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 40 0000. ref SDS 39 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090519 1613 Millie responded, ref SDS 31 8V8H, to the Doctor's
040902 - letter earlier yesterday afternoon on 090519 1536, ref SDS 30 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 31 TY3X,
040905 - and further as planned by the doctor during the meeting on 090515
040906 - 1140. ref SDS 29 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 31 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 31 TX4W
040912 -  ..
040913 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
040914 - ref SDS 36 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 37
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 37 6M4F
040923 -  ..
040924 - On 090521 2006, Millie received a letter from Doctor Johnson
040925 - responding to Millie's letter to the medical team on 090520 1710, and
040926 - requesting that Kaiser prescribe treatment suitable for Millie's
040927 - patient profile for recovering from 8th relapse of cancer. ref SDS 36
040928 - P65H   Doctor Johnson's letter was sent through Kaiser's Knowledge
040929 - Management System and so was not disclosed to the medical team, and it
040930 - did transmit the Doctor Johnson's medical chart for the meeting on
040931 - 090515, ref SDS 29 YT5N, and said that Millie could "choose" any
040932 - treatment she wants, and no treatment is superior for Millie's patient
040933 - profile, 090521 2006, ref SDS 39 9Q9H; the doctor noted Millie's
040934 - cancer is progressing and so she needs to start treatment by the end
040935 - of the week, which was in just 12 hours, which means today,
040936 - ref SDS 39 HC8O, and the doctor told Millie to call Medicare for
040937 - prescribing treatment to recover from the 8th relapse of cancer.
040938 - ref SDS 39 HC93
040940 -  ..
040941 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
040942 - 2006 and submitted copies to the medical team to maintain
040943 - collaboration that has been effective treating Millie the past 8
040944 - years.  Millie also sent a copy to Jullian Kwok to notify Medicare
040945 - that Kaiser is refusing treatment. ref SDS 40 RX6L  Millie asked
040946 - Kaiser to prepare a workup and Tumor Board to evaluate Millie's next
040947 - treatment, including trade-offs comparing all of the treatments
040948 - available for Millie. ref SDS 40 7Z5Y  Millie reports having called
040949 - Kaiser numerous times to speak with the doctor on prescribing
040950 - treatment. ref SDS 40 7Z9Y  Millie notifies medical team she chooses
040951 - hyperthermia and radiation, Doxil, or other agent suitable for
040952 - Millie's patient profile. ref SDS 40 715V
040954 -  ..
040955 - On 090522 1247 Millie received a response from Doctor Johnson to
040956 - Millie's letter on 090522 0813. ref SDS 40 RX6L who sent copies to the
040957 - medical team. ref SDS 0 XO5O
040958 -
040959 -    1.  Subject:  Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
040960 -        Date: Fri, 22 May 2009 11:14:19 -0700
040970 -         ..
040971 -    2.  All the work-ups have been done [responding to Millie's letter
040972 -        requesting a workup to evaluate major change in patient profile
040973 -        of 8th relapse of cancer compounded by breathing problems,
040974 -        reported earlier today on 090522 0813. ref SDS 40 7Z5V]
040976 -         ..
040977 -    3.  Tumor Board will add nothing substantial to your case because
040978 -        after multiple treatments there is no defined choice of care
040979 -        provided that the patient's performance status is adequate.
040980 -        Yours is fine.
040982 -  ..
040983 - Need copies of "workups" and Tumor Board hearings previously prepared
040984 - by Kaiser on Millie's case.
040986 -  ..
040987 - Kaiser's medical chart now has elements of a workup, but there is
040988 - zero analysis and consideration of alternatives.
040990 -  ..
040991 - Doctor Johnson's letter to medical team continues...
040992 -
040993 -    4.  Therefore that choice lies with you.  I have indicted that
040994 -        Navelbine and Gemzar have known activity as single agents in
040995 -        breast cancer.  They are good choices and known choices.
040997 -  ..
040998 - The doctor has said numerous times that single-agent treatments are
040999 - not suitable for Millie's patient profile, shown in case study on
041000 - 090325 0830. ref SDS 21 A33L
041002 -  ..
041003 - Kaiser does not explain trade-offs between treatments, which was
041004 - requested in Millie's letter earlier today on 090522 0813, ref SDS 40
041005 - 7Z7R, and including CPT 11. ref SDS 40 7Z6W
041007 -  ..
041008 - Kaiser does not respond to Millie's choice of getting treatment with
041009 - hyprthermia, radiation, and Doxil or other appropriate agents,
041010 - presented in the letter to Kaiser on 090522 0813. ref SDS 40 715V
041011 -
041012 -            [On 090522 1351 Millie asks again for Kaiser to explain
041013 -            CPT-11 and trade-offs with other treatments for Millie's
041014 -            patient profile to recover from 8th relapse of cancer.
041015 -            ref SDS 41 2T9W
041017 -             ..
041018 -            [On 090522 1351 Millie asks medical team for expected
041019 -            results from prescribing treatment with single-agent
041020 -            chemotherapy that conflicts with Millie's patient profile -
041021 -            will this be weeks of agony then progression of cancer at
041022 -            Kaiser - rather than recovery with MPA "targeted" to treat
041023 -            Millie's patient profile at UCSF Cancer Center and no
041024 -            adverse side effects? ref SDS 41 2T4S
041026 -             ..
041027 -            [On 090522 1351 Millie notifies medical team that absent
041028 -            medical advice, she chooses treatment with hyperthermia and
041029 -            radiation and Doxil or other appropriate agent, previously
041030 -            prescribed by Doctor Rugo at UCSF Cancer Center, and
041031 -            effective during Feb - Mar recovering from 7th relapse of
041032 -            cancer; Millie asks Kaiser to schedule the work at UCSF on
041033 -            the prior referral order. ref SDS 41 2T5R
041035 -             ..
041036 -            [On 090522 1953 Kaiser discloses that Millie's doctor has
041037 -            "no idea" how treatment proposed with Gemzar and Navelbine
041038 -            will affect Millie's complex patient profile; the doctor
041039 -            says these single-agent chemotherapy treatments may not
041040 -            work at all for Millie to recover from 8th relapse of
041041 -            cancer. ref SDS 42 UW6G
041043 -             ..
041044 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041045 -            and advised that Doctor Johnson prescribed treatment for
041046 -            Millie with Gemzar to start immediately this week; further
041047 -            reported side effects of Gemzar will be very difficult for
041048 -            Millie to tolerate, and asked to verify that Millie agrees
041049 -            to get this treatment. ref SDS 43 8J8L
041051 -             ..
041052 -            [On 090601 0818 at 1153 Sheree called in the Kaiser
041053 -            Chemotherapy Infusion Clinic and advised that Millie cannot get
041054 -            a blood draw to start Gemzar this week, because Doctor Johnson
041055 -            submitted the chemoterhapy order without a signature, and then
041056 -            went home with a headache, and so the order cannot be signed
041057 -            until the doctor recovers and returns to work, ref SDS 43 I96J,
041058 -            reflecting emotional stress expressed during the meeting at
041059 -            Kaiser on 090515 saying he would get in trouble for prescribing
041060 -            single-agent treatments for Millie's patient profile.
041061 -            ref SDS 29 658J
041063 -             ..
041064 -            [On 090605 1447 Millie received documentation from Kaiser
041065 -            with additional problems Gemzar presents for Millie's
041066 -            patient profile, saying that Gemzar requires extreme
041067 -            caution given after a patient has been treated with
041068 -            radiation, which Millie received for 4 weeks in February
041069 -            and March, and contiues to suffer side effects; Kaiser
041070 -            further says treatment with Gemzar requires avoiding blood
041071 -            thinners, and Millie is required to take blood thinners
041072 -            every day for PE. ref SDS 44 V34K
041074 -  ..
041075 - Doctor Johnson's letter to medical team continues...
041076 -
041077 -    5.  However, some people choose, at this point, to go with a
041078 -        Clinical Trial.  I cannot make that choice for you.
041080 -  ..
041081 - Doctor Johnson errs refusing to prescribe treatment for Millie in a
041082 - clinical trial.  Patient history shows in following case study that
041083 - Doctor Johnson made the treatment choice for a clinical trial on...
041084 -
041085 -              1.  040318.................... ref SDS 1 PU6M
041086 -              2.  041130.................... ref SDS 4 028N
041087 -              3.  041210.................... ref SDS 5 CF9F
041088 -              4.  041230.................... ref SDS 6 2V85
041089 -              5.  070105.................... ref SDS 12 PK68
041090 -              6.  080829.................... ref SDS 15 PX5V
041091 -              7.  081024.................... ref SDS 16 K67J
041093 -  ..
041094 - Millie has nver before been asked to make a "choice."
041095 -
041096 -            [On 090522 1351 Millie asks Kaiser for advice on getting
041097 -            treatment with a clinical trial. ref SDS 41 2T4V
041099 -  ..
041100 - Doctor Johnson's letter to medical team continues...
041101 -
041102 -    6.  My request to "let me know" by today is that I do not want you
041103 -        to think that I am in any way delaying the next step of your
041104 -        treatment.  You have to make this decision.  If you need more
041105 -        time to decide, that is fine.  I in no way want to appear to be
041106 -        pressuring you.
041108 -  ..
041109 - On 090515 Kaiser delayed treatment by failing to order treatment which
041110 - Kaiser knows Millie urgently needs based on the letter Kaiser received
041111 - from UCSF on 090514 prescribing MPA "targeted" to Millie's patient
041112 - profile to recover from the 8th relapse of cancer; and Kaiser was
041113 - previously notified that Millie suffered relapse, reported on 090331
041114 - 2047, ref SDS 25 Q64R, and Millie requested treatment on 090412 2241.
041115 - ref SDS 26 9S9Y
041116 -
041117 -            [On 090522 1351 Millie responds to Kaiser saying she wants
041118 -            to start treatment as soon as possible; since today is
041119 -            Friday, 090522, Millie requests treatment next week to
041120 -            recover from 8th relapse of cancer progressing since
041121 -            090331. ref SDS 41 7R7J
041123 -  ..
041124 - Doctor Johnson's letter to medical team continues...
041125 -
041126 -    7.  As I have said before, your tumor cells have been exposed to
041127 -        many agents and by definition are resistant.  Therefore, I also
041128 -        indicated that at this point Hospice, best supportive care, is
041129 -        also an option.
041131 -  ..
041132 - Doctor Johnson examined Millie on 090515 and made findings she is ECOG
041133 - performance score 0, ref SDS 29 YF9L, showing that she is "perfectly"
041134 - healthy, provided she has effective treatment for cancer.  Hospice
041135 - provides palliation to ease pain and suffering when declining into
041136 - death for patients ECOG performance score 3 and 4, reviewed on 090213
041137 - 1140. ref SDS 20 VW63
041138 -
041139 -            [On 090522 1351 Millie asks medical team for expected
041140 -            results prescribing treatment with single-agent
041141 -            chemotherapy that conflicts with Millie's patient profile -
041142 -            will this be weeks of agony then progression of cancer at
041143 -            Kaiser - rather than recovery with MPA "targeted" to treat
041144 -            Millie's patient profile at UCSF Cancer Center and no
041145 -            adverse side effects? ref SDS 41 2T4S
041147 -             ..
041148 -            [On 090605 1447 Millie received documentation from Kaiser
041149 -            with additional problems Gemzar presents for Millie's
041150 -            patient profile, saying that Gemzar requires extreme
041151 -            caution given after a patient has been treated with
041152 -            radiation, which Millie received for 4 weeks in February
041153 -            and March, and contiues to suffer side effects; Kaiser
041154 -            further says treatment with Gemzar requires avoiding blood
041155 -            thinners, and Millie is required to take blood thinners
041156 -            every day for PE. ref SDS 44 V34K
041158 -  ..
041159 - Case study telling Millie she has a year to live, and to choose
041160 - hospice rather than get treatment is also shown on 090213 1140.
041161 - ref SDS 20 L19H
041163 -  ..
041164 - The doctor admits today that Millie's cancer resists single-agent
041165 - treatments, like Gemzar and Navelbine, and so proposing that she
041166 - "choose" treatments expected to fail, and have severe side effects
041167 - which destroy quality of life, does not comply with Kaiser's duty to
041168 - prescribe effective care under Millie's insurance policy in EOC
041169 - section 2, reviewed on 070927 1311. ref SDS 14 WS6M
041171 -  ..
041172 - Doctor Johnson's letter to medical team continues...
041173 -
041174 -    8.  I hope this clarifies your issues.
041175 -
041188 -
041189 -
041190 -
041191 -
041192 -
041193 -
041194 -
041195 -
041196 -
041197 -
041198 -
041199 -
041200 -
041201 -
041202 -
0413 -