CONTACTS 
0203 - CMS Region 9                                                                                                                                                       O-00000877 0605
020301 - Ms. Jullin Kwok; Kaiser Contract Manager                                                                                                                         O-00000877 0605
020303 - 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 58 0000. ref SDS 57 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 090121 1041 Glenna called and said that progression of Millie's
040902 - cancer, most notably in the breastbone area requires UCSF to change
040903 - treatments, as ordered by Doctor Johnson at Kaiser on 081219.  Doctor
040904 - Rugo needs a list of treatments from Millie's records which UCSF has
040905 - planned to treat Millie's cancer as a chronic disease, ref SDS 6 Y67L,
040906 - further ordered by Doctor Johnson at Kaiser on 081219. ref SDS 5 V93O
040908 -  ..
040909 - On 090123 1326 Doctor Johnson confirms prior guidance that multiple
040910 - (7) relapses have mutated Millie's cancer into a very aggressive
040911 - disease that requires immediate change in treatment in order for
040912 - Millie to recover. ref SDS 8 RK6O
040914 -  ..
040915 - On 090129 0800 UCSF delayed Millie's treatment 1 week due to problems
040916 - of missed communication between Oncology and Infusion, reported on
040917 - 090130 1722. ref SDS 9 AY8Q
040919 -  ..
040920 - On 090129 1036 Doctor Rugo at UCSF notified Kaiser that Millie needs
040921 - immediate treatment to recover from 7th relapse of cancer, which is
040922 - worse in the breastbone area, and proposes treatment in UCSF Radiation
040923 - Oncology Department with hyperthermia and Doxil, reported on 090130
040924 - 1722. ref SDS 9 TZ6H
040926 -  ..
040927 - On 090201 2017 UCSF delayed treatment for Millie's 7th relapse of
040928 - cancer, because the Radiation Oncology Department needed more time to
040929 - schedule the work. ref SDS 10 GV4M
040931 -  ..
040932 - On 090202 1047 Kaiser delayed authorization for Millie's treatment
040933 - because the doctor did not fill out a form correctly referring
040934 - Millie's treatment to UCSF. ref SDS 11 9Y5I
040936 -  ..
040937 - On 090202 1353 UCSF delayed treatment again for 6 weeks to maintain an
040938 - orderly schedule. ref SDS 12 SP6H
040940 -  ..
040941 - On 090202 1932 Doctor Rugo at UCSF Oncology Department notified the
040942 - medical team that Millie needs urgent treatment quickly in time to be
040943 - effective. ref SDS 13 Y15J
040945 -  ..
040946 - On 090203 1438 UCSF Radiation Oncology Department advances Millie's
040947 - treatment 4 weeks to begin in time to be effective. ref SDS 14 XX5I
040949 -  ..
040950 - On 090204 0219 Millie's letter asks Doctor Rugo to submit proactive
040951 - planning for follow on treatment after hyperthermia and Doxil for
040952 - Millie's 6th relapse of IBC. ref SDS 15 278T
040954 -  ..
040955 - On 090205 0830 Doctor Hsu examination in UCSF Radiation Oncology
040956 - Department finds Millie's cancer has progressed significantly due to
040957 - delays starting treatment; changes treatment protocol from
040958 - hyperthermia and Doxil to radiation and hyperthermia. ref SDS 16 EY5F
040960 -  ..
040961 - On 090213 1140 Doctor Johnson notifies Millie that she has less than 1
040962 - year to live, ref SDS 18 646L, unless she gets effective treatment
040963 - quickly for cancer that has mutated into aggressive disease that will
040964 - cascade out of control. ref SDS 18 ES7I
040966 -  ..
040967 - On 090218 1205 Millie notifies Doctor Rugo again that Doctor Johnson
040968 - has authorized UCSF Cancer Center to begin planning Millie's next
040969 - treatment after radiation and hyperthremia, because she has a narrow
040970 - margin for delay getting treatment to survive. ref SDS 19 TH6U
040972 -  ..
040973 - On 090219 1315 UCSF begins treatment 4-weeks late on referral from
040974 - Kaiser for Millie to recover from 7th relapse of cancer. ref SDS 20
040975 - E57G
040977 -  ..
040978 - On 090310 0351 after 3-weeks treatment with radiation and
040979 - hyperthermia Millie notifies medical team that cancer in the
040980 - breastbone area seems worse. ref SDS 22 O56X
040982 -  ..
040983 - On 090331 2947 Millie notified medical team of possible IBC
040984 - progression on lower left arm, and asked about starting treatment to
040985 - recover from 8th relapse of cancer. ref SDS 26 Q64R
040987 -  ..
040988 - On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower left
040989 - arm as progression of IBC. ref SDS 27 R24X
040991 -  ..
040992 - On 090401 0046 Millie asks about getting treatment of IBC spreading to
040993 - lower left arm, which establishes the 8th relapse of cancer diagnosed
040994 - by Doctor Hsu. ref SDS 28 RE8P
040996 -  ..
040997 - On 090401 0121 Doctor Rugo reports Millie's wound in breastbone area
040998 - diagnosed as reaction to 4-weeks of radiation that ended on 090317
040999 - must heal before starting treatment for IBC relapse, and so defers the
041000 - meeting scheduled on 090402 0800; Doctor Rugo expects full recovery
041001 - from IBC in areas treated with radiation and hyperthermia because this
041002 - regimen to be very effective. ref SDS 29 K56O
041004 -  ..
041005 - On 090412 2241 Millie reports again to the medical team that IBC on
041006 - lower left arm is getting worse, and requests immediate treatment in
041007 - order to prevent problems cited by Doctor Johnson that delay risks
041008 - losing control and death. ref SDS 30 9S8Y
041010 -  ..
041011 - On 090510 1220 Millie reports wound in the breastbone diagnosed as
041012 - reaction to radiation looks worse; asks if this might be IBC because
041013 - of a mistake in performing radiation treatments?   Millie further
041014 - asked about doing a biopsy to test for cancer, so that treatment can
041015 - begin immediately under Doctor Johnson's warning that immediate
041016 - treatment is essential for recovery. ref SDS 32 LJ5T
041018 -  ..
041019 - On 090514 0830 Doctor Rugo prescribes treatment with MPA, ref SDS 33
041020 - D647, and submits a letter to Kaiser submitting the protocol,
041021 - ref SDS 33 DI63, as previously requested by Doctor Johnson on 081219
041022 - 1140. ref SDS 5 V93O
041024 -  ..
041025 - On 090515 0800 Doctor Rugo notifies medical team that Kaiser failed to
041026 - perform requirements for referral to pay for Millie's treatment
041027 - recommended by UCSF Cancer Center as the best evidence of care that
041028 - has the best chance for Millie to recover, which Kaiser is required to
041029 - provide under section 2 of EOC. ref SDS 34 WP6S
041031 -  ..
041032 - On 090515 1017 Millie notified medical team that Doctor Rugo's letter
041033 - was received; that Kaiser is responsible for Millie's care, and Millie
041034 - will meet with the primary care doctor at Kaiser on 090515 1140 and
041035 - request that Kaiser prescribe care for Millie's 8th relapse of cancer
041036 - based on the best evidence, ref SDS 35 6Q8W, as shown in Doctor Rugo's
041037 - letter to Kaiser on 090514 0830. ref SDS 33 DI63
041039 -  ..
041040 - On 090515 1518 Doctor Rugo responds wishing Millie "good luck."
041041 - ref SDS 37 PW7H
041043 -  ..
041044 - On 090515 1140 Millie met with Doctor Johnson at Kaiser and the doctor
041045 - said that he was told by Doctor Mason that the primary care physician,
041046 - Doctor Johnson, cannot prescribe standard of care treatment for Millie
041047 - in a clinical trial, despite patient history having prescribed prior
041048 - clinical trials 4 times previously for standard of care in oncology,
041049 - and as a result, Doctor Johnson requested a draft to assist him
041050 - preparing an appeal to file with Member Services so that Kaiser can
041051 - expedite Millie's recovery from the 8th relapse of cancer. ref SDS 36
041052 - 655R
041054 -  ..
041055 - On 090516 0858 Millie notified Doctor Rugo that Doctor Johnson is
041056 - filing an appeal for Kaiser to treat Millie with MPA protocol
041057 - recommended by UCSF to recover from the 8th relapse of cancer.
041058 - ref SDS 38 SY4J
041060 -  ..
041061 - On 090518 0017 Millie submits letter to Doctor Johnson with copy to
041062 - Doctor Rugo at UCSF, and transmitting a draft to assist Doctor Johnson
041063 - filing his appeal with Member Services to assisting Kaiser implement
041064 - Doctor Johnson's strategy to treat Millie's cancer as a chronic
041065 - disease in time for Millie to recover from the 8th relapse of cancer.
041066 - ref SDS 39 R16I
041068 -  ..
041069 - On 090519 1536 Doctor Johnson changed his mind; he sent the draft
041070 - appeal to Doctor Mason, and tells Millie to file an appeal with Member
041071 - Services, which is incorrect since at this time Millie has not been
041072 - denied medical services; and the doctor further says he is suddenly
041073 - relieved of responsibility performed continuously the past 8 years to
041074 - prescribe treatment for Millie to recover from cancer, because
041075 - Kaiser's Outside Referrals Department has a better understanding of
041076 - Medicare. ref SDS 40 5K7H
041078 -  ..
041079 - On 090519 1613 Millie responded, ref SDS 41 8V8H, to the Doctor's
041080 - letter earlier yesterday afternoon on 090519 1536, ref SDS 40 5K7H;
041081 - and, Millie asks the doctor to prescribe treatment so she can recover
041082 - from cancer, as done previously in patient history, ref SDS 41 TY3X,
041083 - and further as planned by the doctor during the meeting on 090515
041084 - 1140. ref SDS 36 655R  Millie also asked the doctor to call on
041085 - expediting treatment in time to be effective, see again on 090520
041086 - 1613, ref SDS 41 TY4W; and Millie asks Doctor Rugo for a "drop dead"
041087 - date on how soon treatment must start in order to be effective, also,
041088 - reported on 090519 1613. ref SDS 41 TX4W
041090 -  ..
041091 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
041092 - ref SDS 47 ZF4Q, then on 090521 0211 Millie's letter to Doctor Rugo at
041093 - UCSF with copy to Doctor Hsu asks about getting treatment with
041094 - hyperthermia and Doxil, while Kaiser resolves delays ordering MPA
041095 - prescribed by Doctor Rugo for Millie to recover from 8th relapse of
041096 - cancer, which Millie reports is getting worse every day, ref SDS 48
041097 - FM7Q, and since Kaiser has previosuly authorized treatment with
041098 - hyperthermia and Doxil, which Doctor Rugo recommended earlier on
041099 - 090129 for Millie to recover from the 7th relapse. ref SDS 48 6M4F
041101 -  ..
041102 - On 090521 2006, Millie received a letter from Doctor Johnson
041103 - responding to Millie's letter to the medical team on 090520 1710, and
041104 - requesting that Kaiser prescribe treatment suitable for Millie's
041105 - patient profile for recovering from 8th relapse of cancer. ref SDS 47
041106 - P65H   Doctor Johnson's letter was sent through Kaiser's Knowledge
041107 - Management System and so was not disclosed to the medical team, and it
041108 - did transmit the Doctor Johnson's medical chart for the meeting on
041109 - 090515, ref SDS 36 YT5N, and said that Millie could "choose" any
041110 - treatment she wants, and no treatment is superior for Millie's patient
041111 - profile, 090521 2006, ref SDS 50 9Q9H; the doctor noted Millie's
041112 - cancer is progressing and so she needs to start treatment by the end
041113 - of the week, which was in just 12 hours, which means today,
041114 - ref SDS 50 HC8O, and the doctor told Millie to call Medicare for
041115 - prescribing treatment to recover from the 8th relapse of cancer.
041116 - ref SDS 50 HC93
041118 -  ..
041119 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
041120 - 2006 and submitted copies to the medical team to maintain
041121 - collaboration that has been effective treating Millie the past 8
041122 - years.  Millie also sent a copy to Jullian Kwok to notify Medicare
041123 - that Kaiser is refusing treatment. ref SDS 51 RX6L  Millie asked
041124 - Kaiser to prepare a workup and Tumor Board to evaluate Millie's next
041125 - treatment, including trade-offs comparing all of the treatments
041126 - available for Millie. ref SDS 51 7Z5Y  Millie reports having called
041127 - Kaiser numerous times to speak with the doctor on prescribing
041128 - treatment. ref SDS 51 7Z9Y  Millie notifies medical team she chooses
041129 - hyperthermia and radiation, Doxil, or other agent suitable for
041130 - Millie's patient profile. ref SDS 51 715V
041132 -  ..
041133 - On 090522 1247 Millie received a response from Doctor Johnson to
041134 - Millie's letter on 090522 0813. ref SDS 51 RX6L who sent copies to the
041135 - medical team, and saying Kaiser has performed workups, but does not
041136 - submit any works, and says Millie's patient profile is too complex for
041137 - Tumor Board to evaluate best course of treatment, and that Millie's
041138 - patient profile resists single agent treatments like Gemzar and
041139 - Navelbine, and that Millie can choose Hospice instead of treatment
041140 - with drugs which her patient profile now resists. ref SDS 52 XO5O
041142 -  ..
041143 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
041144 - Johnson on 090522 1247, ref SDS 52 XO5O, confirming Millie needs
041145 - urgent treatment to start quickly, reported on 090522 1351,
041146 - ref SDS 53 7R7J; Millie asks if treatment with Gemzar, Navelbine, and
041147 - possibly CTP, ref SDS 53 2T9W and ref SDS 53 2T4P, will be weeks of
041148 - agony then progression of cancer that requires another treatment
041149 - "targeted" to treat Millie's patient profile. ref SDS 53 2T4S  Millie
041150 - requested advice on treatment with a clinical trial at Kaiser, based
041151 - on patient history, ref SDS 53 2T4V, and further requested trade-offs
041152 - getting more hyperthermia and radiation and Doxil or other appropriate
041153 - agent, including vaccines. ref SDS 53 2T4Y
041154 -
041156 -  ..
041157 - Millie Over-treated Cannot Estimate Time to Progression
041158 - May Not Work at All Millie Over-treated Patient Profile Resists Chemo
041159 - Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
041160 - Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
041161 -
041162 - Follow up ref SDS 58 NM6J, ref SDS 57 NM6J.
041163 -
041164 - On 090522 1953 Millie received a letter from Doctor Johnson responding
041165 - to Millie's letter to the medical team at Kaiser and UCSF this
041166 - afternoon, reported on 090522 1351. ref SDS 53 7R7J  For some reason,
041167 - the doctor he did not submit copies to the medical team, demonstrating
041168 - uneven case management for coordination and collaboration; the doctor
041169 - confirms that treatment with single-agent chemotherapies presented as
041170 - the only choices for care may not work at all for Millie to recover
041171 - from 8th relapse of cancer. ref SDS 54 NV4L
041172 -
041173 -
041175 -  ..
041176 - Demand for Treatment Standard of Care Millie's Patient Profile
041177 -
041178 - Follow up ref SDS 58 ON8G.
041179 -
041180 - On 090523 0148 Millie sent a letter to Paula in the Kaiser Claims
041181 - Resolution Department with copy to medical team demanding treatment to
041182 - recover from 8th relapse applying standard of care for Millie's
041183 - patient profile. ref SDS 55 2P6J
041185 -  ..
041186 - On 090528 0803 called Paula for progress processing Millie's claim for
041187 - treatment with standard of care for Millie's patient profile.
041188 - ref SDS 57 T04L
041190 -  ..
041191 - On 090528 1228 Millie sent a letter to Paula confirming claim
041192 - demanding timely treatment for 8th relapse of cancer. ref SDS 58 UD5H
041193 - and saying that she will get treatment through another provider and
041194 - bill Kaiser, because her doctor at Kaiser says Millie needs immediate
041195 - treatment, and Kaiser has failed to perform. 090528 1228, ref SDS 58
041196 - 4N8X
041197 -
041198 -
041200 -  ..
0413 -
0414 -
0415 - Progress
0416 -
041601 - Kaiser Defaults Insurance Contract Millie Orders Work from Others
041602 -
041603 - On 090528 1334 Millie sent a letter to Doctor Rugo and Doctor Hsu at
041604 - UCSF requesting treatment, and sent a copy to notify the medical team
041605 - she has been forced to get treatment from another provider to mitigate
041606 - damages from Kaiser's failure to provide care. ref SDS 0 UD5H
041607 -
041608 -    1.  Subject: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041609 -        Date: Thu, 28 May 2009 14:05:05 -0700
041619 -         ..
041620 -    2.  As you know, I have been discussing with Kaiser prescribing
041621 -        treatment for my 8th relapse of cancer [see patient history,
041622 -        reported on 090528 1334, ref SDS 0 CI7J].  Kaiser has discussed
041623 -        Navelbine, Gemzar, CPT [reported on 090522 1351. ref SDS 53
041624 -        2T4P], hyperthermia with radiation or other modalities,
041625 -        including chemotherapy with Doxil, bevacizumab, and with
041626 -        clinical trials [see Millie's letter to Paula in Kaiser Member
041627 -        Services Claims Resolution reported on 090528 1228. ref SDS 58
041628 -        4N5U].  However, no treatment has been prescribed [see Kaiser's
041629 -        letter to Millie failing to prescribe treatment on 090522 1953.
041630 -        ref SDS 54 NV4L, and noted in Millie's letter to Paula reported
041631 -        on 090523 0148. ref SDS 55 DQ9Q]
041633 -         ..
041634 -    3.  Communication today with Kaiser indicates performing Kaiser's
041635 -        procedures to order care will significantly delay treatment
041636 -        [reported on 090528 1228, ref SDS 58 4M6Y and ref SDS 58 4N7U].
041637 -        My last systemic treatment was on 090122, ref SDS 7 AT6N, and
041638 -        my last treatment with radiation and hyperthermia was on
041639 -        090317. ref SDS 24 9L7K  Progression was reported by Tara in
041640 -        your office on 090423, ref SDS 31 DW6F, and later by Doctor Hsu
041641 -        on the same day. ref SDS 31 UG5L  Your examination on 090514
041642 -        found that my IBC has progressed further, still mostly on my
041643 -        left arm, but beginning in other areas outside those treated
041644 -        with radiation and hyperthermia. ref SDS 33 5U4M
041646 -         ..
041647 -    4.  Right now I am feeling very good.  IBC has compounded
041648 -        lymphedema on the left arm.  Patient history shows if I do not
041649 -        get treatment soon, I will decline quickly toward death
041650 -        [notified by Doctor Johnson, primary care physician during
041651 -        meetings at Kaiser beginning on 080829, shown by case study on
041652 -        090325. ref SDS 25 L15M  On 090213, when IBC got very bad and
041653 -        the cancer marker soared to the highest level because I was
041654 -        without treatment for a month, Doctor Johnson said I had less
041655 -        than a year to live, ref SDS 18 9L7N [unless I get timely
041656 -        treatment at UCSF of cancer as a chronic disease. ref SDS 18
041657 -        WZ6K].  Doctor Hsu then advanced my treatment date, and this
041658 -        demonstrated that I can still respond well to treatment, when
041659 -        provided in time.
041661 -         ..
041662 -    5.  Since I have been without treatment now for 2 months, I have
041663 -        told Kaiser that in order to allow time for steps Kaiser needs
041664 -        to prescribe my treatment, I will personally authorize payment
041665 -        for your time to prescribe treatment and submit your bill and
041666 -        the prescription to Kaiser.  If Kaiser does not prescribe
041667 -        treatment, I will authorize UCSF to provide treatment and
041668 -        recover costs from Kaiser, as based on best evidence and
041669 -        medical necessity [Millie's letter to Paula with Member
041670 -        Services Claims Resolution reported on 090528 1228. ref SDS 58
041671 -        4N8X].
041673 -         ..
041674 -    6.  Can you please let me know what I need to do to start treatment
041675 -        as soon as possible, or as you feel is required.
041676 -
041683 -
041684 -
041685 -
041686 -
041687 -
041688 -
041689 -
041690 -
041691 -
041692 -
0417 -