CONTACTS 
020304 -

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 56 0000. ref SDS 53 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 32 QR3M
040904 - This was confirmed in Millie's letter to the medical team later that
040905 - day on 090423. ref SDS 33 ZL6T  Tara also found expanding IBC on the
040906 - lower left arm, ref SDS 32 DW6F, also confirmed in the letter to the
040907 - medical team. ref SDS 33 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 32 R15K
040913 - Collaboration plans were further confirmed in Millie's letter to the
040914 - medical team on 090423. ref SDS 33 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 32 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 32 FJ6K, and despite
040921 - confirming diagnosis of IBC relapse on the lower left arm, ref SDS 32
040922 - 5G4G, and despite growing doubts about vertical line of sking infected
040923 - either by IBC or radiation side effects. ref SDS 32 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 32 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 33 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 33 ZL4X, and notes the meeting scheduled
040935 - with Doctor Rugo on 090514. ref SDS 33 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 34 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 35 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 35 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 36 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 37 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 37 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 38 RF4J
040967 -  ..
040968 - On 090511 2313, Millie notified Doctor Rugo that case study on 090325,
040969 - ref SDS 24 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 39 YN4L
040973 -  ..
040974 - On 090512 Millie went to Kaiser for the lab.  ref SDS 40 6Z4F
040976 -  ..
040977 - On 090513 1654 Millie submitted results of Kaiser's lab to UCSF,
040978 - ref SDS 41 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 41 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 31 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 42 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 43 PQ5N
040999 -  ..
041000 - On 090514 0830 Millie met with Doctor Rugo, ref SDS 44 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 44 A13N  The doctor
041003 - was encouraged about powerful new treatments becoming available to
041004 - treat Millie, ref SDS 44 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 44 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 44 DI63
041011 -  ..
041012 - On 090514 2346, Millie sent a letter notifying the medical team,
041013 - ref SDS 45 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 45 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 45 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 46 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 47 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 48 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 48 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 49 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 50 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 51 R16I
041055 -  ..
041056 - On 090519 1536 Doctor Johnson responded to Millie's letter submitted
041057 - to Kaiser yesterday on 090518 0017, ref SDS 51 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 52 5K7H
041063 -  ..
041064 - On 090519 1613 Millie responded, ref SDS 53 8V8H, to the Doctor's
041065 - letter earlier yesterday afternoon on 090519 1536, ref SDS 52 5K7H;
041066 - and, Millie asks the doctor to prescribe treatment so she can recover
041067 - from cancer, as done previously in patient history, ref SDS 53 TY3X,
041068 - and further as planned by the doctor during the meeting on 090515
041069 - 1140. ref SDS 48 655R  Millie also asked the doctor to call on
041070 - expediting treatment in time to be effective, see again on 090520
041071 - 1613, ref SDS 53 TY4W; and Millie asks Doctor Rugo for a "drop dead"
041072 - date on how soon treatment must start in order to be effective, also,
041073 - reported on 090519 1613. ref SDS 53 TX4W
041075 -  ..
041076 - On 090520 1052, since the doctor did not call nor write to respond to
041077 - Millie's letter on 090519 1613, this morning called Kaiser Oncology
041078 - Department and asked for Doctor Johnson to schedule treatment, and was
041079 - told the doctor would be busy in meetings all day and could not call
041080 - to schedule treatment for Millie. ref SDS 55 IW6O
041082 -  ..
041083 - On 090520 1113 Millie received a letter from Doctor Johnson,
041084 - ref SDS 56 UC9G, responding to Millie's letter yesterday requesting
041085 - that Kaiser prescribe treatment for the 8th relapse of cancer.
041086 - ref SDS 53 TY3X  The doctor did not prescribe treatment, and said that
041087 - Kaiser "offers" Millie Gemzar or Navelbine, and further confirmed that
041088 - these treatments are high risk of failure and causing harm for
041089 - Millie's patient profile, and said Member Services and Outside
041090 - Referrals interpret clinical trials for Millie to recover from 8th
041091 - relapse of cancer. ref SDS 56 UC9G
041093 -  ..
041094 - Today, on 090520 1137 Millie responded to Doctor Johnson with copies
041095 - to the medical team, including Paula, who was helpful resolving prior
041096 - communication problems with Kaiser....
041097 -
041098 -    1.  Subject: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041099 -        Date: Wed, 20 May 2009 11:49:14 -0700
041112 -         ..
041113 -    2.  Thanks very much for your letter this morning [received on
041114 -        090520 1135, ref SDS 56 UC9G], noting your prior counsel on
041115 -        risks I face in my 8th relapse of cancer.  You were very clear
041116 -        in the meeting last Friday on 090515 indicating that Navelbine
041117 -        and Gemzar do not meet Kaiser's standard of care [for Millie's
041118 -        patient profile, ref SDS 48 658J, see also below, ref SDS 0
041119 -        SR6U], and that I need timely, effective treatment.  I
041120 -        understood in the meeting on 090515 that you counseled my best
041121 -        course of care is for Kaiser and UCSF to continue collaboration
041122 -        you implemented in your letter to Doctor Rugo on 061230.
041123 -        ref SDS 7 3X6K
041124 -
041125 -            [On 090520 1153 Paula in Kaiser Member Services Case
041126 -            Resolution Center received Millie's letter, and advised
041127 -            that Kaiser requires "evidenced-based" medical practice;
041128 -            and recommends expedited claims to assist primary care
041129 -            doctor prescribing treatment in time to be effective for
041130 -            Millie to recover from the 8th relapse of cancer.
041131 -            ref SDS 57 4M9G
041133 -             ..
041134 -            [On 090520 1703 Doctor Johnson notifies medical team that
041135 -            Gemzar and Navelbine meeting Kaiser's standard of care for
041136 -            treating cancer, but does not say they are suitable for
041137 -            Millie's patient profile. ref SDS 59 HN4I
041139 -             ..
041140 -            [On 090605 Millie received documentation from Kaiser that
041141 -            says Gemzar has high risks for Millie's patient profile;
041142 -            requires extreme caution given after getting treatment with
041143 -            radiation, which Millie received for 4 weeks in February
041144 -            and March, and contiues to suffer side effects; Kaiser
041145 -            further says treatment with Gemzar requires avoiding blood
041146 -            thinners, and Millie is required to take blood thinners
041147 -            every day to prevent death from pulmonary embolism; Gemzar
041148 -            can cause low blood counts that leads to infection and
041149 -            death, Millie has a history of low blood counts.
041150 -            ref SDS 63 V34K
041151 -
041153 -         ..
041154 -    3.  I called your office [yesterday on 090519 1614, ref SDS 54
041155 -        9G57], to discuss your letter [earlier on 090519 1536,
041156 -        ref SDS 52 5K7H, The receptionist said you are seeing another
041157 -        patient, and would call back later. ref SDS 54 HJ3J  She
041158 -        further advised that you asked her to let me know that you
041159 -        received the protocol documentation I hand delivered yesterday
041160 -        on the course of treatment Doctor Rugo at UCSF recommended in
041161 -        her letter to you last week on 090514, and which we discussed
041162 -        the next day in your office on Friday, 090515.
041164 -         ..
041165 -    4.  At that time on Friday, I understood you to say that Navelbine
041166 -        and Gemzar are the only drugs you have left for my diagnosis of
041167 -        breast cancer, but that these treatments conflict with Kaiser's
041168 -        standard of care for my patient profile, because as you note
041169 -        again today, they [single-agent regimens] present significant
041170 -        risks to me. 090520 1113. ref SDS 56 UC9G  You were very
041171 -        concerned on Friday that prescribing these drugs for me at this
041172 -        time would not be good practice [reported on 090515 1140,
041173 -        ref SDS 48 658J].
041175 -             ..
041176 -            [On 090605 Millie received documentation from Kaiser that
041177 -            says Gemzar has high risks for Millie's patient profile;
041178 -            requires extreme caution given after getting treatment with
041179 -            radiation, which Millie received for 4 weeks in February
041180 -            and March, and contiues to suffer side effects; Kaiser
041181 -            further says treatment with Gemzar requires avoiding blood
041182 -            thinners, and Millie is required to take blood thinners
041183 -            every day to prevent death from pulmonary embolism; Gemzar
041184 -            can cause low blood counts that leads to infection and
041185 -            death, Millie has a history of low blood counts.
041186 -            ref SDS 63 V34K
041188 -         ..
041189 -    5.  Naturally, if you feel Navelbine and Gemzar are the best course
041190 -        of care for my patient profile, rather than the care prescribed
041191 -        by Doctor Rugo in her letter to you last week on 090514, then
041192 -        please prescribe treatment you feel is best for me, so we can
041193 -        get started.
041194 -
041195 -            [On 090520 1153 Paula in Kaiser Member Services Case
041196 -            Resolution Center received Millie's letter, and advised
041197 -            that Kaiser requires "evidenced-based" medical practice.
041198 -            ref SDS 57 4M9G
041200 -         ..
041201 -    6.  I am concerned that you prescribed Navelbine and Gemzar (one or
041202 -        the other) in the meeting at Kaiser on 061208, ref SDS 6 XU3O;
041203 -        I was scheduled to start treatment at Kaiser on 070105 [as
041204 -        reported also on 061208 1200. ref SDS 6 PF3O  When I came in
041205 -        for treatment of my 4th relapse of cancer a month later on
041206 -        070105, you changed the prescription to cetuximab and
041207 -        Carboplatin [reported on 070105 1040, ref SDS 8 PK7L] under
041208 -        Doctor Rugo's care at UCSF that implemented Kaiser's standard
041209 -        of care for using clinical trials to expand my treatments for
041210 -        survival [reported on 040318 1615, ref SDS 3 PU6M], and you
041211 -        held in reserve Navelbine and Gemzar treatments for use later.
041212 -        Your prescription was effective.  This past February you drew a
041213 -        graph on 090213 1140, ref SDS 21 4W72, and you drew another
041214 -        graph the following month in March on 090325 0830, showing your
041215 -        prescription has enabled survival well beyond the "disease
041216 -        trajectory" for my cancer. ref SDS 24 P39M
041218 -         ..
041219 -    7.  Now 3 years later, you counsel that Navelbine and Gemzar do not
041220 -        meet Kaiser's standard of care due to risks for my patient
041221 -        profile that resists single agent drugs because my cancer has
041222 -        mutated through 8 relapses [presented during meeting at Kaiser
041223 -        on 090515 1140. ref SDS 48 658J
041224 -
041225 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041226 -            and advised that Doctor Johnson prescribed treatment for
041227 -            Millie with Gemzar to start immediately this week; advised
041228 -            that side effects of Gemzar will be very difficult for to
041229 -            tolerate for Millie's patient profile, and asked to verify
041230 -            that Millie agrees to get this treatment. ref SDS 62 8J8L
041232 -             ..
041233 -            [On 090601 0818 at 1153 Sheree called in the Kaiser
041234 -            Chemotherapy Infusion Clinic and advised that Millie cannot get
041235 -            a blood draw to start Gemzar this week, because Doctor Johnson
041236 -            submitted the chemoterhapy order without a signature, and then
041237 -            went home with a headache, and so the order cannot be signed
041238 -            until the doctor recovers and returns to work, ref SDS 62 I96J,
041239 -            reflecting emotional stress expressed during the meeting at
041240 -            Kaiser on 090515 saying he would get in trouble for prescribing
041241 -            single-agent treatments for Millie's patient profile.
041242 -            ref SDS 48 658J
041244 -             ..
041245 -            [On 090605 Millie received documentation from Kaiser that
041246 -            says Gemzar has high risks for Millie's patient profile;
041247 -            requires extreme caution given after getting treatment with
041248 -            radiation, which Millie received for 4 weeks in February
041249 -            and March, and contiues to suffer side effects; Kaiser
041250 -            further says treatment with Gemzar requires avoiding blood
041251 -            thinners, and Millie is required to take blood thinners
041252 -            every day to prevent death from pulmonary embolism; Gemzar
041253 -            can cause low blood counts that leads to infection and
041254 -            death, Millie has a history of low blood counts.
041255 -            ref SDS 63 V34K
041257 -         ..
041258 -        Trade-offs Treatment Options Medical Analysis Requested
041259 -
041260 -    8.  Please explain trade-offs between prescribing Navelbine and
041261 -        Gemzar, Doctor Rugo's prescription for clinical trials, and
041262 -        getting further treatment with hyperthermia.  As set out in the
041263 -        letter yesterday, I need medical guidance on how quickly I need
041264 -        to get treatment started.  In the meeting on 090213 you gave me
041265 -        less than a year to live.  Right now thanks to Doctor Rugo's
041266 -        prescription, and to your referral, and to Doctor Hsu's
041267 -        excellent work at UCSF, along with timely support in Kaiser's
041268 -        Outside Referral office, I feel very good having just survived
041269 -        the 7th relapse of cancer.  My concern is how to deal with the
041270 -        hideous spread of IBC I see everyday and in time to be
041271 -        effective.
041272 -
041273 -            [On 090520 1153 Paula in Kaiser Member Services Case
041274 -            Resolution Center received Millie's letter, and advised
041275 -            that Kaiser requires "evidenced-based" medical practice;
041276 -            and recommends expedited claims to assist primary care
041277 -            doctor prescribing treatment in time to be effective for
041278 -            Millie to recover from the 8th relapse of cancer.
041279 -            ref SDS 57 4M9G
041281 -             ..
041282 -            [On 090520 1203 Millie asks Kaiser Expedited Claims
041283 -            Department to assist the Oncology Department prescribing
041284 -            treatment appropriate for Millie's patient profile and in
041285 -            time to be effective. ref SDS 58 9595
041287 -             ..
041288 -            [On 090520 1710 Millie asks again for Kaiser to prescribe
041289 -            treatment and explain trade-offs between treatment options
041290 -            for Millie to recover from the 8th relapse of cancer.
041291 -            ref SDS 60 ZF4Y
041293 -             ..
041294 -            [On 090521 2006 Millie received a letter from Doctor
041295 -            Johnson saying Millie can choose which next treatment
041296 -            regimen that Millie wants, and that no treatment would be
041297 -            considered more superior than another, ref SDS 61 UD5H; the
041298 -            doctor says Millie needs urgent treatment and so should
041299 -            notify Kaiser which treatment Millie chooses by the end of
041300 -            the week, which is the next day in roughly 12 hours.
041301 -            ref SDS 61 HC8O; the doctor further tells Millie to call
041302 -            Medicare for prescribing appropriate treatment. ref SDS 61
041303 -            HC93
041305 -         ..
041306 -    9.  Doctor Hsu at UCSF says he [can] give me more radiation and
041307 -        hyperthermia or combinations with other modalities under Doctor
041308 -        Mason's approval for the current referral.  He explained on
041309 -        090330 [actually on 090423] that standard of care calls for
041310 -        systemic treatment for "maintenance" before he fires his last
041311 -        "bullet" with hyperthermia and radiation [reported on 090423
041312 -        0830, ref SDS 32 UG6I].  Doctor Rugo prescribed her best course
041313 -        of care in the letter to you 090514 0830. ref SDS 44 DI63
041315 -         ..
041316 -   10.  Based on this evidence, what does Kaiser prescribe that has the
041317 -        best chance of being effective?
041319 -         ..
041320 -   11.  Thanks again for help and guidance at this critical time.
041322 -             ..
041323 -            [On 090520 1710 Millie asks again for Kaiser to prescribe
041324 -            treatment and explain trade-offs between treatment options
041325 -            for Millie to recover from the 8th relapse of cancer.
041326 -            ref SDS 60 ZF4Y
041328 -             ..
041329 -            [On 090521 2006 Millie received a letter from Doctor
041330 -            Johnson saying Millie can choose which next treatment
041331 -            regimen that Millie wants, and that no treatment would be
041332 -            considered more superior than another, ref SDS 61 UD5H; the
041333 -            doctor says Millie needs urgent treatment and so should
041334 -            notify Kaiser which treatment Millie chooses by the end of
041335 -            the week, which is the next day in roughly 12 hours.
041336 -            ref SDS 61 HC8O; the doctor further tells Millie to call
041337 -            Medicare for prescribing appropriate treatment. ref SDS 61
041338 -            HC93
041339 -
041346 -
041347 -
041348 -
041349 -
041350 -
041351 -
041352 -
041353 -
041354 -
041355 -
041356 -
0414 -