CONTACTS 
0206 - CMS Region 9                                                                                                                                                       O-00000877 0605
020601 - Ms. Jullin Kwok; Kaiser Contract Manager                                                                                                                         O-00000877 0605
020603 - Kaiser Medicare Contract                                                                                                                                         O-00000877 0605

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 37 0000. ref SDS 36 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090519 1613 Millie responded, ref SDS 29 8V8H, to the Doctor's
040902 - letter earlier yesterday afternoon on 090519 1536, ref SDS 28 5K7H;
040903 - and, Millie asks the doctor to prescribe treatment so she can recover
040904 - from cancer, as done previously in patient history, ref SDS 29 TY3X,
040905 - and further as planned by the doctor during the meeting on 090515
040906 - 1140. ref SDS 27 655R  Millie also asked the doctor to call on
040907 - expediting treatment in time to be effective, see again on 090520
040908 - 1613, ref SDS 29 TY4W; and Millie asks Doctor Rugo for a "drop dead"
040909 - date on how soon treatment must start in order to be effective, also,
040910 - reported on 090519 1613. ref SDS 29 TX4W
040912 -  ..
040913 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
040914 - ref SDS 34 ZF4Q, then on 090521 0211 Millie's letter to Doctor Rugo at
040915 - UCSF with copy to Doctor Hsu asks about getting treatment with
040916 - hyperthermia and Doxil, while Kaiser resolves delays ordering MPA
040917 - prescribed by Doctor Rugo for Millie to recover from 8th relapse of
040918 - cancer, which Millie reports is getting worse every day, ref SDS 35
040919 - FM7Q, and since Kaiser has previosuly authorized treatment with
040920 - hyperthermia and Doxil, which Doctor Rugo recommended earlier on
040921 - 090129 for Millie to recover from the 7th relapse. ref SDS 35 6M4F
040923 -  ..
040924 - On 090521 2006, Millie received a letter from Doctor Johnson responding
040925 - to Millie's letter to the medical team on 090520 1710, and requesting
040926 - that Kaiser prescribe treatment suitable for Millie's patient profile
040927 - for recovering from 8th relapse of cancer. ref SDS 34 P65H   Doctor
040928 - Johnson's letter was sent through Kaiser's Knowledge Management System
040929 - and so was not disclosed to the medical team, and it did transmit the
040930 - Doctor Johnson's medical chart for the meeting on 090515, ref SDS 27
040931 - YT5N, and said that Millie could "choose" any treatment she wants, and
040932 - no treatment is superior for Millie's patient profile, 090521 2006,
040933 - ref SDS 37 9Q9H; the doctor noted Millie's cancer is progressing and
040934 - so she needs to start treatment by the end of the week, which was in
040935 - just 12 hours, which means today, ref SDS 37 HC8O, and the doctor told
040936 - Millie to call Medicare for prescribing treatment to recover from the
040937 - 8th relapse of cancer. ref SDS 37 HC93
040939 -  ..
040940 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
040941 - 2006, 090521 2006, ref SDS 37 9Q9H, and submitted copies to the
040942 - medical team to maintain collaboration that has been effective
040943 - treating Millie the past 8 years.  Millie also sent a copy to Jullian
040944 - Kwok to notify Medicare that Kaiser is refusing treatment...
040945 -
040946 -    1.  Subject: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
040947 -        Date: Fri, 22 May 2009 09:02:03 -0700
040960 -         ..
040961 -    2.  Yesterday evening about 8pm I received your letter dated 090521
040962 -        [reported on 090521 2006. ref SDS 37 9Q9H], along with the
040963 -        medical chart for the meeting in your office at Kaiser last
040964 -        week on 090515, as entered in patient history. 090515 1140,
040965 -        ref SDS 27 YT5N
040967 -         ..
040968 -    3.  You were hurried on Friday, so there wasn't time to make the
040969 -        normal distribution of the medical chart.
040971 -         ..
040972 -    4.  Pamela Powell with Expedited Claims (EC) called yesterday
040973 -        morning [reported on 090521 0902. ref SDS 36 UD5H].  She
040974 -        planned to call you to facilitate prescribing my next treatment
040975 -        [reported, 090521 0902, ref SDS 36 RW7M]  Pamela advised that
040976 -        EC was not denying my inquiry, but instead submitted the matter
040977 -        to Member Services in Pleasenton, because my case does not fit
040978 -        the EC venue.  Recall your letter in February on 090205 worried
040979 -        that I am slipping through the cracks at Kaiser [reported on
040980 -        090205 1318. ref SDS 15 278T].
040981 -
040982 -            [On 090522 1247 Doctor Johnson reports to the medical team
040983 -            that all workups have been done; he does not submit the
040984 -            workup; Doctor Johnson refuses support of Tumor Board
040985 -            because he says Millie's complex treatment history
040986 -            ref SDS 38 XO5O
040988 -         ..
040989 -    5.  I requested in the letter to the team on 090520 [1710.
040990 -        ref SDS 34 ZF4T] and in discussions with Pamela in EC [reported
040991 -        on 090520 1203. ref SDS 33 9595]...
040993 -             ..
040994 -        1.  Written workup and treatment plan for the 8th relapse of
040995 -            cancer that follows Kaiser's Standard of Care for my
040996 -            patient profile, discussed with you on 090213. 090213 1140,
040997 -            ref SDS 16 ES7I
040999 -             ..
041000 -        2.  Medical opinion on how soon I must start treatment in order
041001 -            to maintain local control.
041003 -             ..
041004 -        3.  Medical opinion on trade-offs between treatment choices,
041005 -            which I listed as Navelbine and Gemzar, Doctor Rugo's
041006 -            clinical trial, and hyperthermia and associated modalities.
041007 -
041008 -               [On 090522 1247 Doctor Johnson reports to the medical
041009 -               team that all workups have been done; he does not submit
041010 -               the workup; Doctor Johnson refuses support of Tumor
041011 -               Board because he says Millie's complex treatment
041012 -               history; the doctor does not explain trade-offs between
041013 -               treatments being considered for Millie to recover from
041014 -               8th relapse of cancer. ref SDS 38 XO5O
041016 -                ..
041017 -               [On 090522 1351 Millie asks again for Kaiser to explain
041018 -               CPT-11 and trade-offs with other treatments for Millie's
041019 -               patient profile to recover from 8th relapse of cancer.
041020 -               ref SDS 39 2T9W
041022 -         ..
041023 -    6.  First, the medical chart goes a long way toward providing a
041024 -        thorough "workup."  Our meeting on 041130 shows Kaiser
041025 -        publishes a document....
041027 -         ..
041028 -        Breast Cancer Treatment Guidelines for Patients
041029 -
041030 -        ...and it specifies detailed requirements for patient work-up
041031 -        [reported on 041130 1000. ref SDS 4 UB4H  Have these
041032 -        requirements been met in my case?
041034 -         ..
041035 -    7.  Would Tumor Board review be helpful to assess treatment
041036 -        options?  You have submitted my case many times, but not since
041037 -        April 2004.  At that time, there was a mix up.  The Tumor Board
041038 -        that met on 040416, did not have a chance to consider my IBC
041039 -        situation, because the biopsy was a few days later on 040419,
041040 -        so nobody knew for a long time.  We talked about going back to
041041 -        the Tumor Board for input on this major change, but somehow
041042 -        that didn't happen. Has the current crisis been submitted to
041043 -        the Tumor Board?
041045 -         ..
041046 -    8.  My feeling is that the medical chart for our meeting on 090515
041047 -        has a lot of data and assessment that indicates, despite my
041048 -        age, I am a healthy candidate for full treatment [reported on
041049 -        090515 1140. ref SDS 27 YF9L].  You have explained a key fact
041050 -        that there is no evidence of distant metastasis in internal
041051 -        organs, and so age should not bar my getting equal treatment.
041052 -
041053 -            [On 090522 1247 Doctor Johnson reports to the medical team
041054 -            that all workups have been done; he does not submit the
041055 -            workup; Doctor Johnson refuses support of Tumor Board
041056 -            because he says Millie's complex treatment history
041057 -            ref SDS 38 WP7L
041058 -
041060 -  ..
041061 - Kaiser Delays Treatment Giving Patient 1 Day Notice
041062 -
041063 -
041064 -    9.  Your letter yesterday says to let you know by the "end of the
041065 -        week" on starting treatment.  This is a big fact.
041067 -         ..
041068 -   10.  The "end of the week" is today.  This leaves no time for
041069 -        deliberation, consultation, research - it's another emergency.
041070 -        It is hard for me to choose from unspecified treatments in less
041071 -        than 24 hours without discussion with you and Doctor Rugo.
041072 -
041073 -           [On 090522 1247 Doctor Johnson reports to the medical
041074 -           team that all workups have been done; he does not submit
041075 -           the workup; Doctor Johnson refuses support of Tumor
041076 -           Board because he says Millie's complex treatment
041077 -           history; the doctor does not explain trade-offs between
041078 -           treatments being considered for Millie to recover from
041079 -           8th relapse of cancer. ref SDS 38 XO5O
041080 -
041081 -
041083 -  ..
041084 - Communication with Doctor Denied Phone Calls Never Returned
041085 -
041086 -
041087 -   11.  I have called your office and left messages sometimes
041088 -        twice-a-day about 5 times this past week, and you have
041089 -        understandably been busy.  I know your schedule is hectic.  You
041090 -        have however called in the past during off-hours, so that would
041091 -        be fine for me, including the weekend.  I am visiting family on
041092 -        Saturday so my cell phone is ************ and land is *******
041093 -        ****).
041094 -
041096 -  ..
041097 - Choosing Treatment Denied in 2004 But Required to Choose in 2009
041098 - Patient Choosing Treatment Conflicts with Kaiser Medical Pracitce
041099 - Kaiser Demands Patient Choose Treatment But Offers No Treatment Choices
041100 -
041101 -
041102 -   12.  I have never in 8 years of care been given a choice of
041103 -        treatments.  In every case, you have prescribed my care.  I
041104 -        have signed consents to participate in clinical trials which
041105 -        you prescribed at Kaiser and at UCSF, but I was not presented a
041106 -        choice of trials, nor of treatments.  You have at all times
041107 -        prescribed my care.  I asked once about being treated with
041108 -        Taxotere, which had been effective on a prior relapse.  You
041109 -        explained trade-offs and that doctor discretion for medical
041110 -        necessity required delaying my treatment for 2 months so that
041111 -        you could prescribe a clinical trial.  Oddly today, we seem
041112 -        somehow to have reversed field.
041114 -         ..
041115 -   13.  Treatment which you ask me to choose is unclear in your letter,
041116 -        since it lists no treatments.
041117 -
041119 -  ..
041120 - Kaiser UCSF Not Enough Time Review Treatments for Patient Profile
041121 - Treatment Targeted to Millie's Patient Profile Not Yet Reviewed
041122 -
041123 -
041124 -   14.  In the meeting on 090325, you asked for a list of treatments
041125 -        considered for my patient profile [reported on 090325 0830.
041126 -        ref SDS 18 GO4O]  This was submitted the next day [reported on
041127 -        090326 0058. ref SDS 19 DW5S, and in a follow up letter, Millie
041128 -        asked if the doctor had reviewed the list? ref SDS 20 QM3V  You
041129 -        responded that you would discuss the list during the next
041130 -        meeting [also reported on 090326 1733. ref SDS 21 T64N]  Since
041131 -        your schedule was backed up on 090515, our meeting was delayed
041132 -        90 minutes.  After doing the examination, and explaining Doctor
041133 -        Mason's concerns about clinical trials, there was no time to
041134 -        discuss treatments, because you were late for another meeting.
041135 -        So I have no way to make a choice, and must question sweeping
041136 -        comments that all treatments are equal.
041137 -
041138 -
041140 -  ..
041141 - Single-agent Gemzar Navelbine Treatments Conflict Patient Profile
041142 - Gemzar Navelbine Single-agent Treatments Conflict Patient Profile
041143 -
041144 -
041145 -   15.  I accept that Navelbine and Gemzar are generally of equal
041146 -        consideration.  You explained that carefully in the meeting at
041147 -        Kaiser on 061208 1200. ref SDS 9 RW5I
041149 -         ..
041150 -   16.  What is not clear in your letter is whether the choice is
041151 -        between single agents or couplets [in light of continual
041152 -        warnings by Doctor Johnson that Millie cannot be treated
041153 -        effectively with single-agent drugs shown by case study on
041154 -        090325 0830. ref SDS 18 LE67].  For example, Doctor Benz
041155 -        recommended in his 2nd opinion for UCSF on 041117 I might
041156 -        respond well to Gemzar and Doxil. 041117 1015, ref SDS 3 OU5V
041158 -         ..
041159 -   17.  He later seemed to withdraw this in a subsequent opinion
041160 -        received from you on 060929, indicating Navelbine and Gemzar
041161 -        should be given for me as single agents. 060929 1643,
041162 -        ref SDS 7 WR3Y
041163 -
041165 -  ..
041166 - CPT 11 New Treatment Option for Millie Not Previously Proposed
041167 -
041168 -
041169 -   18.  The medical chart lists CPT 11 as a possible treatment [shown
041170 -        on 090515 1140. ref SDS 27 QQ7F
041172 -         ..
041173 -   19.  I have never heard of it.  How can I possibly choose?
041174 -
041175 -            [On 090522 1247 Doctor Johnson tells Millie to choose a
041176 -            treatment, and does not explain CPT 11, nor present
041177 -            trade-offs to choose the best course of treatment for
041178 -            Millie to recover from 8th relapse of cancer. ref SDS 38
041179 -            XO5O
041181 -             ..
041182 -            [On 090522 1351 Millie asks again for Kaiser to explain
041183 -            CPT-11 and trade-offs with other treatments for Millie's
041184 -            patient profile to recover from 8th relapse of cancer.
041185 -            ref SDS 39 2T9W
041187 -             ..
041188 -            [On 090522 1953 Doctor Johnson notifies Millie that CPT 11
041189 -            is prescribed for patients with colon cancer; does not
041190 -            confirm nor clarify if entry in Millie's medical chart is a
041191 -            mistake, or that CPT 11 is a viable choice for her current
041192 -            care to recover from the 8th relapse of cancer, and does
041193 -            not present trade-offs with other treatments, which Millie
041194 -            requested to facilitate choce of care. ref SDS 40 YT5M
041195 -
041196 -
041198 -  ..
041199 - CPT 11 Same as Bevacizumab Kaiser Collaboration with UCSF
041200 - Bevacizumab Safe Millie's Patient Profile PE Collaborate withy UCSF
041201 - Collaboration between Kaiser and UCSF on CPT 11 Same as Bevacizumab
041202 -
041203 -
041204 -   20.  Research on the Internet seems to correlate CPT 11 with
041205 -        Avastin, which I think is bevacizumab.  You prescribed this in
041206 -        2004 as a clinical trial [reported on 040318 1615. ref SDS 1
041207 -        PU6M].  I received 7 or 8 treatments until I was diagnosed with
041208 -        PE [reported on 041104 1030. ref SDS 2 N438].  Doctor Rugo
041209 -        recently discussed prescribing bevacizumab, despite my PE.  She
041210 -        seemed to cite thorough research following the big scare in
041211 -        2004 did not find a strong causal link between PE and
041212 -        bevacizumab; and, further, that she could design treatment
041213 -        prudently to treat my cancer, while avoiding or minimizing PE
041214 -        risks [reported on 070130 1300, ref SDS 10 LD6Y, and cited in
041215 -        case study on Doctor Rugo's consideration of Millie's treatment
041216 -        options, reported on 090121 1017. ref SDS 13 EV53].  Is this
041217 -        your plan?  Have you collaborated with Doctor Rugo on this?  I
041218 -        relapsed with PE on 061002. 061002 1341, ref SDS 8 MI5I
041220 -         ..
041221 -   21.  Research on 060722 found a study that says 45% of recurrent PE
041222 -        results in death, 060722 0810, ref SDS 6 BI5J, and my patient
041223 -        history shows I am high risk for PE. ref SDS 6 6G6O
041225 -         ..
041226 -   22.  On the other hand, since you gave me less than a year to live
041227 -        in February [reported on 090213 1140. ref SDS 16 9L7N], if we
041228 -        can get 3 -4 months from bevacizumab, the numbers would be
041229 -        about even.
041231 -         ..
041232 -   23.  If CPT 11 is not bevacizumab, can you please explain the
041233 -        treatment?  Is it a drip treatment, oral, how often; what about
041234 -        side effects?  What is the track record?  What are your
041235 -        expectations for my situation?
041236 -
041237 -            [On 090522 1247 Doctor Johnson tells Millie to choose a
041238 -            treatment, and does not explain CPT 11, nor present
041239 -            trade-offs to choose the best course of treatment for
041240 -            Millie to recover from 8th relapse of cancer. ref SDS 38
041241 -            XO5O
041243 -             ..
041244 -            [On 090522 1351 Millie asks again for Kaiser to explain
041245 -            CPT-11 and trade-offs with other treatments for Millie's
041246 -            patient profile to recover from 8th relapse of cancer.
041247 -            ref SDS 39 2T9W
041249 -             ..
041250 -            [On 090522 1953 Doctor Johnson notifies Millie that CPT 11
041251 -            is prescribed for patients with colon cancer; does not
041252 -            confirm nor clarify if entry in Millie's medical chart is a
041253 -            mistake, or that CPT 11 is a viable choice for her current
041254 -            care to recover from the 8th relapse of cancer, and does
041255 -            not present trade-offs with other treatments, which Millie
041256 -            requested to facilitate choce of care. ref SDS 40 YT5M
041257 -
041258 -
041260 -  ..
041261 - Radiation Hyperthermia Effective Millie's Treatment Choice
041262 -
041263 -
041264 -   24.  Absent professional guidance, I would choose to get more
041265 -        radiation and hyperthermia from Doctor Hsu's team [combined
041266 -        with Doxil originally prescribed by Doctor Rugo, reported on
041267 -        090130 1722, ref SDS 14 HK3V, and also combined with vaccines,
041268 -        discussed with Doctor Hsu and Chris on 090312 0800. ref SDS 17
041269 -        F991].  You indicated in the meeting on 090515 [that treatment
041270 -        with radiation and hyperthermia] was effective in the treated
041271 -        areas. 090515 1140, ref SDS 27 OT76  Doctor Hsu says my cancer
041272 -        will never return to these treated areas [reported during
041273 -        meeting at UCSF on 090422, 090423 0830, ref SDS 24 V46K and
041274 -        confirmed in a letter to the medical team on 090423 2337.
041275 -        ref SDS 25 ZL9V].  That seems like solid evidence to base
041276 -        treatment, and it significantly improves my patient history
041277 -        where previously IBC returned again and again to my chest and
041278 -        stomach.
041279 -
041280 -            [On 090522 1247 Kaiser does not respond to Millie's choice
041281 -            and request for trade-offs getting more hyperthermia and
041282 -            radiation and Doxil or other appropirate agents.
041283 -            ref SDS 38 4Q8H
041285 -             ..
041286 -            [On 090522 1351 Millie asks the medical team how
041287 -            hyperthermia, radiation, and Doxil which has been very
041288 -            effective fit in the treatment plan, and Millie confirms
041289 -            choice, absent medical advice, to rely on care with these
041290 -            modalities to recover from the 8th relapse of cancer, which
041291 -            were effective in Feb and Mar recovering from 7th relapse
041292 -            of cancer. ref SDS 39 2T4Y
041293 -
041295 -  ..
041296 - Hyperthermia Doxil Millie's Second Choice for Treatment
041297 -
041298 -
041299 -   25.  Since IBC to be treated now is outside previously treated areas
041300 -        there seems less risk of exceeding tolerance for radiation.
041301 -        Alternatively, Doctor Rugo originally prescribed hyperthermia
041302 -        with Doxil.  If radiation is not a good solution, Doxil or some
041303 -        other agent should be tried to affirmatively eliminate IBC from
041304 -        infected sites.
041306 -         ..
041307 -   26.  Weighing against this is Doctor Hsu's recommendation on 090423
041308 -        that my best course of care is for Doctor Rugo to prescribe
041309 -        systemic treatment [reported on 090423 0830, ref SDS 24 UG6I].
041310 -        He may have been referencing systemic care to complement
041311 -        radiation, because radiation has a tolerance limitation [also
041312 -        reported on 090423, ref SDS 24 UG6L], whereas he seemed to
041313 -        indicate hyperthermia can be given as often as needed [reported
041314 -        on 090312 0800, ref SDS 17 F973].  The question is whether an
041315 -        alternate modality from radiation would be effective [combined
041316 -        with hyperthermia]?  This requires medical judgment.
041318 -         ..
041319 -   27.  Since you have asked me to choose immediately today [in Doctor
041320 -        Johnson's letter on 090521 2006. ref SDS 37 HC8O], the only
041321 -        track record I have for effectiveness is hyperthermia and
041322 -        something.  I would love to come in and get started today,
041323 -        Monday, as soon as possible.  As you know, progression was
041324 -        reported in March, and weekly through April and May it has
041325 -        gotten worse [reported on 090521 0211, ref SDS 35 FM7Q, and
041326 -        earlier on 090510 1953. ref SDS 26 LJ5T].
041327 -
041328 -            [On 090522 1247 Kaiser does not respond to Millie's choice
041329 -            and request for trade-offs getting more hyperthermia and
041330 -            radiation and Doxil or other appropirate agents.
041331 -            ref SDS 38 4Q8H
041333 -             ..
041334 -            [On 090522 1351 Millie asks the medical team how
041335 -            hyperthermia, radiation, and Doxil which has been very
041336 -            effective fit in the treatment plan, and Millie confirms
041337 -            choice, absent medical advice, to rely on care with these
041338 -            modalities to recover from the 8th relapse of cancer, which
041339 -            were effective in Feb and Mar recovering from 7th relapse
041340 -            of cancer. ref SDS 39 2T4Y
041342 -         ..
041343 -   28.  Thanks again for helping me get treatment, and for explaining
041344 -        in your letter yesterday that I need urgent treatment quickly
041345 -        [reported on 090521 2006. ref SDS 37 HC8O].
041347 -         ..
041348 -   29.  Please let me know what to do.
041349 -
041355 -
041356 -
041357 -
041358 -
041359 -
041360 -
041361 -
041362 -
041363 -
041364 -
041365 -
041366 -
0414 -