref DRT 3 0001 from Brigid saying...
930525 -
930526 -    1.  It is always difficult when you are getting labs drawn in 2
930527 -        places.  I would suggest you only get the CA 15-3 drawn in one
930528 -        place, once a month.  This is for accuracy. ref DRT 3 0001
930529 -
930530 -            [On 080404 1440 Brigid noted again that coordination is
930531 -            difficult to provide comprehensive care, and is even harder
930532 -            for complex case management between hospitals treating
930533 -            patients on referral. ref SDS 28 SE5L
930535 -         ..
930536 -    2.  Labs are different at various insitutions and we really
930537 -        encourage only monthly draws of tumor markers. ref DRT 3 R36H
930539 -         ..
930540 -    3.  We don't need to change anything urgently because of the
930541 -        outside CA 15-3, your last one here at UCSF was normal on
930542 -        4/26/07, we will check another at the end of the month.
930543 -        Especially if you are feeling well and no change in any
930544 -        symptoms we will stay on course. ref DRT 3 FD6L
930546 -  ..
930547 - Monthly draws are effective when the cancer marker is going down, and
930548 - is stable below the level that signals caution.  When the marker is
930549 - rising, Millie's patient history listed on 070426, ref SDS 18 087J,
930550 - shows that testing for cancer markers helps guide treatment before
930551 - cancer cascades out of control, reported on 051121. ref SDS 6 FV6L
930553 -  ..
930554 - After the UCSF letter at 0728 this morning advising Millie to rely
930555 - only on monthly CA 15-3 testing, ref DRT 3 0001, Nurses Notes for
930556 - treatment at UCSF today show considerations for another blood draw due
930557 - to elevated CA 15-3. ref SDS 23 2N5J
930558 -
930559 -        [On 070524 CA 15-3 37 makes dramatic reversal and begins to
930560 -        rise in the UCSF test method, ref SDS 25 EU4I; examination
930561 -        seems to show IBC at all sites continues to subside.
930562 -        ref SDS 25 EU6O
930564 -         ..
930565 -        [On 070524 UCSF continues treatment with cetuximab alone based
930566 -        on favorable CT test and examination showing no visible
930567 -        evidence of rising IBC. ref SDS 24 M645
930569 -         ..
930570 -        [On 070531 UCSF not concerned results of blood test today show
930571 -        CA 15-3 37 rising 30% from the prior report on 070426, because
930572 -        CT scans show no metastatic cancer, and IBC inflammation
930573 -        appears to be subsiding. ref SDS 26 NQ6K
930575 -  ..
930576 - Difficulty coordinating referral work with divided responsibilities
930577 - and separate business systems that maintain and distribute patient
930578 - history requires careful planning, noted by Brigid today, and cited by
930579 - Jackie on 070222. ref SDS 14 VK5N  Difficulties today coordinating
930580 - betewen Kaiser and UCSF illustrate problems coordinating initial
930581 - administration of Millie's referral, shown in a case study on 070130.
930582 - ref SDS 13 2W58  Communication and coordination problems also occur
930583 - internally, illustrated by the study on 070307. ref SDS 15 G56L
930584 -
930585 -        [On 071017 problems ordering blood tests at Kaiser the day
930586 -        before treatment at UCSF - Jackie faxes request for blood draw
930587 -        to Arlette at Kaiser in Walnut Creek, Millie's main treatment
930588 -        location. ref SDS 27 Q45F  Arlette is at lunch, delay finding
930589 -        out where to get blood drawn. ref SDS 27 4Q5M  Arlette advises
930590 -        UCSF blood draw request was ordered by the doctor; tells
930591 -        customer to coordinate with Kaiser to schedule blood draws.
930592 -        ref SDS 27 4Q7G  Kaiser in Walnut Creek cannot do blood draw
930593 -        until next week, ref SDS 27 YE9G; Millie goes to Kaiser in
930594 -        Martinez for the blood draw; finds the order is not entered in
930595 -        the computer, ref SDS 27 OS3F; blood draw performed using order
930596 -        found in the computer for prior blood draw from last January.
930597 -        ref SDS 27 OS5K
930599 -  ..
930600 - Accuracy in testing rises from reconciling differences in reporting,
930601 - sometimes called "cross-checking."  UCSF proposal today to limit
930602 - cross-checking between labs seems conflicting with requirements to
930603 - verify accuracy. ref SDS 0 466H
930604 -
930605 -
930606 -
9307 -

SUBJECTS
CT Test Scheduled 070520 Patient Requests  Cmparison Test 060930 Lun

B103 -
B104 - 1644
B10501 -  ..
B10502 - Kaiser Notified Test Status Lung Heart Disorders Guide Treatment
B10503 -
B10505 -  ..
B10506 - Millie submitted ref DIT 2 0001 to the primary care physician at
B10507 - Kaiser responding to the doctor's letter received earlier today, per
B10508 - above, and addressing Kaiser's cost/benefit policy that has delayed
B10509 - testing to assess patient lung and heart disorders. ref SDS 0 OS5G
B10510 -
B10511 -    1.  Kaiser diagnosed PE from a test on 041103, some weeks later on
B10512 -        041230 you provided results of a follow up test on 041217 that
B10513 -        reported the previous PE was "no longer visualized," as shown
B10514 -        in the record. ref SDS 4 PW3K, ref DIT 2 0001
B10516 -         ..
B10517 -    2.  I was relieved by this report, and felt comfortable resuming
B10518 -        work outs.  On 051007, we stopped treatment for PE after a year
B10519 -        of continuing reports showing no recurrent PE. ref SDS 5 XN7K,
B10520 -        ref DIT 2 C16F
B10522 -         ..
B10523 -    3.  Testing at this time showing no visualization of prior
B10524 -        conditions, or alternatively showing prior problems have
B10525 -        worsened will guide me in considering what to do, including
B10526 -        relief from doubt and worry. ref DIT 2 616L
B10528 -         ..
B10529 -    4.  As always, I am guided by your advice.  If you feel that my
B10530 -        care cannot be aided by comparing test results on 070521 with
B10531 -        prior work on 060930, as was done previously, then lets skip
B10532 -        it. ref DIT 2 227H
B10534 -         ..
B10535 -    5.  Thanks for considering this issue.
B10536 -
B10537 -
B10538 -
B10539 -
B106 -