CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 42 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040508 -
0406 -
SUBJECTS
Breathing Difficulty Pain Radiation Injury Medical Mistake Radiation
1503 -
1504 - Background
150501 - ..
150502 - Breathing Difficulty Increases Causing Pain Kaiser Says Go to ER
150503 -
150504 -
150505 - Millie had a meeting at UCSF on 090716 to evaluate progress getting
150506 - treatment with MPA protocol.
150508 - ..
150509 - The agenda for the meeting reported improvement recovering from IBC
150510 - evident by decreasing inflammation in the left arm, after getting
150511 - worse for several weeks following start of treatment and examination
150512 - at UCSF the month before on 090616. The agenda further requested
150513 - treatment for rising breathing problems reported the past few months.
150515 - ..
150516 - Examination concurred that IBC has worsened since the meeting on
150517 - 090616, and was unable to recognize improvement in the past few days.
150519 - ..
150520 - Tara was very concerned during the meeting about Millie's difficulty
150521 - breathing evident from ordinary conversation. Tara had Millie do a
150522 - test walking down the hallway connected to diagnostic aparatus. Tara
150523 - did not recognize any particular problems; she said the diagnostics
150524 - look okay doing the breathing test.
150526 - ..
150527 - Tara said she feels Millie may be suffering pulmonary embolism (PE).
150528 - She asked when Millie's next CT test is scheduled? Since Millie's
150529 - last CT was on 090612, the next test is due 8 weeks later on 090812,
150530 - based on MPA protocol. Tara said Millie should get another CT test
150531 - immediately at Kaiser to check for PE, based on rising symptoms.
150533 - ..
150534 - Tara left the examination room. She returned about 10 minutes later,
150535 - and seemed to say she had consulted with Doctor Rugo or possibly
150536 - another doctor, because she later said Doctor Rugo was on a plane
150537 - returning from a trip, and could not receive calls.
150539 - ..
150540 - When Tara returned, she said Millie must end treatment with MPA
150541 - immediately, and cast this drastic change in care to finding that
150542 - Millie's IBC is worse than a month before, and despite evidence of
150543 - improvement in the past week.
150545 - ..
150546 - Ending treatment immediately is much different than occurred with the
150547 - prior treatments, when similar circumstances occurred. On 070301
150548 - Doctor Rugo thought examination showed Millie was not responding to
150549 - treatment with cetuximab, but continued treatment for another week to
150550 - evaluate the cancer marker. The following week, when the cancer
150551 - marker showed significant improvement, the doctor continued Millie's
150552 - treatment, and this lasted for nearly 2 years. Similarly, on 090108
150553 - the doctor was concerned about possibility of IBC progressing with the
150554 - sunitinib protocol. She allowed Millie to continue getting treatment
150555 - another 2 weeks to verify treatment actually failed. On Thursday,
150556 - ending treatment immediately was like ending Avastin on 041103.
150557 -
150559 - ..
1506 -
1507 -
1508 - 1445
1509 -
150901 - Since Thursday, Millie has suffered progressive breathing problems.
150902 - The big difference is she now has pain coughing or breathing deeply.
150903 - These problems have been reported to the medical team for advice.
150905 - ..
150906 - There has been no response.
150908 - ..
150909 - This afternoon, symptoms have increased again, Millie is in
150910 - significant distress.
150912 - ..
150913 - Called Kaiser to speak with Doctor Johnson.
150915 - ..
150916 - The doctor is onsite today, but he is working in the Palliation
150917 - project to relieve distress of cancer patients. Was transferred to
150918 - the doctor's assistant. Reported problem of pain. The nurse said she
150919 - can contact Doctor Johnson for emergency advice in a few minutes. She
150920 - went offline to contact Doctor Johnson working in the Palliation
150921 - Department.
150923 - ..
150924 - The nurse came back online and said to take Millie to the Emergency
150925 - Department.
150926 -
150928 - ..
1510 -
1511 -
1512 - 1449
1513 -
151301 - Pam called to see if Millie's doctor called to schedule a meeting.
151302 -
151303 - Explained that the doctor said to take Millie to the ER for evaluation
151304 - of difficult breathing.
151305 -
151306 -
151307 -
151309 - ..
1514 -
1515 -
1516 - 1533
1517 -
151701 - Emergency Department Admission Recover Breathing Problems
151702 -
151703 -
151704 - Arrived at Kaiser ER.
151705 -
151706 - Reported painful breathing.
151708 - ..
151709 - The receptionist took Millie immediately for care. This improves
151710 - significantly prior practice in ER that takes 3 - 4 hours to see a
151711 - doctor.
151713 - ..
151714 - Millie connected to diagnostics.
151716 - ..
151717 - Fever 99.7 worrisome about getting Cellulitis on left arm with IBC.
151719 - ..
151720 - Stewart did an EKG. Results were negative for any problems.
151721 -
151723 - ..
1518 -
1519 -
1520 - 1603
1521 -
152101 - Millie wheeled into the hallway on a gurney to wait for a room so a
152102 - doctor can make an examination.
152103 -
152105 - ..
1522 -
1523 -
1524 - 1618
1525 -
152501 - Pam arrived to visit with Millie.
152502 -
152503 - She called Steve and Ron to let them know Millie is in the ER.
152504 -
152505 -
152507 - ..
1526 -
1527 -
1528 - 1652
1529 -
152901 - Millie taken from waiting area to an emergency room for diagnosis and
152902 - treatment.
152904 - ..
152905 - Diana is the nurse.
152907 - ..
152908 - She connects diagnostics.
152909 -
152911 - ..
1530 -
1531 -
1532 - 1717
1533 -
153301 - Doctor Lozano arrives.
153302 -
153303 - Reviews patient history from Doctor Johnson's notes in the medical
153304 - chart reporting on meeting at Kaiser on 090626.
153306 - ..
153307 - Update the doctor with recent history starting treatment at UCSF on
153308 - 090616 with MPA and ending treatment this past Thursday on 090716
153309 - because the doctor feels there may be progression of IBC, and also
153310 - because of Millie's increasing problems breathing, since pulmonary
153311 - embolism is a side effect of MPA.
153313 - ..
153314 - Doctor Lozano asked about inflammatory breast cancer? He said IBC is
153315 - new to his practice.
153316 -
153317 - [On 090919 0742 Doctor Roth was also no familiar with IBC when
153318 - Millie was treated again for breathing problems. ref SDS 43 EQ6K
153320 - ..
153321 - The doctor asked how long Millie has had breathing problems?
153323 - ..
153324 - Explained this began in late March and April, and has gradually gotten
153325 - worse, per background above. ref SDS 0 DQ5O Millie began suffering
153326 - pain with her breathing about Thursday or Friday of last week, so 3 or
153327 - 4 days ago. Today the pain increased, so Millie requested guidance
153328 - from the primary care physician. The Advice Nurse for Oncology said
153329 - Millie should be treated immediately in the Emergency Department, per
153330 - above. ref SDS 0 P13H
153332 - ..
153333 - She has had occassional pain from tightness on the left side for
153334 - several months. This has gradually gotten worse to now affect
153335 - breathing.
153337 - ..
153338 - Doctor Lozano examined Millie and asked about the extensive rash on
153339 - Millie left side and her arm? Millie said that is the IBC disease.
153341 - ..
153342 - Doctor Lozano asked about the severe sore in Millie's chest, that is
153343 - covered with a bandage. He removed the bandage to examine the wound.
153345 - ..
153346 - Explained problems with radiation treatments that missed IBC in this
153347 - location. Doctor Lozano seemed to say he found on Kaiser's computer
153348 - the report on Millie's xray test on 090709, ordered by Doctor Johnson
153349 - to evaluate Millie's increasing breathing problems the past few
153350 - months. Today, Doctor Lozano indicated that if there was lung cancer
153351 - causing Millie's breathing problems, then the xray test should have
153352 - shown it. Therefore, he feels lung cancer is not likely the cause of
153353 - Millie's severe breathing problems today.
153355 - ..
153356 - Reviewed findings of ground glass opacities in the lungs reported for
153357 - the CT test on 090415 and on 090612. This could signal radiation
153358 - injury to the lungs from treatment at UCSF in Feb and Mar.
153360 - ..
153361 - The doctor feels Millie's breathing problems could be caused by...
153362 -
153363 - 1. Pulmonary embolism discussed at UCSF on 090716 as side
153364 - effect of MPA; the doctor cited Millie's susceptibility
153365 - from 2 prior PEs.
153366 -
153367 - 2. Radiation injury progressing in lungs aligns with long
153368 - period of rising breathing problems for past 3 months.
153370 - ..
153371 - 3. Cancer metastasis in lungs from untreated IBC on
153372 - breastbone since 090122, could be possible despite
153373 - negative findings from several readings of recent CT
153374 - tests, and the xray test last week.
153376 - ..
153377 - The doctor ordered a CT test to evaluate causes of Millie's breathing
153378 - problems.
153379 -
153380 - [...below results CT test favorable, no cancer, no lung
153381 - injury. ref SDS 0 GA37
153383 - ..
153384 - The doctor said a nurse will draw blood and set up an IV for injecting
153385 - contrast medium to perform the CT test.
153387 - ..
153388 - There was extensive discussion that Millie's patient profile listed on
153389 - 090213 1140. ref SDS 37 AC6G, requires injecting contrast medium for
153390 - CT tests only through her Power Port.
153392 - ..
153393 - Doctor Lozano said that the CT Department refuses to inject contrast
153394 - medium through ports, because port catheters are not designed for
153395 - high pressure injection.
153397 - ..
153398 - Reviewed the record of Millie's patient history. Kaiser performed
153399 - surgery on 080708 to remove Millie's conventional port catheter and
153400 - installed a Power Port that is designed for injecting contrast medium
153401 - to perform CT tests. ref SDS 30 JE7N Kaiser's CT Department here at
153402 - Walnut Creek has used Millie's Power Port 4 - 5 times for injecting
153403 - contrast medium, most recently on 090413 1500. ref SDS 38 3G5I
153405 - ..
153406 - Doctor Lozano called the CT department. He asked if he can send
153407 - Millie for a CT test using her Power Port to inject contrast medium?
153409 - ..
153410 - The attendant at the CT Department said nobody in the department knows
153411 - anything about using Power Ports. The deparmtment will only do the CT
153412 - test using a conventional IV. Doctor Lozano could not present patient
153413 - history to assist the CT Department performing Doctor Johnson's
153414 - prescription for Millie to have CT contract medium injected through
153415 - her Power Port, because her patient profile conflicts with using
153416 - conventional IV practice.
153418 - ..
153419 - As a result, Doctor Lozano proposed to Millie that the nurse try
153420 - setting a coventional needle puncture IV to inject contrast medium for
153421 - the CT test he has ordered to evaluate Mil's breathing problems.
153422 -
153423 - [On 090919 0742 ER Department reported getting training and
153424 - orientation on using Huber needle with Power Port technology
153425 - rather than conventional IV needles to support CT tests.
153426 - ref SDS 43 QY6W
153428 - ..
153429 - We reviewed the record on 080425 showing that trying to set
153430 - conventional needle IVs is extremely difficult and frustrating for the
153431 - nurse, and very painful for Millie. ref SDS 28 FP6F
153433 - ..
153434 - The doctor noted advantages of timely, accurate memory available in
153435 - the SDS record for treating the patient today. He has never
153436 - encountered this level of detailed support for care in the ER, and
153437 - commended the role of doctor patient partnership.
153439 - ..
153440 - Doctor Lozano said not to tell Nurse Deana that Millie's veins are
153441 - difficult to setup an IV because notice that placing an IV in Millie's
153442 - right arm is difficult will make the nurse nervous, and increase
153443 - chances of failure.
153444 -
153446 - ..
1535 -
1536 -
1537 - 1748
1538 -
153801 - Deana arrives and tries to setup an IV for CT test contrast medium.
153802 -
153803 - After several attempts, Deana cannot find a vein to setup the IV with
153804 - adequate blood flow. Deana is very disappointed and emotional because
153805 - the problem is more difficult than expected. Deana requests assisance
153806 - from Maria.
153808 - ..
153809 - Deana leaves.
153811 - ..
153812 - Since the ER nurses were not accessing Millie's Power Port, per Doctor
153813 - Lozano's instructions, Millie did not remind the nurses to use a 1"
153814 - high strength steel needle, reported in the record on 080708 as
153815 - essential for adequate blood flow. ref SDS 30 JE7N, and which Kaiser
153816 - has standardized using Lifeguard 1" Huber needles, reported on 081017.
153817 - ref SDS 33 045H
153819 - ..
153820 - Maria explains that Deana is upset today, because she has a reputation
153821 - in the department for solving the most difficult blood draw problems.
153823 - ..
153824 - Maria apologizes for difficulty causing Millie pain and suffering
153825 - setting the IV required for the CT test.
153827 - ..
153828 - Maria is finally able to find a vein and set up an IV to draw blood
153829 - for labs ordered by Doctor Lozano, but they are unable to get IV setup
153830 - in the manner required for high pressure injection of contrast medium.
153831 - Apparently the rate of blood flow is still insufficient using the 3 or
153832 - 4 veins tried so far.
153833 -
153835 - ..
1539 -
1540 -
1541 - 1926
1542 -
154201 - Pam is upset by difficulty her mom is experiencing getting the IV
154202 - setup for the CT test contrast medium.
154204 - ..
154205 - Pam leaves for home.
154206 -
154207 - [On 090919 0742 ER Department reported getting training and
154208 - orientation on using Huber needle with Power Port technology
154209 - rather than conventional IV needles to support CT tests.
154210 - ref SDS 43 QZ45
154211 -
154212 -
154214 - ..
1543 -
1544 -
1545 - 1932
1546 -
154601 - Diana came into Millie's Emergency Room, replacing Deana and Maria.
154602 -
154603 - Diana apologizes for severe pain Millie has suffered attempting to
154604 - set and IV, rather than use Millie's Power Port, ordered by Doctor
154605 - Johnson to avoid problems occurrig today.
154607 - ..
154608 - Diana offered to try one more time to do a convetional needle puncture
154609 - IV for contrast medium for Millie's CT test. She has discussed
154610 - Millie's situation with Deana and Maria, and feels there may be
154611 - another way to accomplish the IV in Millie's arm, so that the CT
154612 - Department can do the test tonight ordered by Doctor Lozano to
154613 - evaluate Millie's breathing problems.
154615 - ..
154616 - Diana further proposed that if this attempt fails again, then she will
154617 - talk to Doctor Lozano about changing the CT test from tonight to
154618 - tomorrow. She is not sure the doctor can do this. He might have to
154619 - send Doctor Johnson a letter and ask the primary care physician to
154620 - order a CT test through normal channels, rather than through the ER.
154622 - ..
154623 - Diana set up to try another IV for CT test contrast medium.
154625 - ..
154626 - Millie pointed to a spot on inner elbow.
154628 - ..
154629 - Diana studied this area for several minutes, and agreed to try the
154630 - IV.
154631 -
154633 - ..
1547 -
1548 -
1549 - 1941
1550 -
155001 - Diana succeeded getting the IV configured for injecting CT test
155002 - contrast medium.
155004 - ..
155005 - This was painful for Millie. Diana appologized for this.
155007 - ..
155008 - Millie thanked Diana for making another try, and said the pain is
155009 - worth it to get the CT test done tonight so the painful breathing
155010 - problem can be fixed.
155012 - ..
155013 - Diana called the CT Department and asked them to send someone to get
155014 - Millie.
155015 -
155016 -
155017 -
155018 -
155019 -
155021 - ..
1551 -
1552 -
1553 - 2010
1554 -
155401 - Nurse arrived for Millie's CT test.
155402 -
155403 -
155405 - ..
1555 -
1556 -
1557 - 2032
1558 -
155801 - Millie returns from CT Department.
155802 -
155804 - ..
1559 -
1560 -
1561 - 2038
1562 -
156201 - Diana comes in and connects Millie to diagnostics again.
156202 -
156203 -
156205 - ..
1563 -
1564 -
1565 - 2105
1566 -
156601 - Notice diagnostics not working. Notify Diana.
156602 -
156603 - She explains she forgot to activate the equipment.
156605 - ..
156606 - Diagnostics now running.
156608 - ..
156609 - Concern is Millie's temperature. She had a fever when she arrived of
156610 - 99.8.
156612 - ..
156613 - Rising temperature can signal cellulitis. and if this occurs with IBC
156614 - on the left arm it will be difficult to treat.
156615 -
156617 - ..
1567 -
1568 -
1569 - 2200
1570 -
157001 - Doctor arrives with results of the CT test.
157002 -
157003 - Doctor Lozano would not submit the report to the customer. He said
157004 - patients have to go to the business office. He said the business
157005 - office is closed at this time, but customers can drive back to the
157006 - hosptial tomorrow and stand in line to get the report he has in his
157007 - hand.
157008 -
157009 -
157010 -
1571 -
SUBJECTS
CT Test 090720 Kaiser Radiology Report Prescribed by Doctor Lazano K
2503 -
250401 - ..
250402 - CT Test Results Favorable
250403 -
250404 - Doctor Lozano ordered a CT test to evaluate Millie's painful
250405 - breathing, per above. ref SDS 0 RW43
250406 -
250407 - Millie's last CT test was on 090612, ref SDS 40 026E, with
250408 - results reported on 090617. ref SDS 41 GM3N
250410 - ..
250411 - Test History No Evidence Distant Metastasis
250412 - Distant Metastasis No Evidence 8 Years Imaging Tests
250413 -
250414 - Follow up ref SDS 41 GM3N. ref SDS 39 GM3N.
250415 -
250416 - CT test today on 090720 continues Millie's 8 year history of
250417 - testing that finds no evidence of distant metastasis.
250419 - ..
250420 - Type Date Received Source
250421 - 1. CT 090720 reported on 090720.............. ref SDS 0 DA6Q
250422 - 2. CT 090612 reported on 090617.(neck)....... ref SDS 41 DA6Q
250423 - CT 090612 reported on 090617.(1st part)... ref SDS 41 DA6Q
250424 - 3. CT 090413 reported on 090415.............. ref SDS 39 DA6Q
250425 - 4. CT 081230 reported on 090107.(neck)....... ref SDS 36 DA6Q
250426 - CT 081230 reported on 090107.(1st part)... ref SDS 36 5O6N
250427 - 5. CT 081107 reported on 081113 (neck)....... ref SDS 35 DA6Q
250428 - CT 081107 reported on 081112 (1st part)... ref SDS 34 5O6N
250429 - 6. CT 080911 reported on 080912.............. ref SDS 32 DA6Q
250430 - 7. CT 080718 reported on 080723.............. ref SDS 31 DA6Q
250431 - 8. CT 080425 reported on 080428.............. ref SDS 29 DA6Q
250432 - 9. CT 080212 reported on 080215.............. ref SDS 27 DA6Q
250433 - 10. CT 071210 reported on 071213.............. ref SDS 26 UG4L
250434 - 11. CT 070930 reported on 071018.............. ref SDS 25 VK8L
250435 - 12. CT 070723 reported on 070802.............. ref SDS 24 IM6M
250436 - 13. CT 070520 reported on 070524.............. ref SDS 23 DA6Q
250437 - 14. CT 070326 reported on 070329.............. ref SDS 22 DA6Q
250438 - 15. CT 070131 reported on 070202.............. ref SDS 21 1Y8G
250439 - 16. PET/CT 061227 reported on 070102.............. ref SDS 20 1Y8G
250440 - 17. CT 060930 reported on 061012.............. ref SDS 19 284J
250441 - 18. MRI 060708 reported on 060711.............. ref SDS 18 PT4K
250442 - 19. Xray 060623 reported on 060711.............. ref SDS 18 WJ6G
250443 - 20. CT 060505 reported on 060523.............. ref SDS 17 E355
250444 - 21. PET 060414 reported on 060428.............. ref SDS 16 WJ6G
250445 - 22. PET 060120 reported on 060126.............. ref SDS 15 WJ6G
250446 - 23. PET/CT 051005 reported on 051007.............. ref SDS 14 WJ6G
250447 - 24. CT 050530 reported on 050610.............. ref SDS 13 G75L
250448 - 25. CT 050325 reported on 050422.............. ref SDS 12 G75L
250449 - 26. CT 041217 reported on 041230.............. ref SDS 11 G75L
250450 - 27. CT 041103 reported on 041104.............. ref SDS 10 WV7H
250451 - 28. CT 040921 reported on 041005.............. ref SDS 9 NL4N
250452 - 29. CT 040710 reported on 040811.............. ref SDS 8 H85S
250453 - 30. CT 040410 reported on 040416.............. ref SDS 7 LK5L
250454 - 31. CT 040307 reported on 040318.............. ref SDS 6 LK5L
250455 - 32. CT 031031 reported on 031205.............. ref SDS 5 IG9K
250456 - 33. CT 030626 reported on 030710.............. ref SDS 4 AL6N
250457 - 34. CT 030428 reported on 030508.............. ref SDS 3 LK5L
250458 - 35. PET 021218 reported on 030109.............. ref SDS 2 LK5L
250459 - 36. PET 020529 reported on 020603.............. ref SDS 1 0001
250461 - ..
250462 - Good news - Doctor Lozano said the report for the CT test today...
250463 -
250464 - 1. Pulmonary embolism - negative.
250466 - ..
250467 - 2. Radiation injury progressing in lungs aligns with long
250468 - period of rising breathing problems for past 3 months.
250470 - ..
250471 - 3. Cancer metastasis in lungs from untreated IBC on breastbone
250472 - since 090122 - negative - could be possible despite
250473 - negative findings from several readings of recent CT tests,
250474 - and the xray test last week.
250476 - ..
250477 - Doctor Lazano said at this time Millie's pain and difficulty
250478 - breathing, and progressing cough have undetermined etiology, since
250479 - testing this evening has shown no evident cause, per above.
250480 - ref SDS 0 GA37
250482 - ..
250483 - Doctor Lazano prescribes follow up with primary care physician, Doctor
250484 - Johnson, and with Internal Medicine...
250485 -
250486 - 925 295 4070
250487 -
250488 -
250489 -
250490 -
250491 -
250492 -
250493 -
2505 -