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 44 0000. ref SDS 43 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 090519 1613 Millie responded, ref SDS 34 8V8H, to the Doctor's
040902 - letter earlier yesterday afternoon on 090519 1536, ref SDS 33 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 34 TY3X,
040905 - and further as planned by the doctor during the meeting on 090515
040906 - 1140. ref SDS 32 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 34 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 34 TX4W
040912 -  ..
040913 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
040914 - ref SDS 39 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 40
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 40 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 39
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 31 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 42 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 42 HC8O, and the doctor told Millie to call Medicare for
040937 - prescribing treatment to recover from the 8th relapse of cancer.
040938 - ref SDS 42 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 43 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 43 7Z5Y  Millie reports having called
040949 - Kaiser numerous times to speak with the doctor on prescribing
040950 - treatment. ref SDS 43 7Z9Y  Millie notifies medical team she chooses
040951 - hyperthermia and radiation, Doxil, or other agent suitable for
040952 - Millie's patient profile. ref SDS 43 715V
040954 -  ..
040955 - On 090522 1247 Millie received a response from Doctor Johnson to
040956 - Millie's letter on 090522 0813. ref SDS 43 RX6L who sent copies to the
040957 - medical team, and saying Kaiser has performed workups, but does not
040958 - submit any works, and says Millie's patient profile is too complex for
040959 - Tumor Board to evaluate best course of treatment, and that Millie's
040960 - patient profile resists single agent treatments like Gemzar and
040961 - Navelbine, and that Millie can choose Hospice instead of treatment
040962 - with drugs which her patient profile now resists. ref SDS 44 XO5O
040964 -  ..
040965 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
040966 - Johnson on 090522 1247. ref SDS 44 XO5O
040967 -
040968 -    1.  Subject: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
040969 -        Date: Fri, 22 May 2009 14:46:35 -0700
040982 -         ..
040983 -    2.  Thanks very much for clarifying that I need to start treatment
040984 -        soon, but there is a little time for planning [presented in
040985 -        Kaiser's letter earlier today on 090522 1247, ref SDS 44 4Q91].
040986 -        My goal is to start treatment next week [to recover from cancer
040987 -        progressing since 090331, ref SDS 27 Q64R].
040989 -         ..
040990 -    3.  Can you comment please on CPT 11 listed in the medical chart,
040991 -        and discussed in my letter this morning [reported on 090522
040992 -        0813. ref SDS 43 7Z6W, and which was not presented in Kaiser's
040993 -        response letter on 090522 1247. ref SDS 44 XO5O]  How does CPT
040994 -        11 compare with other treatment options I have [repeating
040995 -        question on 090522 0813, ref SDS 43 715R]?
040996 -
040997 -            [On 090522 1953 Doctor Johnson notifies Millie that CPT 11
040998 -            is prescribed for patients with colon cancer; does not
040999 -            confirm nor clarify if entry in Millie's medical chart is a
041000 -            mistake, or that CPT 11 is a viable choice for her current
041001 -            care to recover from the 8th relapse of cancer, and does
041002 -            not present trade-offs with other treatments, which Millie
041003 -            requested to facilitate choce of care. ref SDS 45 YT5M
041005 -         ..
041006 -    4.  Sounds like your treatment plan is Navelbine, Gemzar [see
041007 -        Doctor Johnson's letter on 090522 1247. ref SDS 44 4Q8H, and]
041008 -        maybe CTP 11 [per above, ref SDS 0 2T9W].
041009 -
041011 -  ..
041012 - Agony of Chemotherapy Side Effects to Achieve Progression
041013 -
041014 -
041015 -    5.  What is your estimated time to progression with these agents
041016 -        and what side effects do you expect?  Will this be weeks and
041017 -        months of agony to achieve progression [repeating questions to
041018 -        Doctor Rugo at UCSF on 090519 1613, ref SDS 34 TX4W, and on
041019 -        090521 0211. ref SDS 40 FM6X]
041020 -
041021 -           [On 090522 1953 Kaiser discloses that Millie's doctor has
041022 -           "no idea" how treatment Kaiser propose for Millie with
041023 -           Gemzar and Navelbine will affect Millie's complex patient
041024 -           profile; the doctor says these single-agent chemotherapy
041025 -           treatments may not work at all for Millie to recover from
041026 -           8th relapse of cancer. ref SDS 45 UW6G
041028 -            ..
041029 -           [On 090605 1447 Millie received documentation from Kaiser
041030 -           with additional problems Gemzar presents for Millie's
041031 -           patient profile, saying that Gemzar requires extreme
041032 -           caution given after a patient has been treated with
041033 -           radiation, which Millie received for 4 weeks in February
041034 -           and March, and contiues to suffer side effects; Kaiser
041035 -           further says treatment with Gemzar requires avoiding blood
041036 -           thinners, and Millie is required to take blood thinners
041037 -           every day for PE. ref SDS 46 V34K
041039 -         ..
041040 -    6.  Does Kaiser still have clinical trials?  You have prescribed
041041 -        clinical trials for my care many times, beginning on 040318
041042 -        {reported in case study on 090522 1247. ref SDS 44 4Q88].  In
041043 -        each case you presented extensive advice on merits, explaining
041044 -        in great detail why a treatment would help me and side effects
041045 -        [e.g., on 040318 1615. ref SDS 1 PU6M]  As my doctor, I've
041046 -        asked you for medical advice on clinical trial options for my
041047 -        8th relapse of cancer [submitted to the medical team on 090326
041048 -        0058, ref SDS 24 DW5S, and cited again in a follow up letter to
041049 -        Doctor Johnson alone also on 090326 0947. ref SDS 25 QM3V]
041051 -         ..
041052 -    7.  I've also asked for advice on getting more hyperthermia and
041053 -        radiation, Doxil or other appropriate modalities [including
041054 -        vaccines, presented in Millie's letter to the medical team on
041055 -        090522 0813. ref SDS 43 715V, and which is not answered in
041056 -        Kaiser's response on 090522 1247. ref SDS 44 XO5O, and] which
041057 -        you prescribed in February [see Kaiser Referral dated 090202
041058 -        received in the record on 090205 1426. ref SDS 20 278T], and
041059 -        which was very effective [reported on 090522 0813, ref SDS 43
041060 -        715V].  How does this fit in the treatment plan?  Should
041061 -        hyperthermia be done immediately or wait to see the response
041062 -        from chemo?
041064 -         ..
041065 -    8.  Your letter yesterday asked [me] to choose a treatment
041066 -        [reported on 090522 1247. ref SDS 44 4Q8H
041068 -         ..
041069 -    9.  As presented in the prior letter [reported on 090522 0813.
041070 -        ref SDS 43 715V], absent medical advice, my choice is to treat
041071 -        recurrent IBC on my left arm and isolated other areas with
041072 -        hyperthermia according to Doctor Hsu's design, as he did in
041073 -        February, and discussed on 090312 0800, ref SDS 22 F984].  Can
041074 -        you please coordinate with UCSF to schedule this work.  If he
041075 -        needs a week or so to get started, then you can prescribe
041076 -        Navelbine, Gemzar, or CPT 11 for interim care, at your
041077 -        discretion.
041078 -
041085 -
041086 -
041087 -
041088 -
041089 -
041090 -
041091 -
041092 -
041093 -
041094 -
041095 -
041096 -
0411 -