CONTACTS
020304 -
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 51 0000. ref SDS 50 0000.
040502 -
040503 -
040504 -
040506 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090423 Millie met with Tara in the Breast Care Clinic at UCSF for
040902 - examination, which showed recovery from side effects of radiation and
040903 - hyperthermia treatments during February and March 2009. ref SDS 31 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 32 ZL6T Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 31 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 32 ZL7P
040909 - ..
040910 - At that time, on 090423 Tara planned to discuss with Doctor Hsu in the
040911 - UCSF Radition Oncology Department concerns about slow healing of
040912 - radiation side effects in Millie's breastbone area. ref SDS 31 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 32 ZL7V
040916 - ..
040917 - In the afternoon on 090423 1315 Millie met with Doctor Hsu to check on
040918 - recovery from radiation side effects. ref SDS 31 4H5G Doctor Hsu gave
040919 - Millie a "thumbs up" that she was well enough to take time from
040920 - treatment to go on a 2-week vacation, ref SDS 31 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 31
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 31 EX4I The doctor
040924 - recommended against taking a biopsy because the skin was thought to be
040925 - radiated, and surrounding tissue was radiated, and so this would delay
040926 - and prevent normal recovery from a biopsy wound. ref SDS 31 456H
040928 - ..
040929 - On 090423 2337 Millie's letter to medical team reports Doctor Hsu's
040930 - favorable report that IBC cannot recur in treated areas, because
040931 - nothing can grow in treated areas. ref SDS 32 ZL9V The letter further
040932 - confirms UCSF plans to treat IBC recurrence on the lower left arm as a
040933 - chronic disease with systemic agents prescribed by Doctor Rugo in the
040934 - Breast Care Clinic, ref SDS 32 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 32 ZL5Q
040937 - ..
040938 - Yesterday on 090510 1553, Millie submitted an agenda for the meeting
040939 - on 090514 to start treatment of the 8th relapse. ref SDS 33 QH9J The
040940 - letter was hurried to fit commitments for attending Mother's Day
040941 - family event. In the afternoon on 090510 1953, after retrurning home,
040942 - Millie sent a second letter to further explain the agenda for meeting
040943 - on Thursday 090514 at UCSF with Doctor Rugo. ref SDS 34 FJ3G
040945 - ..
040946 - This morning, called and talked to Amanda about coordinating to
040947 - facilitate the agenda for meeting with Doctor Rugo on Thursday,
040948 - 090514, particularly on requirements for blood tests at Kaiser, as
040949 - discussed in Millie's letter on 090510 1953. ref SDS 34 LJ7X
040951 - ..
040952 - Amanda requested a copy of Millie's letter to the medical team that
040953 - explains details about getting a lab. Millie sent the letter to
040954 - Amanda and requested clarification on requirements for a lab.
040955 - ref SDS 35 YN33 After sending the letter to Amanda this afternoon,
040956 - Kaiser notified Millie on 090511 1427 that Doctor Johnson has a
040957 - standing order at Kaiser for Millie to get a monthly blood test,
040958 - ref SDS 36 FJ5L; so, Millie then sent a letter notifying the medical
040959 - team that the blood draw will be done on 090512, so that people can be
040960 - prepared for a productive meeting at UCSF on 090514. ref SDS 36 FJ6G
040962 - ..
040963 - On 090511 2013, Doctor Rugo sent a letter saying that scope for labs
040964 - at Kaiser performed to support examinations at UCSF should be
040965 - determined by Kaiser rather than by UCSF. ref SDS 37 RF4J
040967 - ..
040968 - On 090511 2313, Millie notified Doctor Rugo that case study on 090325,
040969 - ref SDS 23 KZ6N, shows UCSF has been setting the scope on labs at
040970 - Kaiser for the past 3 years that are used to guide the work for
040971 - Millie's care at UCSF on referral from Kaiser, ref SDS 38 YN4L
040973 - ..
040974 - On 090512 Millie went to Kaiser for the lab. ref SDS 39 6Z4F
040976 - ..
040977 - On 090513 1654 Millie submitted results of Kaiser's lab to UCSF,
040978 - ref SDS 40 N54I, and notifies Doctor Mason at Kaiser's Outside
040979 - Referrals Department about more mistakes at Kaiser that causes poor
040980 - coordination of Millie's care at UCSF on referral from Kaiser.
040981 - ref SDS 40 ZH6W, and follows up Doctor Mason's plan on 090420 for
040982 - Kaiser to work harder with greater diligence to avoid mistakes in
040983 - order to continue doing labs at Kaiser rather than include labs for
040984 - referral at UCSF for Millie's treatments at UCSF. ref SDS 30 8G3N
040986 - ..
040987 - Millie received a letter from Pam who works for Doctor Mason in
040988 - Kaiser's Outside Referrals Department, and asking why the Outside
040989 - Referrals Department was notified about mistakes at Kaiser performing
040990 - labs required for Millie's care at UCSF on referral from Kaiser.
040991 - ref SDS 41 2T5L
040993 - ..
040994 - Millie replied to Pam's letter explaining patient history assists
040995 - Doctor Mason evaluate requirements for effective coordination because
040996 - chronic mistakes at Kaiser can be avoided by performing labs at UCSF
040997 - for Millie's care at UCSF. ref SDS 42 PQ5N
040999 - ..
041000 - On 090514 0830 Millie met with Doctor Rugo, ref SDS 43 TP9L, and the
041001 - doctor prescribed treatment in the MPA clinical trial to help Millie
041002 - recover from the 8th relapse of cancer. ref SDS 43 A13N The doctor
041003 - was encouraged about powerful new treatments becoming available to
041004 - treat Millie, ref SDS 43 3F7M, but was very discouraged saying Kaiser
041005 - would never get on board to treat Millie's cancer as a chronic
041006 - disease. ref SDS 43 3F82 As a first step to order treatment, Doctor
041007 - Rugo sent a letter to Kaiser recommending treatment for Millie with
041008 - the MPA protocol that is targeted to Millie's patient profile.
041009 - ref SDS 43 DI63
041011 - ..
041012 - On 090514 2346, Millie sent a letter notifying the medical team,
041013 - ref SDS 44 LF3H, about the new MPA treatment prescribed by UCSF, and
041014 - cited the letter Doctor Rugo sent to Kaiser explaining prospects for
041015 - recover, ref SDS 44 WF9V; and Millie's letter further submitted the
041016 - agenda for meeting tomorrow with Doctor Johnson at Kaiser to perform
041017 - oversight review. ref SDS 44 WF9Y
041019 - ..
041020 - On 090515 0952, Doctor Rugo sent a reply this morning to Millie and
041021 - the medical team saying that Kaiser notified UCSF that Kaiser refused
041022 - to treat Millie for recovering from the 8th relapse of cancer.
041023 - ref SDS 45 GR4O
041025 - ..
041026 - On 090515 1017, Millie notified the medical team that Kaiser is
041027 - responsible for her care, must prescribe treatment based on the best
041028 - evidence, and that Millie will meet with the primary care physician
041029 - today at 090515 1140 and support review for ordering treatment
041030 - recommended by Doctor Rugo, and in time to effective. ref SDS 46 EY5L
041032 - ..
041033 - On 090515 1140 Millie met with Doctor Johnson, primary care physician
041034 - at Kaiser to prescribe treatment for Millie's 8th relapse of cancer.
041035 - ref SDS 47 J47M The doctor asked Millie to assist him preparing an
041036 - appleal to Memeber Services for clarification of incorrect guidance he
041037 - received from Doctor Mason. ref SDS 47 655R
041039 - ..
041040 - On 090515 1518 Millie received a letter from Doctor Rugo wishing
041041 - Millie "good luck" assisting Kaiser perform the agreement to prescribe
041042 - standard of care treatment for Millie's 8th relapse of cancer.
041043 - ref SDS 48 PW7H
041045 - ..
041046 - On 090516 0858, Millie notified Doctor Rugo that Doctor Johnson going
041047 - to bat for Millie at Kaiser to prescribe treatment by filing appeas
041048 - with Memeber Services. ref SDS 49 SY4O
041050 - ..
041051 - On 090518 0017 prepared a draft appeal for Doctor Johnson to file with
041052 - Member Services on requirements for prescribing Millie's treament to
041053 - recover from the 8th relapse of cancer. ref SDS 50 R16I
041055 - ..
041056 - On 090519 1536 Doctor Johnson responded to Millie's letter submitted
041057 - to Kaiser yesterday on 090518 0017, ref SDS 50 R16I, and telling
041058 - Millie he changed his mind and so would not expedite treatment by
041059 - sending an appeal to Member Services, and instead tells Millie to
041060 - submit an appeal for treatment to recover from Millie's 8th relapse of
041061 - cancer. ref SDS 51 5K7H
041063 - ..
041064 - Today, on 090519 1613 Millie responds to the Doctor's letter this
041065 - afternoon on 090519 1536, ref SDS 51 5K7H, and asks the doctor to
041066 - prescribe treatment so she can recover from cancer, as planned by the
041067 - doctor during the meeting on 090515 1140. ref SDS 47 655R
041068 -
041069 - 1. Subject: Draft Appeal to Member Services Authorize Clinical Trial at UCSF
041070 - Date: Tue, 19 May 2009 16:21:30 -0700
041071 - From: Millie Buck
041072 - To: Robert.A.Johnson@kp.org
041073 - CC: hrugo@medicine.ucsf.edu
041074 - Hsu, I-Chow (Joe)"
041076 - ..
041077 - Dear Doctor Johnson,
041079 - ..
041080 - 2. Thanks very much for timely action on arranging for my next
041081 - treatment, as set out in your letter this afternoon [reported
041082 - in the record today on 090519 1536. ref SDS 51 5K7H]
041083 -
041084 -
041086 - ..
041087 - Dropt Dead Date When Must Treatment Start to be Effective
041088 - How Much Time Does Millie Have to Prevent Losing Control of Cancer
041089 -
041090 -
041091 - 3. For Doctor Rugo -- since progression was observed on 090331, do
041092 - we have any idea of my "drop dead" date, such that if we don't
041093 - start treatment I'm a lost cause? On 090202 you wrote to the
041094 - team that I needed urgent treatment quickly. Doctor Hsu then
041095 - advanced treatment several weeks, and things worked out. How
041096 - much time do we have in this case to help Kaiser through the
041097 - authorization exercise?
041098 -
041099 - [On 090522 1351 Millie asks medical team for expected
041100 - results from prescribing treatment with single-agent
041101 - chemotherapy that conflicts with Millie's patient profile -
041102 - will this be weeks of agony then progression of cancer at
041103 - Kaiser - rather than recovery with MPA "targeted" to treat
041104 - Millie's patient profile at UCSF Cancer Center and no
041105 - adverse side effects? ref SDS 56 2T4S
041106 -
041108 - ..
041109 - Radiation Hyperthermia Request Interim Care Pending Systemic Treatment
041110 -
041111 -
041112 - 4. Since I have authorization for hyperthermia and other
041113 - modalities, including chemo at UCSF, can we come up with an
041114 - interim solution while making arrangements for systemic care,
041115 - which you feel I should have? Right now the main problem is on
041116 - the lower left arm, and it is getting worse each day.
041117 -
041119 - ..
041120 - Recovering from Severe Side Effects Radiation Ended 090317
041121 -
041122 -
041123 - 5. Otherwise I'm feeling stronger. Hiked for 3 days in a row, and
041124 - went to the gym this morning.
041125 -
041126 -
041128 - ..
041129 - Kaiser Loses Patient Treatment Plans Resubmit to Doctor
041130 - MPA Protocol Lost at Kaiser Resubmit to Primary Care Doctor
041131 -
041132 -
041133 - 6. For Doctor Johnson...
041135 - ..
041136 - 7. Yesterday, I submitted the explanation of the care [with the
041137 - MPA protocol] proposed by Doctor Rugo during the meeting at
041138 - UCSF on 090514 [ref SDS 43 A13N, and cited in [...
041139 - Millie's...] letter to the medical team on 090514 2314.
041140 - ref SDS 44 WF9P] As you recall, I forget to bring it to the
041141 - meeting with you the next day at Kaiser on 090515, so I left it
041142 - at the front desk for you yesterday around noon, after a hike
041143 - at Lafayette Reservoir. My mind has been a whirl. I recall
041144 - that Doctor Rugo wrote you a letter while meeting with me on
041145 - 090514, and she related outlines of a program to treat my
041146 - cancer as a chronic disease. ref SDS 43 DI63 When we met on
041147 - Friday, you were uncertain where to find Doctor Rugo's letter
041148 - listing the proposed treatment. ref SDS 47 0V7L Did you get
041149 - the brochure on the proposed treatment?
041150 -
041152 - ..
041153 - Primary Care Doctor Filing Appeal to Member Services
041154 -
041155 -
041156 - 8. My understanding is that you will personally file an appeal to
041157 - Member Services in order to expedite my care, and based on a
041158 - telecon you had earlier with Doctor Mason in Outside Referrals
041159 - [discussed during the meeting at Kaiser on 090514 1140,
041160 - ref SDS 47 655R].
041162 - ..
041163 - 9. Note that I cannot file an appeal, until there is an official
041164 - denial of service by Doctor Mason. In order for Doctor Mason
041165 - to deny service, you have to submit a referral. However, you
041166 - can make an appeal for exigent review based on your telecon
041167 - with Doctor Mason, and urgency for your patient to get standard
041168 - of care [responding to Doctor Johnson's letter asking the
041169 - patient to file an appeal reported on, 090519 1536, ref SDS 51
041170 - 5K7H]
041172 - ..
041173 - 10. You asked me to visit Member Services after our meeting ended
041174 - OA 2p, and submit the name of the director for the Member
041175 - Services Department. ref SDS 47 TY5K You also asked for a
041176 - draft. ref SDS 47 655Y I did these two tasks to facilitate
041177 - your work and save you time, because writing up an appeal is a
041178 - big job.
041180 - ..
041181 - 11. I think it would be helpful to submit your draft appeal to
041182 - Doctor Mason for input, as indicated in your letter today, if
041183 - he is willing to be constructive. I assume you can judge his
041184 - cooperation from the phone calls you had with him, which you
041185 - described last Friday. ref SDS 47 T59N
041187 - ..
041188 - 12. The draft appeal sounds in standard of care for oncology, which
041189 - is your expertise and practice experience. You are also aware
041190 - of my patient history. In our meeting on Friday, you seemed to
041191 - indicate that the only treatment you might be able to give me
041192 - is Navelbine, but said this conflicts with standard of care.
041194 - ..
041195 - 13. The appeal explains that you can prescribe more hyperthermia
041196 - and radiation, or hyperthermia and Doxil or some other agent
041197 - Doctor Rugo might propose. This regimen has proven effective,
041198 - and Doctor Mason has already approved payment. However, Doctor
041199 - Hsu at UCSF advised on 090425 that standard of care for
041200 - oncology requires withholding further hyperthermia, pending
041201 - systemic treatment by Doctor Rugo. As you know from patient
041202 - history, that is the standard of care you presented to me on
041203 - 030710, on 040318, on 041130, 041230, and on 070105, long
041204 - before I ever heard of Medicare. Since that standard of care
041205 - has been effective it seems reasonable to apply that standard
041206 - to the current situation.
041208 - ..
041209 - 14. Since you were able to prescribe standard of care for me
041210 - without regard to Medicare in 2003, 2004, and 2007, then you
041211 - can prescribe standard of care for me today.
041213 - ..
041214 - 15. The very nice woman who works for Doctor Mason told me on
041215 - 090401 that nobody knows Medicare rules. They are an
041216 - unfathomable labyrinth. Appealing on the basis of standard of
041217 - care falls within your expertise and experience, Medicare rules
041218 - are irrelevant.
041220 - ..
041221 - 16. In any case, the last thing I want to do is get sideways with
041222 - you and Doctor Rugo. My only hope of survival rests in your
041223 - good hands. We can re-do the draft in a manner that fits your
041224 - view of the case.
041226 - ..
041227 - 17. Please give me a call to discuss this. Right now I am
041228 - concerned about running out of time.
041229 -
041230 - [On 090519 1643 Millie called Kaiser to speak with Doctor
041231 - Johnson in order to expedite prescribing treatment; the
041232 - doctor did not call back. ref SDS 52 9G57
041234 - ..
041235 - [On 090520 1052 Millie called Kaiser again and was told
041236 - Doctor Johnson said he was in meetings all day and could
041237 - not call Millie to prescirbe urgent treatment. ref SDS 53
041238 - IW6O
041240 - ..
041241 - [On 090520 1113 Millie received a letter from Doctor
041242 - Johnson saying Kaiser "offers" Millie Gemzar or Navelbine,
041243 - and confirmed these "single-agent" chemotherapy drugs are
041244 - high risk of failure and causing harm for Millie's patient
041245 - profile, and said Member Services and Outside Referrals
041246 - interpret clinical trials for Millie to recover from 8th
041247 - relapse of cancer. ref SDS 54 UC9G
041249 - ..
041250 - [On 090520 1710 notified medical team of having left
041251 - telephone messages trying to schedule urgent treatment for
041252 - Millie in time to be effective, and which have not been
041253 - returned for several days. ref SDS 55 ZF5R
041255 - ..
041256 - [On 090528 1228 Millie notifies Kaiser Member Services
041257 - Claims Resolution Department that email is the only means
041258 - of communication with Kaiser, because everybody is too busy
041259 - to return calls. ref SDS 57 4N8U
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