CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 86 0000. ref SDS 85 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 24 Y67L,
040906 - further ordered by Doctor Johnson at Kaiser on 081219. ref SDS 23 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 26 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 27 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 27 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 28 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 29 9Y5I
040936 -  ..
040937 - On 090202 1353 UCSF delayed treatment again for 6 weeks to maintain an
040938 - orderly schedule. ref SDS 30 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 31 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 32 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 33 278T
040954 -  ..
040955 - On 090204 1914 Doctor Rugo defers teamwork for practice synergy and
040956 - proactive management to plan for alternate scenarios that optimize
040957 - coprehensive care is prevented because Millie's case is very
040958 - complicated. ref SDS 35 063I
040960 -  ..
040961 - On 090205 0830 Doctor Hsu examination in UCSF Radiation Oncology
040962 - Department finds Millie's cancer has progressed significantly due to
040963 - delays starting treatment; changes treatment protocol from
040964 - hyperthermia and Doxil to radiation and hyperthermia. ref SDS 36 EY5F
040966 -  ..
040967 - On 090213 1140 Doctor Johnson notifies Millie that she has less than 1
040968 - year to live, ref SDS 38 646L, unless she gets effective treatment
040969 - quickly for cancer that has mutated into aggressive disease that will
040970 - cascade out of control. ref SDS 38 ES7I
040972 -  ..
040973 - On 090218 1205 Millie notifies Doctor Rugo again that Doctor Johnson
040974 - has authorized UCSF Cancer Center to begin planning Millie's next
040975 - treatment after radiation and hyperthremia, because she has a narrow
040976 - margin for delay getting treatment to survive. ref SDS 39 TH6U
040978 -  ..
040979 - On 090219 1315 UCSF begins treatment 4-weeks late on referral from
040980 - Kaiser for Millie to recover from 7th relapse of cancer. ref SDS 40
040981 - E57G
040983 -  ..
040984 - On 090310 0351 after 3-weeks treatment with radiation and
040985 - hyperthermia Millie notifies medical team that cancer in the
040986 - breastbone area seems worse. ref SDS 42 O56X
040988 -  ..
040989 - On 090331 2947 Millie notified medical team of possible IBC
040990 - progression on lower left arm, and asked about starting treatment to
040991 - recover from 8th relapse of cancer. ref SDS 46 Q64R
040993 -  ..
040994 - On 090401 0032 Doctor Hsu diagnosed new rash on Millie's lower left
040995 - arm as progression of IBC. ref SDS 47 R24X
040997 -  ..
040998 - On 090401 0046 Millie asks about getting treatment of IBC spreading to
040999 - lower left arm, which establishes the 8th relapse of cancer diagnosed
041000 - by Doctor Hsu. ref SDS 48 RE8P
041002 -  ..
041003 - On 090401 0121 Doctor Rugo reports Millie's wound in breastbone area
041004 - diagnosed as reaction to 4-weeks of radiation that ended on 090317
041005 - must heal before starting treatment for IBC relapse, and so defers the
041006 - meeting scheduled on 090402 0800; Doctor Rugo expects full recovery
041007 - from IBC in areas treated with radiation and hyperthermia because this
041008 - regimen to be very effective. ref SDS 49 K56O
041010 -  ..
041011 - On 090412 2241 Millie reports again to the medical team that IBC on
041012 - lower left arm is getting worse, and requests immediate treatment in
041013 - order to prevent problems cited by Doctor Johnson that delay risks
041014 - losing control and death. ref SDS 50 9S8Y
041016 -  ..
041017 - On 090510 1220 Millie reports wound in the breastbone diagnosed as
041018 - reaction to radiation looks worse; asks if this might be IBC because
041019 - of a mistake in performing radiation treatments?   Millie further
041020 - asked about doing a biopsy to test for cancer, so that treatment can
041021 - begin immediately under Doctor Johnson's warning that immediate
041022 - treatment is essential for recovery. ref SDS 53 LJ5T
041024 -  ..
041025 - On 090514 0830 Doctor Rugo prescribes treatment with MPA, ref SDS 55
041026 - D647, and submits a letter to Kaiser submitting the protocol,
041027 - ref SDS 55 DI63, as previously requested by Doctor Johnson on 081219
041028 - 1140. ref SDS 23 V93O
041030 -  ..
041031 - On 090515 0800 Doctor Rugo notifies medical team that Kaiser failed to
041032 - perform requirements for referral to pay for Millie's treatment
041033 - recommended by UCSF Cancer Center as the best evidence of care that
041034 - has the best chance for Millie to recover, which Kaiser is required to
041035 - provide under section 2 of EOC. ref SDS 56 WP6S
041037 -  ..
041038 - On 090515 1017 Millie notified medical team that Doctor Rugo's letter
041039 - was received; that Kaiser is responsible for Millie's care, and Millie
041040 - will meet with the primary care doctor at Kaiser on 090515 1140 and
041041 - request that Kaiser prescribe care for Millie's 8th relapse of cancer
041042 - based on the best evidence, ref SDS 57 6Q8W, as shown in Doctor Rugo's
041043 - letter to Kaiser on 090514 0830. ref SDS 55 DI63
041045 -  ..
041046 - On 090515 1518 Doctor Rugo responds wishing Millie "good luck."
041047 - ref SDS 59 PW7H
041049 -  ..
041050 - On 090515 1140 Millie met with Doctor Johnson at Kaiser and the doctor
041051 - said that he was told by Doctor Mason that the primary care physician,
041052 - Doctor Johnson, cannot prescribe standard of care treatment for Millie
041053 - in a clinical trial, despite patient history having prescribed prior
041054 - clinical trials 4 times previously for standard of care in oncology,
041055 - and as a result, Doctor Johnson requested a draft to assist him
041056 - preparing an appeal to file with Member Services so that Kaiser can
041057 - expedite Millie's recovery from the 8th relapse of cancer. ref SDS 58
041058 - 655R
041060 -  ..
041061 - On 090516 0858 Millie notified Doctor Rugo that Doctor Johnson is
041062 - filing an appeal for Kaiser to treat Millie with MPA protocol
041063 - recommended by UCSF to recover from the 8th relapse of cancer.
041064 - ref SDS 60 SY4J
041066 -  ..
041067 - On 090518 0017 Millie submits letter to Doctor Johnson with copy to
041068 - Doctor Rugo at UCSF, and transmitting a draft to assist Doctor Johnson
041069 - filing his appeal with Member Services to assisting Kaiser implement
041070 - Doctor Johnson's strategy to treat Millie's cancer as a chronic
041071 - disease in time for Millie to recover from the 8th relapse of cancer.
041072 - ref SDS 61 R16I
041074 -  ..
041075 - On 090519 1536 Doctor Johnson changed his mind; he sent the draft
041076 - appeal to Doctor Mason, and tells Millie to file an appeal with Member
041077 - Services, which is incorrect since at this time Millie has not been
041078 - denied medical services; and the doctor further says he is suddenly
041079 - relieved of responsibility performed continuously the past 8 years to
041080 - prescribe treatment for Millie to recover from cancer, because
041081 - Kaiser's Outside Referrals Department has a better understanding of
041082 - Medicare. ref SDS 62 5K7H
041084 -  ..
041085 - On 090519 1613 Millie responded, ref SDS 63 8V8H, to the Doctor's
041086 - letter earlier yesterday afternoon on 090519 1536, ref SDS 62 5K7H;
041087 - and, Millie asks the doctor to prescribe treatment so she can recover
041088 - from cancer, as done previously in patient history, ref SDS 63 TY3X,
041089 - and further as planned by the doctor during the meeting on 090515
041090 - 1140. ref SDS 58 655R  Millie also asked the doctor to call on
041091 - expediting treatment in time to be effective, see again on 090520
041092 - 1613, ref SDS 63 TY4W; and Millie asks Doctor Rugo for a "drop dead"
041093 - date on how soon treatment must start in order to be effective, also,
041094 - reported on 090519 1613. ref SDS 63 TX4W
041096 -  ..
041097 - Since Kaiser has delayed ordering treatment, reported on 090520 1710.
041098 - ref SDS 70 ZF4Q, then on 090521 0211 Millie's letter to Doctor Rugo at
041099 - UCSF with copy to Doctor Hsu asks about getting treatment with
041100 - hyperthermia and Doxil, while Kaiser resolves delays ordering MPA
041101 - prescribed by Doctor Rugo for Millie to recover from 8th relapse of
041102 - cancer, which Millie reports is getting worse every day, ref SDS 71
041103 - FM7Q, and since Kaiser has previosuly authorized treatment with
041104 - hyperthermia and Doxil, which Doctor Rugo recommended earlier on
041105 - 090129 for Millie to recover from the 7th relapse. ref SDS 71 6M4F
041107 -  ..
041108 - On 090521 2006, Millie received a letter from Doctor Johnson
041109 - responding to Millie's letter to the medical team on 090520 1710, and
041110 - requesting that Kaiser prescribe treatment suitable for Millie's
041111 - patient profile for recovering from 8th relapse of cancer. ref SDS 70
041112 - P65H   Doctor Johnson's letter was sent through Kaiser's Knowledge
041113 - Management System and so was not disclosed to the medical team, and it
041114 - did transmit the Doctor Johnson's medical chart for the meeting on
041115 - 090515, ref SDS 58 YT5N, and said that Millie could "choose" any
041116 - treatment she wants, and no treatment is superior for Millie's patient
041117 - profile, 090521 2006, ref SDS 73 9Q9H; the doctor noted Millie's
041118 - cancer is progressing and so she needs to start treatment by the end
041119 - of the week, which was in just 12 hours, which means today,
041120 - ref SDS 73 HC8O, and the doctor told Millie to call Medicare for
041121 - prescribing treatment to recover from the 8th relapse of cancer.
041122 - ref SDS 73 HC93
041124 -  ..
041125 - On 090522 0813 Millie responded to Doctor Johnson's letter on 090521
041126 - 2006 and submitted copies to the medical team to maintain
041127 - collaboration that has been effective treating Millie the past 8
041128 - years.  Millie also sent a copy to Jullian Kwok to notify Medicare
041129 - that Kaiser is refusing treatment. ref SDS 74 RX6L  Millie asked
041130 - Kaiser to prepare a workup and Tumor Board to evaluate Millie's next
041131 - treatment, including trade-offs comparing all of the treatments
041132 - available for Millie. ref SDS 74 7Z5Y  Millie reports having called
041133 - Kaiser numerous times to speak with the doctor on prescribing
041134 - treatment. ref SDS 74 7Z9Y  Millie notifies medical team she chooses
041135 - hyperthermia and radiation, Doxil, or other agent suitable for
041136 - Millie's patient profile. ref SDS 74 715V
041138 -  ..
041139 - On 090522 1247 Millie received a response from Doctor Johnson to
041140 - Millie's letter on 090522 0813. ref SDS 74 RX6L who sent copies to the
041141 - medical team, and saying Kaiser has performed workups, but does not
041142 - submit any workups, and says Millie's patient profile is too complex
041143 - for Tumor Board to evaluate best course of treatment, and that
041144 - Millie's patient profile resists single agent treatments like Gemzar
041145 - and Navelbine, and that Millie can choose Hospice instead of treatment
041146 - with drugs which her patient profile now resists. ref SDS 75 XO5O
041148 -  ..
041149 - On 090522 1351 Millie responded to Kaiser's letter submitted by Doctor
041150 - Johnson on 090522 1247, ref SDS 75 XO5O, confirming Millie needs
041151 - urgent treatment to start quickly, reported on 090522 1351,
041152 - ref SDS 76 7R7J; Millie asks if treatment with Gemzar, Navelbine, and
041153 - possibly CTP, ref SDS 76 2T9W and ref SDS 76 2T4P, will be weeks of
041154 - agony then progression of cancer that requires another treatment
041155 - "targeted" to treat Millie's patient profile. ref SDS 76 2T4S  Millie
041156 - requested advice on treatment with a clinical trial at Kaiser, based
041157 - on patient history, ref SDS 76 2T4V, and further requested trade-offs
041158 - getting more hyperthermia and radiation and Doxil or other appropriate
041159 - agent, including vaccines. ref SDS 76 2T4Y
041160 -
041162 -  ..
041163 - Millie Over-treated Cannot Estimate Time to Progression
041164 - May Not Work at All Millie Over-treated Patient Profile Resists Chemo
041165 - Unfortunately Chemotherapy Drugs Proposed by Kaiser May Not Work at All
041166 - Targeted Treatment Essential Millie's Patient Profile to Recover 8th Relapse
041167 -
041168 - Follow up ref SDS 86 NM6J, ref SDS 85 NM6J.
041169 -
041170 - On 090522 1953 Millie received a letter from Doctor Johnson responding
041171 - to Millie's letter to the medical team at Kaiser and UCSF this
041172 - afternoon, reported on 090522 1351. ref SDS 76 7R7J  For some reason,
041173 - the doctor he did not submit copies to the medical team, demonstrating
041174 - uneven case management for coordination and collaboration; the doctor
041175 - confirms that treatment with single-agent chemotherapies presented as
041176 - the only choices for care may not work at all for Millie to recover
041177 - from 8th relapse of cancer. ref SDS 77 NV4L
041178 -
041179 -
041181 -  ..
041182 - Demand for Treatment Standard of Care Millie's Patient Profile
041183 -
041184 - Follow up ref SDS 86 ON8G, ref SDS 85 ON8G.
041185 -
041186 - On 090523 0148 Millie sent a letter to Paula in the Kaiser Claims
041187 - Resolution Department with copy to medical team demanding treatment to
041188 - recover from 8th relapse applying standard of care for Millie's
041189 - patient profile. ref SDS 78 2P6J
041191 -  ..
041192 - On 090528 0803 called Paula for progress processing Millie's claim for
041193 - treatment with standard of care for Millie's patient profile.
041194 - ref SDS 80 T04L
041196 -  ..
041197 - On 090528 1228 Millie sent a letter to Paula confirming claim
041198 - demanding timely treatment for 8th relapse of cancer. ref SDS 81 UD5H
041199 - and saying that she will get treatment through another provider and
041200 - bill Kaiser, because her doctor at Kaiser says Millie needs immediate
041201 - treatment, and Kaiser has failed to perform. 090528 1228, ref SDS 81
041202 - 4N8X
041203 -
041204 -
041206 -  ..
0413 -
0414 -
0415 - Progress
0416 -
041601 - Kaiser Defaults Insurance Contract Millie Orders Work from Others
041602 - UCSF Prescribes Gemcitabine Treatment for Millie at Kaiser
041603 - Millie Requests Prescription and Comparison of Treatment Choices
041604 -
041605 - Follow up ref SDS 86 UD5H, ref SDS 85 UD5H.
041606 -
041607 - On 090528 1334 Millie sent a letter to Doctor Rugo and Doctor Hsu at
041608 - UCSF requesting treatment, and sent a copy to notify the medical team
041609 - she has been forced to get treatment from another provider to mitigate
041610 - damages from Kaiser's failure to provide care. ref SDS 82 UD5H
041612 -  ..
041613 - On 090528 1613 Doctor Rugo responds to Millie's letter on 090528 1334,
041614 - requesting prescription for treatment because Kaiser has defaulted on
041615 - insurance contract, ref SDS 82 2L7P; UCSF prescribes treatment with
041616 - gemcitabine starting next week. ref SDS 83 XZ4M
041618 -  ..
041619 - On 090528 1652 Millie letter to medical team thanks Doctor Rugo for
041620 - her letter today suggesting a new treatment, ref SDS 83 XZ4M, and asks
041621 - for comparison with other treatments to recover from 8th relapse of
041622 - cancer. ref SDS 84 MZ7N
041624 -  ..
041625 - On 090529 1109 since Kaiser has failed to order treatment, Millie
041626 - requests treatment date and time from UCSF, ref SDS 85 448K, and to
041627 - compare advantages and costs of treatment options.
041628 -
041630 -  ..
041631 - Complex Patient History Causes Confusion Mistakes Conflict
041632 - Misleading Correspondence Kaiser Complains Against Patient
041633 -
041634 - Follow up ref SDS 86 SZ9J.
041635 -
041636 - On 090529 1751 Doctor Johnson responds to Millie's letter earlier in
041637 - the day, ref SDS 85 448K; Kaiser complains that patient correspondence
041638 - is confusing and misleading, and proposes treating Millie with Gemzar
041639 - and Navelbine starting next week. ref SDS 86 SZ9J
041641 -  ..
041642 - On 090531 1544 Millie notifies the medical team responding to Doctor
041643 - Johnson's letter on 090529 1751. ref SDS 86 SZ9J, and reports cancer
041644 - is getting worse so she needs urgent treatment, and asks Kaiser to
041645 - provide treatment based on standard of care for Millie's patient
041646 - profile. ref SDS 0 LD4O
041647 -
041648 -            [On 090531 2227 Kaiser failed to provide treatment, so
041649 -            Millie ordered treatment from UCSF. ref SDS 87 2E4K
041650 -
041651 -    1.  Subject: Treatment Plan 8th Relapse of Cancer Kaiser's Standard of Care
041652 -        Date: Sun, 31 May 2009 16:57:53 -0700
041653 -        From: Millie Buck
041654 -        To: Robert.A.Johnson@kp.org
041655 -        CC: hrugo@medicine.ucsf.edu
041656 -        IHsu@radonc.ucsf.edu
041657 -        Paula.Mcphail@kp.org
041659 -         ..
041660 -        Dear Doctor Johnson,
041662 -         ..
041663 -    2.  Good news.  My energy is up.  Yesterday, worked out in the gym,
041664 -        and then did the 3 mile hike at Lafayette Reservoir, and in a
041665 -        good time.  IBC areas treated with radiation and hyperthermia
041666 -        in February and March continue to recover, as Doctor Hsu
041667 -        predicted on 090423. ref SDS 52 5G4G
041669 -         ..
041670 -    3.  Your letter to the medical team on 090415 advised that the most
041671 -        recent CT test on 090413 shows no signs of cancer in internal
041672 -        organs. ref SDS 51 YO7M  All of the LNs in the neck and
041673 -        axillary that are symptoms of IBC had subsided. ref SDS 51 OO6M
041674 -        and ref SDS 51 4K5H  I expect by now there is new progression.
041676 -         ..
041677 -    4.  This record aligns with your evaluation in the medical chart on
041678 -        090515 finding ECOG performance score 0, ref SDS 58 ME6M,
041679 -        indicating I am a good candidate for timely care, rather than
041680 -        in need of Hospice.
041682 -         ..
041683 -    5.  I am worried now about cancer spreading beyond areas treated
041684 -        with radiation and hyperthermia in February and March.  CA 15-3
041685 -        320 from the blood test at Kaiser on 090512 signals spread of
041686 -        disease, which you observed on 090515, ref SDS 58 OT8N,
041687 -        following notice to Kaiser by Doctor Rugo that I have suffered
041688 -        progression [reported in Doctor Rugo's letter to Doctor Johnson
041689 -        on 090514 0830. ref SDS 55 DI63].  CA 15-3 320 is 400% higher
041690 -        than the level of 80 which you mentioned on 030710 flags
041691 -        patients in your practice who need urgent treatment.
041692 -        ref SDS 3 WS42
041694 -         ..
041695 -    6.  I realize I may not have accurately grasped the import of
041696 -        cancer marker discussions on 030710.  It is a complex technical
041697 -        matter above my expertise.  None-the-less I am worried that my
041698 -        evident good health will deteriorate quickly if I do not get
041699 -        treatment soon.  Doctor Rugo's recent letter on 090528 1456
041700 -        talked about me needing treatment next week. ref SDS 83 XZ4M  I
041701 -        have been requesting treatment since 090412, ref SDS 50 9S6K
041702 -        [and citing Millie's earlier request in a letter to the medical
041703 -        team on 090401 0046. ref SDS 48 RE8P]
041705 -         ..
041706 -    7.  Your letter on 090529 1537 notes my letter to the medical team,
041707 -        ref SDS 86 SZ9J, earlier in the morning at 1143 says I do not
041708 -        have a prescription for urgently needed treatment. ref SDS 85
041709 -        0M4Y  You cited your earlier letter on 090520 1011 that offered
041710 -        me the choice of Navelbine or Gemzar, and further directed me
041711 -        to Member services to interpret regulations on clinical trials.
041712 -        You further cited on 090529 1537 your letter on 090521 1453
041713 -        saying I "...can choose which next treatment I want.  At this
041714 -        time, no treatment would be considered more superior than
041715 -        another." [reported in the record on 090521 2006. ref SDS 73
041716 -        9Q9H
041718 -         ..
041719 -    8.  Your letter on 090529 concludes saying...
041720 -
041721 -        "I have not yet heard your respnse.  We can easily start
041722 -        treating you with either Gemzar or Navelbine, 2 very acceptable
041723 -        agents used in the treatment of breast cancer, this coming
041724 -        week.  Again, I need to hear fron you want you want to do
041725 -        next." [citing Millie's letter on 090529 1751. ref SDS 86 U34S
041726 -        and ref SDS 86 MV5G
041728 -         ..
041729 -    9.  You also note my medical history is confusing, and you complain
041730 -        that my correspondence is misleading. ref SDS 86 SZ9J  I
041731 -        apologize for adding to your burdens.  I do not intend to
041732 -        mislead.
041734 -         ..
041735 -   10.  I request a prescription based on standard of care for my
041736 -        patient profile, as you have done the past 8 years [applying
041737 -        treatments reviewed by UCSF at Doctor Johnson's request,
041738 -        reported on 090121 1017. ref SDS 24 EV53, including clinical
041739 -        trials researched on 090204 1747. ref SDS 34 4R3S, and repeated
041740 -        below, ref SDS 0 IH8W, and aligns with telecon on 090520 1023
041741 -        filing claim with Kaiser Expedited Claims Department demanding
041742 -        Kaiser perform requirements of EOC section 2, ref SDS 69 9595,
041743 -        and presented again to the medical team later that day on
041744 -        090520 1710. ref SDS 70 ZF4T]
041745 -
041746 -            [On 090531 2227 Kaiser failed to provide treatment, so
041747 -            Millie ordered treatment from UCSF. ref SDS 87 2E4K
041749 -         ..
041750 -   11.  I am concerned that your letter on 090522 1754 said Gemzar and
041751 -        Navelbine may not work, because I have resistant cancer.
041752 -        ref SDS 77 UW6G  In the meeting on 090515 I thought you
041753 -        indicated that Kaiser cannot prescribe Navelbine because it is
041754 -        not suitable for my patient profile. ref SDS 58 658J [shown as
041755 -        well by case study on 090325 0830. ref SDS 45 L15M].  It is a
041756 -        good drug, but not for me.
041758 -         ..
041759 -   12.  Research also shows side effects of Gemzar are very severe.
041760 -        [reported on 090529 1109. ref SDS 85 0M5X]
041762 -         ..
041763 -   13.  I object to changing standard of care that requires me to
041764 -        "choose" my next treatment, since I have always relied on my
041765 -        doctor to prescribe treatment.  I am worried about treatments
041766 -        with Navelbine and Gemzar because you have considered these
041767 -        drugs in the past and have not prescribed them (see the record
041768 -        on 040318 prescribing a clinical trial rather than Navelbine or
041769 -        Gemzar. ref SDS 4 PU6M
041771 -         ..
041772 -   14.  I'm worried about low blood counts.  My last test on 090512
041773 -        showed ANC 1320, ref SDS 54 B35J, is already below the level
041774 -        for chemotherapy using drugs like Gemzar, and that is without
041775 -        having any treatment for 2 months.  Gemzar lists low blood
041776 -        counts as a primary side effect.  We can fight that problem
041777 -        with Neupogen, but that is expensive and time consuming [and
041778 -        also causes severely painful side effects.]
041779 -
041780 -            [On 090601 0818 at 1132 Brad in the Kaiser Oncology
041781 -            Pharmacy called and advised that Doctor Johnson prescribed
041782 -            Gemzar chemotherapy; and Brad advised that Millie's blood
041783 -            counts are too low for this treatment; he ordered another
041784 -            blood test and advised that if counts are still too low the
041785 -            Kaiser Pharmacy will not approve Gemzar for Millie.
041786 -            ref SDS 88 FR8L
041788 -             ..
041789 -            [On 090605 Millie received documentation from Kaiser that
041790 -            says Gemzar has high risks for Millie's patient profile;
041791 -            requires extreme caution given after getting treatment with
041792 -            radiation, which Millie received for 4 weeks in February
041793 -            and March, and contiues to suffer side effects; Kaiser
041794 -            further says treatment with Gemzar requires avoiding blood
041795 -            thinners, and Millie is required to take blood thinners
041796 -            every day to prevent death from pulmonary embolism; Gemzar
041797 -            can cause low blood counts that leads to infection and
041798 -            death, Millie has a history of low blood counts.
041799 -            ref SDS 94 V34K
041801 -         ..
041802 -   15.  You have prescribed treatment in clinical trials 4 times over
041803 -        the past 5 years, because they were more effective and had less
041804 -        side effects than Navelbine and Gemzar [reported on 070830
041805 -        0807. ref SDS 15 LQ5I].  This seems like good grounds to
041806 -        prescribe my next treatment.  Doctor Rugo said the MPA protocol
041807 -        is a targeted agent that has a chance of being effective for my
041808 -        ER- status.
041810 -         ..
041811 -   16.  She also said side effects of MPA are even less than cetuximab
041812 -        [reported on 090514 0830. ref SDS 55 DI4F].  Recall my blood
041813 -        counts did not prevent treatment with cetuximab, so I survived
041814 -        with a high quality of life for nearly 2 years with this
041815 -        regimen.  The MPA protocol, like cetuximab, does not list low
041816 -        blood counts as a high risk side effect [reported on 090514
041817 -        0830. ref SDS 55 KV9T].  That saves a lot of time and money for
041818 -        Neupogen to treat low blood counts.
041820 -         ..
041821 -   17.  I ask Kaiser to perform responsibility treating my cancer, and
041822 -        so request that you prescribe the best treatment for oncology
041823 -        standard of care required by my patient profile [repeating
041824 -        request above, ref SDS 0 IH6S], as you have done the past 8
041825 -        years [discussed in the call with Pamela in Kaisre Expedited
041826 -        Claims Department on 090520 1203. ref SDS 69 8S3I]
041828 -         ..
041829 -   18.  As you know I place great trust in you and Doctor Rugo.  Her
041830 -        recent letter said I could get Gemzar at Kaiser next week
041831 -        [reported on 090528 1613. ref SDS 83 4T6K].  I am afraid of
041832 -        Gemzar side effects and worried about effectiveness, as
041833 -        discussed above, but I trust my doctor.  If you prescribe
041834 -        Gemzar I will follow your prescription, because I need
041835 -        treatment desperately.
041836 -
041837 -            [On 090531 2227 Kaiser failed to provide treatment, so
041838 -            Millie ordered treatment from UCSF. ref SDS 87 2E4K
041839 -
041840 -
041842 -  ..
041843 - Gemzar Chemotherapy Weeks of Agony then Progression of Cancer
041844 -
041845 - Follow up ref SDS 76 2T4S.
041846 -
041847 -   19.  I am concerned treatment with Gemzar will fail for reasons you
041848 -        presented on 090515, ref SDS 58 658J [see as well case study on
041849 -        repeated warnings by Kaiser that Gemzar will not be effective,
041850 -        reported on 090325 0830. ref SDS 45 L15M], and we will then
041851 -        have this same discussion all over again in a week or a month,
041852 -        but with me weakened and devastated by worsening cancer and
041853 -        side effects.  Quality of life will be reduced to nothing
041854 -        [repeating analysis reported to the team on 090522 1351,
041855 -        ref SDS 76 2T4S].
041856 -
041857 -            [On 090601 0818 at 1132 Brad in the Kaiser Pharmacy called
041858 -            and advised that Doctor Johnson prescribed treatment for
041859 -            Millie with Gemzar; advised that side effects of Gemzar
041860 -            will be very difficult for Millie to tolerate, and asked to
041861 -            verify that Millie agrees to get this treatment.
041862 -            ref SDS 88 8J8L
041864 -             ..
041865 -            [On 090601 1847 Millie's letter asks medical team again
041866 -            what will be prescribed after Gemzar? ref SDS 89 0C4S
041868 -             ..
041869 -            [On 090603 1128 Millie asks medical team again for work
041870 -            plan with criteria to evaluate progression of her cancer
041871 -            getting Gemzar chemotherapy, and with a list of additional
041872 -            treatments targeted to Millie's patient profile after
041873 -            Gemzar fails, which is expected not to work at all.
041874 -            ref SDS 90 028X
041876 -             ..
041877 -            [On 090603 1412 Doctor Johnson's reply letter to Millie
041878 -            did not respond with criteria for evaluating progression
041879 -            of disease, and when treatment must be changed. 090603
041880 -            1507, ref SDS 91 07AD
041882 -             ..
041883 -            [On 090603 1524 Queenie called from Kaiser Pharmacy and
041884 -            Millie asks for criteria Kaiser will use to evaluate
041885 -            progressio of disease that signals requirement to change
041886 -            treatments; Queenie will discuss with the doctor and send a
041887 -            letter confirming understandings on Kaiser's work plan,
041888 -            including serious side effects of Gemzar. ref SDS 92 7J4I
041890 -             ..
041891 -            [On 090604 1021 Millie's letter to medical team requests
041892 -            treatment plan on criteria for evaluating when treatment
041893 -            needs to be changed, and what treatments can continue
041894 -            Millie's recovery from the 8th relapse of cancer as a
041895 -            chronic disease. ref SDS 93 VM3T
041897 -             ..
041898 -            [On 090605 Millie received documentation from Kaiser that
041899 -            says Gemzar has high risks for Millie's patient profile;
041900 -            requires extreme caution given after getting treatment with
041901 -            radiation, which Millie received for 4 weeks in February
041902 -            and March, and contiues to suffer side effects; Kaiser
041903 -            further says treatment with Gemzar requires avoiding blood
041904 -            thinners, and Millie is required to take blood thinners
041905 -            every day to prevent death from pulmonary embolism; Gemzar
041906 -            can cause low blood counts that leads to infection and
041907 -            death, Millie has a history of low blood counts.
041908 -            ref SDS 94 V34K
041910 -         ..
041911 -   20.  Kaiser has many prescription options for me with potential for
041912 -        success and less side effects [reported previously to the team
041913 -        on 090528 1228, ref SDS 81 4N5U, and citing the list discussed
041914 -        with UCSF on 090121, ref SDS 24 EV53, including research on
041915 -        treatments targeted to Millie's patient profile, listed on
041916 -        090204, ref SDS 34 4R3S, and submitted to Kaiser on 090326, as
041917 -        discussed during the meeting at Kaiser on 090515 1140,
041918 -        ref SDS 58 P36O].
041920 -         ..
041921 -   21.  I have asked before about hyperthermia and Doxil or other
041922 -        agents.  Kaiser has already approved this in the referral on
041923 -        090202, based on Doctor Rugo's letter to you on 090129.  Doxil
041924 -        is listed in the Benz 2nd opinion received from you on 041117,
041925 -        and again in a follow up 2nd opinion on 060929.  Doctor Rugo's
041926 -        letter said hyperthermia increases effectiveness of Doxil.
041927 -        Isn't that what I need right now?
041929 -         ..
041930 -   22.  Radiation and hyperthermia was very effective.  Can this be
041931 -        continued?
041933 -         ..
041934 -   23.  Research seems to say side effects of Doxil are mild to
041935 -        moderate and may be minimized.  That sounds attractive.  The
041936 -        one that jumps out is "hand-foot" syndrome.  Is this similar to
041937 -        neuropathy?  I have have tolerated neuropathy pretty well,
041938 -        although with sunitinib it eventually got so bad after about 2
041939 -        months that I could not hike.
041941 -         ..
041942 -   24.  In sum, I request urgent treatment for my patient profile based
041943 -        on standard of care applied the past 8 years.  I need an
041944 -        appointment to get treatment immediately, as called out in
041945 -        Doctor Rugo's letter on 090528 1456, and requested in my letter
041946 -        to the medical team on 090528 1700.
041947 -
041948 -            [On 090531 2227 Kaiser failed to provide treatment, so
041949 -            Millie ordered treatment from UCSF. ref SDS 87 2E4K
041951 -         ..
041952 -   25.  Thanks very much for assistance.
041953 -
041960 -
041961 -
041962 -
041963 -
041964 -
041965 -
0420 -