CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 17 0000. ref SDS 14 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Yesterday afternoon, Millie received a letter from Doctor Johnson
040902 - advising that instead of filing a referral for Millie's treatment to
040903 - recover from the 8th relapse of cancer, and further instead of filing
040904 - an apeal with Member Services of Doctor Mason's verbal refusal to
040905 - authorize the doctor's referral for Millie's treatment, Doctor Johnson
040906 - sent all correspondence on this matter to Doctor Mason, including the
040907 - draft appeal, which Doctor Johnson had requested from the patient for
040908 - him to file with Member Services, reported on 090519 1536, ref SDS 11
040909 - 5K7H
040911 -  ..
040912 - The doctor cited ignorance of government regulations for failure to
040913 - prescribe urgently needed treatment for Millie to recover from 8th
040914 - relapse of cancer, reported on 090519 1536, ref SDS 11 VK9H
040916 -  ..
040917 - Yesterday afternoon, Millie sent a response to Doctor Johnson's
040918 - letter, and asking Kaiser to prescribe treatment for her 8th relapse
040919 - of cancer as called out by Kaiser's standard of care for oncology.
040920 - 090519 1613. ref SDS 12 TY3X   Millie asked the doctor to call about
040921 - scheduling treatment. ref SDS 12 TY4W
040923 -  ..
040924 - On 090520 1053, since the doctor has not called, this morning, called
040925 - and left a message for Doctor Johnson to discuss when Millie needs to
040926 - start treatment in order for care to be effective recovering from the
040927 - 8th relapse of cancer. ref SDS 14 IW6O  Need to know how much time can
040928 - be invested to assist Kaiser with regulatory issues, as noted in the
040929 - letter yesterday, reported on, 090519 1613, ref SDS 12 TX4W
040931 -  ..
040932 - On 090520 1113 Millie received a letter from Doctor Johnson which
040933 - failed to prescribe treatment, and saying Kaiser "offers" Millie
040934 - Gemzar or Navelbine, and further confirmed these treatments are high
040935 - risk of failure and causing harm for Millie's patient profile, and
040936 - said Member Services and Outside Referrals interpret clinical trials
040937 - for Millie to recover from 8th relapse of cancer. ref SDS 15 UC9G
040939 -  ..
040940 - Today, on 090520 1137 Millie responded to Doctor Johnson with copies
040941 - to the medical team, including Paula, who was helpful resolving prior
040942 - communication problems with Kaiser, and Millie explained urgency for
040943 - Kaiser to prescribe treatment appropriate to Millie's patient profile,
040944 - and in time to be effective, ref SDS 16 5K9M, and noted requests for
040945 - Doctor Johnson to call and expedite care, and several unreturned calls
040946 - to the doctor. ref SDS 16 SR6R   Millie further requested medical
040947 - advice on trade-offs between treatment options, and on how soon
040948 - treatment must be started in order to have a chance of being
040949 - effective. ref SDS 16 SS3W
040951 -  ..
040952 - On 090520 1153 called Paula in Member Services Case Resolution; she
040953 - had read the letter to the medical team on 090520 1137, and advised
040954 - Kaiser requires evidence-based medical practice.  Paula recommended
040955 - Millie request assistance from Expedited Claims for timely
040956 - prescription of treatment appropriate for Millie's patient profile.
040957 - ref SDS 17 4M9G
040958 -
040959 -
040961 -  ..
0410 -
0411 -
0412 - Discussion
0413 -
041301 - Kaiser Policy Requires Evidences-based Medical Practice
041302 -
041303 - Follow up ref SDS 17 4M9G.
041304 -
041305 - Called Kaiser Expedited Claims...
041306 -
041307 -                         888 987 7247
041308 -
041309 - ...implementing Paula's guidance in the call earlier today on 090520
041310 - 1153. ref SDS 17 4M44
041312 -  ..
041313 - Talked to Linda.
041315 -  ..
041316 - Explained difficulties getting Kaiser to prescribe care, per above
041317 - case study. ref SDS 0 UD5H
041319 -  ..
041320 - Linda will have someone call to follow up.
041321 -
041323 -  ..
0414 -
0415 -
0416 - 1504
0417 -
041701 - There was a message when we returned this afternoon, from Pamela in
041702 - Kaiser Expedited Claims.
041703 -
041705 -  ..
0418 -
0419 -
0420 - 1555
0421 -
042101 - Asked for Pamela Powel.
042102 -
042103 - Got Pamela's voice mail.
042105 -  ..
042106 - Left a message with Millie's medical record number.  Asked for an
042107 - email address to submit correspondence to present complex issues of
042108 - stage IV cancer patient requiring treatment for 8th relapse.  Millie
042109 - requested treatment numerous times.  The doctor has urged immediate
042110 - treatment, but has not prescribed care.  Millie wants Kaiser to
042111 - prescribe treatment appropriate for her patient profile, as called out
042112 - in EOC section 2 of the contract.
042113 -
042114 -     [...below Pamela called back, and Millie's claim was presented
042115 -     again. ref SDS 0 9595
042117 -      ..
042118 -     [...below in this record on 090520 1203 Pamela discussed Millie's
042119 -     case with a doctor, who told Pamela to call and ask what the
042120 -     patient wants, because there is disbelief that the doctor would
042121 -     not prescribe treatment, since that is the doctor's core
042122 -     responsibility. ref SDS 0 WH9K
042124 -      ..
042125 -     [On 090521 2006 Millie received a letter from Doctor Johnson that
042126 -     confirms Kaiser refuses to prescribe treatment, saying instead
042127 -     that Millie can "choose" the next treatment, because no treatment
042128 -     is superior to another for Millie's patient profile, ref SDS 20
042129 -     UD5H; the doctor says Millie needs urgent treatment and so should
042130 -     notify Kaiser which treatment Millie chooses by the end of the
042131 -     week, which is the next day in roughly 12 hours. ref SDS 20 HC8O;
042132 -     the doctor further tells Millie to call Medicare for prescribing
042133 -     appropriate treatment. ref SDS 20 HC93
042134 -
042135 -
042137 -  ..
0422 -
0423 -
0424 - 1619
0425 -
042501 - Pamela called back.
042502 -
042503 - Pamela asked what Millie wants.
042505 -  ..
042506 - Cited the message left for Pamela on her voice mail, earlier today,
042507 - per above. ref SDS 0 IU4E  Asked for an email address to submit
042508 - correspondence sent earlier this morning to Paula in Member Services
042509 - Case Resolution, reported on 090520 1137, ref SDS 16 SR6U  Paula said
042510 - that Millie's correspondence sent to the medical team should be
042511 - reviewed by Expedited Claims in order to accurately understand complex
042512 - patient history on medical issues essential to help Kaiser prescribe
042513 - urgent treatment in time for Millie to recover from the 8th relapse of
042514 - cancer.
042516 -  ..
042517 - Pamela said that Paula made a mistake.
042518 -
042519 -              [On 091112 1229 telecon with Paula read internal report
042520 -              prepared by Expedited Claims on this call, and sounded
042521 -              conflicting, largely misrepresentation. ref SDS 30 A57J
042523 -  ..
042524 - Pamela advised that Customer Service representatives in Kaiser's
042525 - Expedited Claims Department are taught not to rely on written
042526 - submission of complex issues from customers for accurate understanding
042527 - to resolve difficult problems in time to be effective.  Pamela
042528 - explained that conversation makes case management fast and easy,
042529 - because there is more flexibility.  She said aligning determinations
042530 - with the record of patient history takes a lot of time.
042532 -  ..
042533 - Pamela refused to submit written confirmation of understandings in the
042534 - call for transparency of this transaction.  Pamela insisted on working
042535 - by conversation.
042537 -  ..
042538 - Pamela asked again what Millie wants...
042540 -  ..
042541 - Asked if Pamela listened to the message on her voice mail system, per
042542 - above, which explains what Millie wants? ref SDS 0 PQ8P
042544 -  ..
042545 - Pamela related having listened to the voice mail on Millie's request
042546 - for support from Expedited Claims Department, but she feels the
042547 - message is unclear, and so she asked again... "What does Millie want?"
042549 -  ..
042550 - Millie initially wants good faith review of complex problems based on
042551 - evidence in the written record that provides transparency and accuracy
042552 - in order to prevent small problems from compounding into conflict and
042553 - calamity.  Transparency and accuracy require Kaiser's Expedited Claims
042554 - Department to perform Kaiser's Healthwise Handbook procedures for
042555 - "ping pong" feedback loops, reviewed on 990625 0945. ref SDS 1 3960
042557 -  ..
042558 - Pamela said she will carefully write down in her record what is said
042559 - during this call, but she will not submit a letter for feedback to
042560 - verify accuracy of what she writes down.  She feels procedures in
042561 - Kaiser's Healthwise Handbook for "ping pong" feedback loops are
042562 - unnecessary overkill to verify accuracy of conversation for saving
042563 - lives, time, and money.
042564 -
042565 -              [On 091112 1229 telecon with Paula read internal report
042566 -              prepared by Expedited Claims on this call, and sounded
042567 -              conflicting, largely misrepresentation. ref SDS 30 A57J
042569 -  ..
042570 - After objecting to Kaiser failing to implement policy for feedback to
042571 - provide transparency and verify accuracy, presented verbally to Pamela
042572 - the following claim for Millie...
042574 -  ..
042575 - Millie wants Kaiser to implement EOC section 2, reviewed on 070927,
042576 - ref SDS 2 WS6M, that says Millie's doctor must prescribe or authorize
042577 - needed care for covered oncology services, as presented in the message
042578 - on Pamela's voice mail earlier today, per above. ref SDS 0 IU4E  This
042579 - requires...
042581 -               ..
042582 -              [On 090520 1710 Millie letter notifies medical team that
042583 -              Kaiser Expeidted Claims Department working with Doctor
042584 -              Johnson to provide health care for Millie required by
042585 -              insurance agreement. ref SDS 18 ZF4T
042586 -
042587 -        1.  Written workup and treatment plan for the 8th relapse of
042588 -            cancer that applies Kaiser's Standard of Care for Millie's
042589 -            patient profile, discussed with Doctor Johnson on 090213.
042590 -            ref SDS 6 ES7I, and with medical opinion comparing
042591 -            trade-offs between Navelbine and Gemzar, Doctor Rugo's
042592 -            clinical trial, and hyperthermia and associated modalities,
042593 -            and further compared to other treatments discussed with the
042594 -            primary care physician on 090515 1140, ref SDS 10 P36O, and
042595 -            which were submitted to the medical team in Millie's letter
042596 -            on 090326, ref SDS 7 DW5S, citing the list on 090121,
042597 -            ref SDS 4 EV53, and the list on 090204 1747, ref SDS 5
042598 -            4R3S, and further as requested in Millie's letter to the
042599 -            medical team this morning on 090520 1137, ref SDS 16 SS3W
042600 -
042601 -               [On 090521 0902 Pamela called back and advised that
042602 -               Millie's doctor has responsibility to prescribe her
042603 -               treatment. ref SDS 19 RW82
042605 -                ..
042606 -               [On 090521 2006 Millie received a letter from Doctor
042607 -               Johnson that confirms Kaiser refuses to prescribe
042608 -               treatment, saying instead that Millie can "choose" the
042609 -               next treatment, because no treatment is superior to
042610 -               another for Millie's patient profile, ref SDS 20 UD5H;
042611 -               the doctor says Millie needs urgent treatment and so
042612 -               should notify Kaiser which treatment Millie chooses by
042613 -               the end of the week, which is the next day in roughly 12
042614 -               hours. ref SDS 20 HC8O; the doctor further tells Millie
042615 -               to call Medicare for prescribing appropriate treatment.
042616 -               ref SDS 20 HC93
042618 -                ..
042619 -               [On 090609 0900 Doctor Hsu examination at UCSF finds
042620 -               that skin blistering in Millie's breastbone area is not
042621 -               radiation side effects; but rather worsening IBC disease
042622 -               which has been untreated since 090122 due to medical
042623 -               mistakes providing radiation traetments at UCSF on
042624 -               referral from Kaiser; cancer untreated since January has
042625 -               spread, and causing growing breathing problems.
042626 -               ref SDS 22 W65W
042628 -                ..
042629 -               [On 090610 0122 notified Paula in Kaisr Claims
042630 -               Resolution Department that UCSF medical mistakes require
042631 -               UCSF to provide treatment for Millie to recover.
042632 -               ref SDS 23 855G
042634 -                ..
042635 -               [On 090610 0930 Paula advised that UCSF is liable to Kaiser
042636 -               for fixing medical mistakes performing radiation services
042637 -               for Millie on referral from Kaiser. ref SDS 24 855G
042639 -                ..
042640 -               [On 090610 1032 letter to Doctor Mason in Kaiser Outside
042641 -               Referrals demands Kaiser direct UCSF to provide care for
042642 -               Millie to recover from medical mistakes UCSF made
042643 -               providing radiation treatments on referral from Kaiser
042644 -               during Feb-Mar 2009. ref SDS 25 1Q7J
042646 -                ..
042647 -               [On 090616 1240 during meeting at UCSF Doctor Rugo
042648 -               notified Millie that UCSF and Kaiser have agreed in a
042649 -               letter that everybody is on board to treat Millie's
042650 -               cancer as a chronic disease for recovering from medical
042651 -               mistakes treating Millie with radiation at UCSF, and
042652 -               that Millie's next treatment after MPA will be with
042653 -               PARP. ref SDS 26 KD6L
042655 -                ..
042656 -               [On 090725 2017 Millie's letter to medical team cites
042657 -               research showing published guidance for standard of care
042658 -               requires doctors compare trade-offs for treatments on
042659 -               effectiveness, side effects (suffering), and cost.
042660 -               ref SDS 27 T58U
042662 -                ..
042663 -               [On 090727 2012 Millie notified Kaiser Claims Resolution
042664 -               Department to process her claim, becasue Kaiser has
042665 -               failed to perform on agreement to provide treamtent for
042666 -               Millie to recover from UCSF medical mistakes that caused
042667 -               injury providing radiation treatment on referral from
042668 -               Kaiser. ref SDS 28 3S4I
042670 -                ..
042671 -               [On 090730 1129 Paula in Kaiser Claims Resolution
042672 -               Department corridinating to get relief at Kaiser for
042673 -               Millie's injuries caused by UCSF medical mistakes
042674 -               providing radiation treatment on referral from Kaiser.
042675 -               ref SDS 29 BD5I
042677 -             ..
042678 -        2.  Medical opinion on how soon Millie must start treatment in
042679 -            time to be effective for maintaining local control, since
042680 -            cancer has not been treated by Kaiser following notice of
042681 -            progression on 090331 2047, ref SDS 8 Q69V, and Kaiser has
042682 -            not prescribed treatment, despite notice of advancing
042683 -            disease and request for treatment on 090412 2241.
042684 -            ref SDS 1 6 9S8Y
042686 -             ..
042687 -        3.  Prescription or authorization for standard of care treating
042688 -            Millie's patient profile discussed with Doctor Johnson at
042689 -            Kaiser on 090213 1140, ref SDS 6 ES7I, and as specified
042690 -            under EOC section 2, reviewed on 070927, ref SDS 2 WS6M,
042691 -            and based on best evidence, as related by Paula in Member
042692 -            Services Resolution Office on 090520 1153, ref SDS 17 HX3O,
042693 -            and which shows according to Doctor Johnson that Kaiser has
042694 -            only single-agent treatments, which are not suitable for
042695 -            Millie's care, reported last week on
042697 -  ..
042698 - Pamela maintained that the doctor has prescribed treatment, because
042699 - Kaiser's medical chart for Millie that reports the meeting on 090515
042700 - says under "Plan," to consider Navelbine, Gemzar and Doctor Rugo's
042701 - treatment at UCSF, reported on 090515 1140. ref SDS 10 QQ7F
042702 -
042703 -              [On 090531 1544 Millie notified the medical team that she
042704 -              demands standard of care for treatment of her patient
042705 -              profile. ref SDS 21 IH6S
042707 -               ..
042708 -              [On 091112 1229 telecon with Paula read internal report
042709 -              prepared by Expedited Claims on this call, and sounded
042710 -              conflicting, largely misrepresentation. ref SDS 30 A57J
042712 -  ..
042713 - We reviewed requirements in EOC section 2 for the doctor to prescribe
042714 - and authorize treatment for oncology services, reviewed on 070927.
042715 - ref SDS 2 WS6M, and which Millie needs to recover from an 8th relapse
042716 - of cancer.
042718 -  ..
042719 - "Consider" in Kaiser in the Medical Chart does not satisify the
042720 - doctor's responsibility to prescribe and/or authorize referral for
042721 - needed treatment.  Millie needs a prescription following best evidence
042722 - standard of care for her patient profile, cited by Paula in the call
042723 - earlier today on 090520 1153. ref SDS 17 HX3O
042725 -  ..
042726 - Asked Pamela why she has time to review the doctor's medical chart,
042727 - but does not have time to read patient documents that correct errors
042728 - and omissions in the Medical Chart?
042730 -  ..
042731 - Pamela explained that doctor's get the same training as Kaiser's
042732 - claims representatives in writing a good story.  She reliance on the
042733 - doctor's story is good enough, because getting both sides of the story
042734 - takes too much time.
042736 -  ..
042737 - Pamela said she has already discussed Millie's case with a doctor in
042738 - the Expedited Claims Department, based on the message in Pamela's
042739 - voice mail earlier this afternoon, per above. ref SDS 0 IU4E  The
042740 - doctor told Pamela to call and ask what Millie wants, because it is
042741 - hard for people in the Expedited Claims Department to believe that a
042742 - doctor has not prescribed treatment for a stage IV cancer patient who
042743 - desperately needs treatment to recover from an 8th relapse of cancer,
042744 - since prescribing treatment is the doctor's main responsibility.
042746 -  ..
042747 - Pamela will present her further understanding of Millie's request for
042748 - evidenced-based treatment appropriate to her patient profile from this
042749 - telecon, per above, ref SDS 0 9595, to the doctor for a determination
042750 - of 3-issues which Millie presents on Kaiesr prescribing treatment for
042751 - Millie to recover from the 8th relapse of cancer, per above.
042752 - ref SDS 0 9595
042753 -
042754 -              [On 090521 0902 Pamela called back and said Expedited
042755 -              Claims cannot rule on Millie's request for support,
042756 -              because Millie's complex case falls through the cracks;
042757 -              Expedited claims cannot deny Millie's request for the
042758 -              doctor to prescribe treatment, but do not want to issue
042759 -              an order for a Kaiser doctor to prescribe care for a
042760 -              patient, and so Expedited Claims called Doctor Johnson to
042761 -              encourage resolution, and also submitted the case to
042762 -              Member Services in Pleasenton. ref SDS 19 UD5H
042764 -               ..
042765 -              [On 091112 1229 telecon with Paula read internal report
042766 -              prepared by Expedited Claims on this call, and sounded
042767 -              conflicting, largely misrepresentation. ref SDS 30 A57J
042768 -
042769 -
042770 -
042771 -
042772 -
042773 -
042774 -
042775 -
0428 -