CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 87 0000. ref SDS 86 0000.
040502 -
040504 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 100427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks
040902 - so good nobody can believe she has such severe cancer, ref SDS 87
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through
040904 - 11 relapses to resist chemotherapy. Kaiser has a new strategy for
040905 - Millie to recover from UCSF medical mistakes, discovered on 090609,
040906 - ref SDS 38 W65W, by prescribing therapy for treating cancer as a
040907 - chronic disease by "targeting" the genetic profile of cancer that has
040908 - mutated in patients, like Millie, to resist chemotherapy. ref SDS 87
040909 - SJ6N Millie overjoyed Kaiser's "new" strategy implements UCSF's work
040910 - plan prescribing PARP, and issued over a year ago on 090616.
040911 - ref SDS 39 D647
040913 - ..
040914 - On 100501 1037 Millie letter to medical team confirms Kaiser's new
040915 - strategy to treat Millie's cancer with "targeted therapy." ref SDS 88
040916 - F25O Millie requests Kaiser immediately switch from Abraxane
040917 - chemotherapy that has failed, and implement Doctor Rugo's plan at UCSF
040918 - on 090616, to treat Millie with PARP that is "targeted" to Millie's
040919 - rare patient profile of "triple negative" and avoids pain and
040920 - suffering from chemotherapy side effects, and for the purpose of
040921 - recovering from UCSF medical mistakes. ref SDS 88 U47P and ref SDS 88
040922 - U49V
040924 - ..
040925 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040926 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040927 - of cancer caused by UCSF medical mistakes. ref SDS 89 HH4I
040929 - ..
040930 - On 100502 2143 Kaiser confirms that some patients respond well to new
040931 - "targeted" therapies. ref SDS 91 YX8L Kaiser contends that all of the
040932 - strategies for "targeted" therapies have been executed for Millie,
040933 - which seems conflicting with the record in this case. ref SDS 91 MZ4N
040935 - ..
040936 - On 100503 1522 Millie notifies medical team that time of the essence
040937 - to get the next treatment going. ref SDS 92 TD5W
040939 - ..
040940 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040941 - with Abraxane chemotherapy that seems to be failing, and then after 3
040942 - more weeks without treatment, following a trip abroad, the doctor will
040943 - discuss "next steps." ref SDS 93 YL5N
040945 - ..
040946 - On 100503 2338 Millie reports to medical team that she will implement
040947 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040948 - letter on 010503, as assurance that recovery will be equal to changing
040949 - treatment immediately on 100505. ref SDS 94 6X7S
040951 - ..
040952 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040953 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040954 - communicate with Doctor Johnson, or had already done so, to coordinate
040955 - with Kaiser on planning Millie's next treatment to recover from the
040956 - 11th relapse of cancer. ref SDS 95 NT5N
040958 - ..
040959 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040960 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040961 - ref SDS 96 KE4K
040963 - ..
040964 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040965 - seemingly on an accelerating rise, which threatens to cascade out of
040966 - control, because Abraxane chemotherapy is not effective. ref SDS 97
040967 - L54I
040969 - ..
040970 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040971 - Abraxane. ref SDS 98 KE4K
040973 - ..
040974 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 99 PK9O
040976 - ..
040977 - On 100527 0217 Millie files claim with Kaiser Case Resolution
040978 - Department for standard of care to recover from 11th relapse of cancer
040979 - caused by medical mistakes getting radiation treatments at UCSF on
040980 - referral from Kaiser. ref SDS A0 IZ7N
040982 - ..
040983 - On 100528 0322 Millie requests support from Medicare to separate
040984 - recovery for medical mistakes getting radiation from UCSF, from health
040985 - care benefits limited by Medicare insurance coverage. ref SDS A1 QQ6N
040987 - ..
040988 - On 100528 1031 called Medicare they have formed a team to review
040989 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040990 - response to Millie's claim. ref SDS A2 4W5F
040992 - ..
040993 - On 100601 0136 Millie submitted agenda to medical team for meeting
040994 - with Doctor Johnson at Kaiser on the work plan for Millie to recover
040995 - from UCSF medical mistakes. ref SDS A3 QQ6N
040997 - ..
040998 - On 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040999 - collaborate with UCSF on treatment for Millie to recover from UCSF
041000 - medical mistakes. He discussed treating Millie with MPA, but this was
041001 - not prescribed because Millie was treated with MPA in 2009, and UCSF
041002 - ended the treatment due to fears about blood clot side effects, which
041003 - were believed to cause breathing problems Millie had, though later
041004 - breathing problems were discovered to be caused by defective radiation
041005 - treatment. Since Doctor Johnson said Kaiser has no more treatments
041006 - for Millie, the only way Millie can get relief from pain caused by
041007 - cancer that is progressing without treatment is get treatment in
041008 - Hospice. Since Hospice is the only choice of care offered today,
041009 - Millie accepted this. ref SDS 0 036C
041010 -
041011 -
041012 -
041013 -
041015 - ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Doctor Johnson looks well. He explained a new tan from working in the
041402 - gqrden at home over the long Memorial day weekend. The doctor has a
041403 - slight cold or the flu this morning, from overwork treating patients
041404 - in Oncology, supporting a new Oncology Department at the new Kaiser
041405 - hospital in Antiock, and from duties as Chief of a new Paliation
041406 - Department, which Doctor Johnson has developed the past 5 years.
041408 - ..
041409 - During the meeting today, one of the receptionists at the front desk,
041410 - knocked and came into the Examination Room. She avised Doctor Johnson
041411 - that a patient getting chemotherapy has just requested an exigent
041412 - meeting with Doctor Johnson.
041414 - ..
041415 - Doctor Johnson advised that his schedule is too hectic. He cannot add
041416 - another meeting to see the patient.
041418 - ..
041419 - Doctor Johnson received Millie's claim requesting immediate treatment
041420 - with PARP or equal, implementing UCSF work plan to provide necessary
041421 - and reasonable care for Millie to recover from UCSF medical mistakes,
041422 - filed on 100527. ref SDS A0 IZ7N
041424 - ..
041425 - The doctor also received Millie's letter sent early this morning with
041426 - via email, and submitting an agenda for the meeting today, and
041427 - requesting treatment with PARP as set out in Millie's claim, reported
041428 - on 100601 0136, ref SDS A3 QQ6N
041430 - ..
041431 - Doctor Johnson was encouraged that Millie's lab on Saturday, 100529,
041432 - shows blood counts are excellent. ref SDS A3 1P5W He was very
041433 - disappointed Millie's cancer has gotten worse without treatment for
041434 - the past 4-weeks, ref SDS A3 1P6U, since she requested switching
041435 - treaetment on 100501. ref SDS 88 U44V
041437 - ..
041438 - Millie asked for a stronger medication to reduce itching that is
041439 - getting worse from IBC lesions rising mostly on the right side. She
041440 - said the problem is worse at night, becasue when groggy, she tears her
041441 - skin scratching, and this causes bleeding.
041443 - ..
041444 - Doctor Johnson prescribed Atarax to relieve itching, which is called
041445 - pruritis in the medical chart. ref SDS 0 W28P
041446 -
041447 - [On 100728 1016 Millie starting to decline, and so is
041448 - medicated with morphine; she then needed less Atarax and
041449 - cortisone to relieve itching. ref SDS B9 QK56
041451 - ..
041452 - Doctor Johnson examined new problem of swelling in both lower legs,
041453 - reported in Millie's letter this morning on 100601 0136, ref SDS A3
041454 - 1Q3S
041456 - ..
041457 - There is a vertical vein visible on the inner side of both lower legs.
041458 - Millie said this area is painful to slight pressure by touch.
041460 - ..
041461 - Doctor Johnson diagnosed Phlebitis.
041463 - ..
041464 - Phlebitis came to prominence when President Nixon resigned in 1974.
041465 - Shortly out of office, the ex-president was diagnosed with life
041466 - threatening Phelibitis infection, reported by Time magazine Monday,
041467 - Nov. 11, 1974...
041468 -
041469 - THE EX-PRESIDENT: Nixon: Surgery, Shock and Uncertainty
041471 - ..
041472 - http://www.time.com/time/magazine/article/0,9171,911480,00.html
041474 - ..
041475 - Nixon's trauma... twelve days in Memorial [hospital] in late
041476 - September and early October for treatment of phlebitis, the
041477 - painful inflammation of the veins in his left leg that... could
041478 - at any time cause a fatal blood clot to travel upward in the
041479 - bloodstream through his heart to the lungs.
041481 - ..
041482 - Doctor Johnson prescribed immediate treatment with Relafen for 2 weeks
041483 - to reduce Phlebitis inflammation and swelling. Asked the doctor to
041484 - include this in the medical chart, and this was entered, shown below.
041485 - ref SDS 0 7E9W
041486 -
041487 - [On 100602 0913 Millie reported to the Hospice rep, Liz,
041488 - that Doctor Johnson prescribed treatment for 2-weeks with
041489 - Relafen to recover from Phlebitis, ref SDS A5 3V70; Liz
041490 - advised that Ralafen can complement morphine to reduce
041491 - Millie's discomfort from IBC, and so increased treatment
041492 - beyond 2-weeks. ref SDS A5 3V94
041494 - ..
041495 - Phlebitis is the second near-fatal infection Millie has suffered since
041496 - getting shingles on 100104. At that time, Doctor Zhang diagnosed
041497 - severe infection was caused by treating Millie with chemotherapy,
041498 - which conflicts with her patient profile, reported on 100104 1115.
041499 - ref SDS 56 PS49 Earlier, on 090601, the Kaiser Pharmacist reported
041500 - that chemotherapy exposes Millie to fatal infections, ref SDS 37 FR8L,
041501 - and that chemotherapy is no longer effective for treating Millie's
041502 - cancer. ref SDS 37 JH4K Despite conflicts with Millie's patient
041503 - profile, Kaiser treated Millie with Gemzar chemotherapy beginning on
041504 - 090728 0930, ref SDS 43 W65H, implementing UCSF recommendations and
041505 - work plan for Millie to recover from UCSF medical mistakes, reported
041506 - on 090716 2106. ref SDS 41 EE5W On 091112, Doctor Johnson reported
041507 - communication with Doctor Rugo on treating Millie with Navelbine and
041508 - Abraxane after Gemzar, and until UCSF can provide "targeted" treatment
041509 - with PARP. ref SDS 47 QN5G
041511 - ..
041512 - This record of 2 near fatal infections while getting treatment with
041513 - chemotherapy demonstrates why Millie needs treatment "targeted" to
041514 - cancer that does not cause side effects, and is more effective than
041515 - chemotherapy, reported on case study on 090213 1140. ref SDS 28 PT3N
041517 - ..
041518 - [On 100706 1452 Linda, Hospice Case Manager, reported no
041519 - signs of phlebitis in either leg, since ending chemotherapy
041520 - and getting treatment. ref SDS B8 2F9K
041532 - ..
041533 - Millie asked this morning if there are any conflicts between Relafen
041534 - prescribed today to recover from Phlebitis, and her other medications,
041535 - including warfarin (Coumadin)?
041537 - ..
041538 - Doctor Johson advised that Relafen is in Kaiser's computer, and so
041539 - Millie's Coagulation Control Case Manager, Gloria, will automatically
041540 - be notified by Kaiser's Knowledge Management computer system to
041541 - investigate for drug conflicts, and can make any adjustments needed to
041542 - prevent complications.
041544 - ..
041545 - Millie was very emotional about complications piling up from
041546 - chemotherapy that has been ineffective treating her cancer, since last
041547 - August, as related in her letter on 100501, asking for treatment with
041548 - PARP "targeted" to her cancer, like cetuximab, that does not cause
041549 - severe side effects, ref SDS 88 U49V, and which Doctor Johnson said a
041550 - week earlier on 100427, is the best strategy for Millie's care.
041551 - ref SDS 87 SJ6N
041553 - ..
041554 - Millie has submitted numerous letters to Kaiser the past year
041555 - requesting the medical team collaborate by telephone and email on
041556 - implementing the UCSF work plan to treat Millie's cancer with PARP in
041557 - time for recovering from UCSF medical mistakes, beginning on 090725
041558 - 2017. ref SDS 42 T64P
041559 -
041560 - [On 100622 1511 case study showing Millie requested
041561 - treatment 44 times to recover from UCSF medical mistakes.
041562 - ref SDS B3 576S
041564 - ..
041565 - Doctor Johnson advised that Kaiser cannot order treatment prescribed
041566 - by Doctor Rugo at UCSF for saving Millie's life by recovering from
041567 - medical mistakes getting radiation treatments at UCSF, as requested in
041568 - Millie's letter again this morning, ref SDS A3 1Q6P, because he has
041569 - been unable over the past 4 weeks to communicate with Doctor Rugo at
041570 - UCSF using the telephone and email, planned by Doctor Johnson in the
041571 - meeting at Kaiser on 100427 0830, ref SDS 87 WT9M, and a week later
041572 - planned by Doctor Rugo in UCSF's letter to Kaiser on 100501, to
041573 - implement UCSF's work plan on 090616, prescribing PARP for Millie's
041574 - next "targeted" treatment to recover from UCSF medical mistakes.
041575 - ref SDS 89 456L
041577 - ..
041578 - Last year, Doctor Johnson was worried Millie's care would "fall
041579 - through the cracks" in the health care system due to communications
041580 - failure, reported on 090205 1318., ref SDS 26 278T
041581 -
041582 - [On 100606 2314 Doctor Johnson reported that Doctor Rugo
041583 - has still not returned his call from Kaiser requesting
041584 - treatment plans for Millie to recover from UCSF medical
041585 - mistakes. ref SDS B1 S66O
041587 - ..
041588 - [On 100616 0832 Jennifer reported that Kaiser's claim team
041589 - has suffered delays resolving Millie's claim for standard
041590 - of care to recover from UCSF medical mistakes, due to
041591 - delays communicating with the doctor. ref SDS B2 WN6N
041593 - ..
041594 - [On 100927 1152 doctor hectic schedule "still running
041595 - around like chicken with head cut off." ref SDS C1 H68J
041597 - ..
041598 - Doctor Johnson related having received a letter from Doctor Rugo using
041599 - UCSF securemail with encryption to protect Millie's privacy, and for
041600 - the purpose of implementing Doctor Rugo's work plan to save Millie's
041601 - life, presented in UCSF's letter using public domain email sent to the
041602 - team on 100501 1711, ref SDS 89 456L, and responding to Millie's
041603 - request for life-saving treatment sent to the medical team using
041604 - public domain email for timely, immediate action earlier the same day
041605 - on 100501 1037. ref SDS 88 F25O
041607 - ..
041608 - Doctor Johnson further disclosed today, that he was unable to open
041609 - Doctor Rugo's encrypted letter. Failure to communicate using secure
041610 - email encrypted to comply with HIPAA regulations to protect patient
041611 - rights for confidential health records violates patient rights to
041612 - choose good health exercised in Millie's letter to the medical team on
041613 - 100502 that waived her right under HIPAA regulations for confidential
041614 - health records, and directed that the medical team use public domain
041615 - email for reliable commnication in time to save her life. ref SDS 90
041616 - CO3W
041618 - ..
041619 - Doctor Johnson's report today of failure to communicate with Doctor
041620 - Rugo at UCSF over the past month using securemail shows continuing
041621 - problems that prevent effective health care. On 100502, Millie was
041622 - unable to open securemail received from the Doctor Johnson at Kaiser.
041623 - ref SDS 91 HH4I The next day, Doctor Johnson solved the problem by
041624 - re-submitting the letter with public domain email, reported on 100503
041625 - 1945, ref SDS 93 HH4I, and which implemented Millie's instructions to
041626 - the medical team the day before on 100502 0140. ref SDS 90 CO3W
041628 - ..
041629 - Doctor Johnon advised today that he did not use public domain email
041630 - to communicate with Doctor Rugo over the past 4-weeks on saving
041631 - Millie's life. Since public domain email has been used for 99% of
041632 - communication for collaboration between Kaiser, UCSF, and the patient
041633 - over the past 10 years, and has been effective extending Millie's
041634 - survival 4 times longer than disease trajectory, reported by Doctor
041635 - Johnson on 090325, ref SDS 30 P39M, there is no evident justification
041636 - for failure to provide notice in this case.
041637 -
041638 - [On 100626 0003, Medicare regulations that guide Kaiser's
041639 - medical practice make patient health the paramount
041640 - consideration for communication giving notice. ref SDS B4
041641 - TQ5T
041643 - ..
041644 - [On 100813 2000 similar problems of computer access
041645 - occurring in computer industry due to variances in
041646 - capitilizing text strings as grounds to deny timely access
041647 - to mission critical content. ref SDS C0 V15F
041649 - ..
041650 - After getting Doctor Rugo's secure email, Doctor Johnson sent an
041651 - encrypted securemail to Doctor Rugo saying he could not open her
041652 - letter. He then received an unsecure letter using public domain email
041653 - from Doctor Rugo, saying that she could not open Doctor Johnson's
041654 - reply, and providing her telephone number, asking Doctor Johnson to
041655 - call her at UCSF about ordering Millie's care. Doctor Johnson called
041656 - UCSF and left a message for Doctor Rugo to call him back using his
041657 - office telephone number at Kaiser. He has received several messages
041658 - from Doctor Rugo and called back and left several messages, but so far
041659 - in the past 30 days, Doctor Johnson has not communicated with Doctor
041660 - Rugo either by email or telephone, contrary to Doctor Rugo's work plan
041661 - for Kaiser and UCSF to collaborate on Millie's care, reported 4-weeks
041662 - ago on 100501 2017, ref SDS 89 456L
041664 - ..
041665 - UCSF sending encrypted secure email to Kaiser on Millie's health care
041666 - aligns with Doctor Rugo's letter to Millie on 100501, saying she
041667 - cannot use unsecure public domain email to notify Millie on progress
041668 - scheduling work for Millie to recover from UCSF medical mistakes,
041669 - ref SDS 89 HH4I, and despite having used public domain email
041670 - successfully for the past 7 years, without breach of Millie's privacy,
041671 - despite Millie having notified the medical team that risks of fatal
041672 - complications using unsecure public domain email for timely, accurate,
041673 - comprehensive case management are far less than risks of fatality from
041674 - communication failures and delays using securemail with encryption,
041675 - and so Millie approves the team using public domain email in her case
041676 - for purposes of getting treatment in time to be effective, reported in
041677 - Millie's letter to the medical team the next day on 100502 0140.
041678 - ref SDS 90 CO3W
041680 - ..
041681 - Doctor Johnson said that without support from Doctor Rugo at UCSF, he
041682 - has no treatments targeted to Millie's cancer for her to recover from
041683 - UCSF medical mistakes, which have now caused the 11th relapse of
041684 - cancer.
041686 - ..
041687 - This record indicates UCSF has defaulted on referral obligations to
041688 - fix medical mistakes, as noted in Millie's letter to Doctor Johnson on
041689 - 100503, asking for notice if UCSF performs commitment to communicate
041690 - with Kaiser on Millie's care. ref SDS 94 6X8W
041691 -
041692 - [On 100606 2314 Doctor Johnson reported that Doctor Rugo
041693 - has still not returned his call from Kaiser requesting UCSF
041694 - treatment plans for Millie to recover from medical
041695 - mistakes. ref SDS B1 S66O
041697 - ..
041698 - The doctor discussed one treatment using Medroxyprogesterone that is
041699 - targeted to Millie's patient profile; he did not disclose the source
041700 - for this idea.
041702 - ..
041703 - Doctor Johnson used the computer in the examination room to check the
041704 - Internet, and found Medroxyprogesterone is part of the UCSF protocol
041705 - for MPA.
041707 - ..
041708 - We reviewed the record showing MPA was prescribed by Doctor Hsu as the
041709 - first treatment for Millie to recover from UCSF medical mistakes
041710 - providing radiation treatments, reported on 090609, ref SDS 38 W66W A
041711 - week later on 090616, Doctor Rugo started Millie on MPA, and advised
041712 - that Kaiser and UCSF had agreed in a letter sent with email that after
041713 - MPA, Millie would be treated with PARP. ref SDS 39 KD6L A month
041714 - later, on 090716, UCSF ended treatment with MPA, becasue Millie
041715 - suffered severe beathing problems, and blood clots are a rare side
041716 - effect of MPA, and Millie was already being treated for pulmonary
041717 - embolism due to blood clots from treatment with bevacizumab in 2004.
041718 - UCSF called at 8pm that night, and said Millie's next treatment would
041719 - be with PARP, as agreed in the letter with Kaiser, but PARP would not
041720 - be ready until September, and so UCSF would pay Kaiser to treat Millie
041721 - with Gemzar until September, as reported in Millie's letter to the
041722 - medical team on 090716 2106. ref SDS 41 EE5W
041724 - ..
041725 - This morning, Doctor Johnson checked Millie's medical chart on the
041726 - computer and found his report for the meeting at Kaiser on 090626
041727 - approving Millie's treatment at UCSF with Medroxyprogesterone, shown
041728 - in parentheses as "MAP," but actually reflecting the UCSF protocol for
041729 - MPA. ref SDS 40 837H
041731 - ..
041732 - Doctor Johnson then recalled that blood clots are a rare side effect
041733 - of MPA, reported in UCSF literature received in the record on 090514.
041734 - ref SDS 35 KW3P
041736 - ..
041737 - The doctor feels that Millie's patient history of pulmonary embolism
041738 - and previous breathing problems, while being treated with MPA,
041739 - precludes prescribing MPA again today, and since email and telephone
041740 - problems prevented collaborating with Doctor Rugo the past month to
041741 - prescribe PARP, as originally agreed in the letter cited by Doctor
041742 - Rugo on 090616, Kaiser cannot order treatment with PARP, despite
041743 - evidence showing PARP is targeted to Millie's patient profile, and has
041744 - no painful side effects, as reviewed by Doctor Johnson during the
041745 - meeting at Kaiser on 100112. ref SDS 60 N586
041747 - ..
041748 - Doctor Johnson scrolled a few more web sites on the Internet for
041749 - another 5 minutes or so, and found listings for cancer treatments. He
041750 - feels these providers cannot treat Millie's complex patient profile,
041751 - reported on 090213 1140. ref SDS 28 AC6G
041753 - ..
041754 - Previously on 090909, Doctor Johnson reported he had time to perform
041755 - research on the 20 so treatments targeted to cancer, and submitted to
041756 - the medical team, at his request on 090326, but which up to that time
041757 - on 090909, the medical team had failed to review. ref SDS 44 VF9Q A
041758 - month later, however, the doctor disclosed that a hectic schedule
041759 - prevented providing standard of care for Millie, reported on 091027
041760 - 0830. ref SDS 46 GN5G
041762 - ..
041763 - Today, Doctor Johnson did not submit any work product showing level of
041764 - effort to provide necessary and reasonable care for Millie to recover
041765 - from UCSF medical mistakes. No notes, diaries, reports, charts,
041766 - showing calls and meetings with others to evaluate and negotiate
041767 - treatments for Millie. The doctor submitted no emails contacting
041768 - providers with Millie's treatment history, and offering financial
041769 - inducments to exercise doctor discretion for medical necessity to save
041770 - Millie's life, which Doctor Rugo reported on 090514, was planned for
041771 - Millie at UCSF. ref SDS 35 265I
041773 - ..
041774 - On 090616, Doctor Rugo advised during a meeting at Kaiser that UCSF
041775 - has many treatments planned for Millie to recover from UCSF medical
041776 - mistakes, including phase I and II clincial trials, since her patient
041777 - profile is too complex for many phase III and IV studies, ref SDS 39
041778 - BL4N, discussed previously meeting at UCSF on 090514. ref SDS 35 3F7M
041779 - At that time, on 09514, Doctor Rugo planned for doctor discretion to
041780 - adjust study criteria for medical necessity to fit Millie's complex
041781 - patient profile. ref SDS 35 265I UCSF demonstrated ability to
041782 - correlate treatment protocol for Millie's history of prior treatments
041783 - by omitting cyclophosphaide from MPA protocol, reported on 090616
041784 - 1245. ref SDS 39 YO4J
041786 - ..
041787 - These innovations were confirmed in a letter Doctor Rugo sent to
041788 - Doctor Johnson at Kasier on 090514 0830, ref SDS 35 DI63, and cited a
041789 - month later during a meeting at UCSF planning to start Millie's
041790 - recovery from medical mistakes at UCSF first with MPA, and then with
041791 - PARP, reported on 090616. ref SDS 39 KD6L
041793 - ..
041794 - Today, the doctor explained that research to find and devise solutions
041795 - for Millie's treatment history takes a lot of time. This aligns with
041796 - Doctor Johnson's report on 091027, that his plan on 090909, to review
041797 - the 20 or so treatments submitted to the medical team on 090326,
041798 - failed because his schedule changed, and became too hectic, so he
041799 - didn't have enough time to exercise doctor discretion to prescribe
041800 - care for medical necessity so that Millie can recover from UCSF
041801 - medical mistakes. ref SDS 46 GN5G
041803 - ..
041804 - Doctor Johnson said he is very sorry practical solutions and
041805 - innovations at UCSF cannot be ordered to treat Millie at Kaiser with
041806 - standard of care for Millie's patient profile using PARP or equal that
041807 - "targets" the genetic weakness of her cancer cells, and with no
041808 - painful side effects, as requested in Millie's claim filed on 100527,
041809 - ref SDS A0 IZ7N, citing agreement in a letter between Kaiser and UCSF,
041810 - reported by Doctor Rugo on 090616, ref SDS 39 KD6L, and further as
041811 - requested again in Millie's letter this morning, reported on 100601
041812 - 0136. ref SDS A3 1Q6P The doctor spread his hands saying he simply
041813 - cannot communicate with Doctor Rugo at UCSF by telephone or email over
041814 - the past 4-weeks to provide treatment for Millie to recover from UCSF
041815 - medical mistakes, per above. ref SDS 0 4F6I
041817 - ..
041818 - [On 100605 1817 Doctor Johnson reported he received
041819 - Millie's letter on 100603 0449, ref SDS A8 036C, and which
041820 - transmitted the record meeting at Kaiser on 100601, when
041821 - the doctor ordered Hospice for Millie, rather than
041822 - treatment targeted to her patient profile. ref SDS B0 FT4G
041824 - ..
041825 - [On 100606 2314 Doctor Johnson reported that Doctor Rugo
041826 - has still not returned his call from Kaiser requesting
041827 - treatment plan for Millie to recover from UCSF medical
041828 - mistakes. ref SDS B1 S66O
041830 - ..
041831 - [On 100616 0832 Jennifer reported that Kaiser's claim team
041832 - has suffered delays resolving Millie's claim for standard
041833 - of care to recover from UCSF medical mistakes, due to
041834 - delays communicating with the doctor. ref SDS B2 WN6N
041836 - ..
041837 - The medical chart for the meeting at Kaiser on 091112, showed
041838 - consideration of Abraxane and Ixempra chemotherapy. ref SDS 47 RV60
041839 - At that time, Ixempra was not actually considered. Abraxane was
041840 - discussed on 091112. ref SDS 47 UN46 The team has continually
041841 - determined that chemotherapy is not appropriate for Millie's patient
041842 - profile because her cancer has mutated to resist chemotherapy, and
041843 - because chemotherapy has painful side effects that have accumulated
041844 - beyond Millie's ability to tolerate, also discussed on 091112.
041845 - ref SDS 47 CP9K This makes chemotherapy torture. It does not treat
041846 - Millie's cancer, and squeezes out the will to live
041848 - ..
041849 - At this point, Millie was crying and said she has tried her best the
041850 - past 8 months to be a good partner suffering agony since August, 2009,
041851 - getting chemotherapy, which Doctor Johnson and the Kaiser Pharmacist
041852 - have both said is wrong and ineffective for treating Millie's advanced
041853 - cancer, and is actually harmful for her weakened immune system, see
041854 - case study on 090213. ref SDS 28 PT3N Chemotherapy Kaiser has
041855 - ordered, contrary to prescribed and essential "targeted therapies,"
041856 - has reduced Millie's life to a point of such misery that she would
041857 - rather be dead, as noted in Millie's claim filed on 100527,
041858 - ref SDS A0 X65W, and which requests Kaiser provide necessary and
041859 - reasonable care to recover from UCSF medical mistakes. ref SDS A0 X58U
041861 - ..
041862 - Doctor Johnson offered to enroll Millie in Hospice to avoid further
041863 - pain and suffering from chemotherapy that has not been effective for
041864 - the past year, because Millie's cancer has mutated to resist
041865 - chemotherapy, reported by Doctor Johnson beginning on 080829, shown in
041866 - case study listed in the record for 090213 1140, ref SDS 28 PT3N
041868 - ..
041869 - Millie feels she has no choice, because getting prescribed treatment
041870 - using "targeted therapy" initially with PARP to get better without
041871 - painful side effects caused by chemotherapy now seems hopeless. Delay
041872 - has denied Millie all treatment options - UCSF has run out the clock.
041874 - ..
041875 - Doctor Johnson seemed genuinely sorry that email and telephone
041876 - problems, related today, per above, ref SDS 0 D658, prevent the
041877 - medical team from providing standard of care for Millie to recover
041878 - from UCSF mistakes treating Millie with radiation on referral from
041879 - Kaiser. He feels everyone has worked hard the past year to find the
041880 - time to review the 20 or so treatments targeted to Millie's cancer,
041881 - and which do not cause painful side effects which Millie has suffered
041882 - needlessly the past 8 months, and so have now destroyed the will to
041883 - live. It is sad that telephone and email problems have prevented
041884 - medical professionals from reviewing a list of treatments requested by
041885 - UCSF and by Kaiser, and which Doctor Johnson has been trying to find
041886 - time for ordering, since his letter over a year ago on 090326.
041887 - ref SDS 33 T64N
041888 -
041889 - [On 100602 1525 Millie received sympathy letter from
041890 - Arlette on ending treatment to recover from UCSF medical
041891 - mistakes. ref SDS A7 036C
041893 - ..
041894 - [On 100605 1817 Doctor Johnson reported he received
041895 - Millie's letter transmitting the record meeting with him at
041896 - Kaiser on 100601, when he signed Millie up for Hospice.
041897 - ref SDS B0 FT4G
041899 - ..
041900 - [On 100630 1148 Millie received letter from Doctor Johnson
041901 - asking if Millie wants to dis-enroll from Hospice.
041902 - ref SDS B5 OY5G
041904 - ..
041905 - [On 100701 0915 received call from Carol saying she is
041906 - Chief of Hospice, and that she was told Millie wants to
041907 - dis-enroll from Hospice, ref SDS B7 Q85S, which conflicts
041908 - with the record of notice to Kaiser in thes letter on
041909 - 100630 1537. ref SDS B6 M93Y
041911 - ..
041912 - Doctor Johnson explained extensive experience working with Hospice,
041913 - as chief of the department earlier in his career.
041915 - ..
041916 - The doctor assured Millie that Hospice will avoid further pain and
041917 - suffering from chemotherapy, and from chemotherapy side effects, and
041918 - can prevent pain from rising cancer that will occur without treatment.
041919 - He feels Hospice is excellent at controlling pain while Kaiser reviews
041920 - Millie's claim for care to recover from medical mistakes made by UCSF
041921 - on referral by Kaiser, filed on 100527 0217. ref SDS A0 IZ7N
041923 - ..
041924 - Millie said anything will be better than chemotehrapy the past 8
041925 - months that has caused her cancer to spread and tortured her with
041926 - constant pain and suffering, including causing fatal infections
041927 - diagnosed again by Doctor Johnson this morning, per above. ref SDS 0
041928 - OP4G Now, she just wants to end the torture.
041930 - ..
041931 - Doctor Johnson then entered an order in the computer transferring
041932 - Millie's care to Hospice - took about 10 seconds. The doctor advised
041933 - that he will continue following Millie's progress, but from now on the
041934 - Hospice department will be responsibile to provide timely case
041935 - management for Millie rather than Oncology.
041936 -
041937 - [On 100606 2314 Doctor Johnson reported that Doctor Rugo
041938 - has still not returned his call from Kaiser requesting
041939 - treatment plan for Millie to recover from UCSF medical
041940 - mistakes. ref SDS B1 S66O
041942 - ..
041943 - [On 100616 0832 Jennifer reported that Kaiser's claim team
041944 - has suffered delays resolving Millie's claim for standard
041945 - of care to recover from UCSF medical mistakes, due to
041946 - delays communicating with the doctor. ref SDS B2 WN6N
041948 - ..
041949 - Doctor Johnson left the office for a few mintues to check on
041950 - something.
041952 - ..
041953 - Arlette came into the examination room to say hello. She gave Millie
041954 - a big hug, and said "Gosh, you look wonderful. How have you been?"
041956 - ..
041957 - Millie said fine, and asked how Arlette is doing?
041959 - ..
041960 - Arlette has had a terrible week scrambling to recover from being let
041961 - down and misled by her real estate agent. She sold her home, and the
041962 - real estate agent said the new buyers agreed not to take posession for
041963 - 2 weeks, while Arlette finds another place. Sounded like the real
041964 - estate agent misled both the new buyers and Arlette, with the result
041965 - that Arlette suffered fiancially, and was forced to move out
041966 - immediately with no place to go and no where to store her belongings,
041967 - cats and dogs.
041969 - ..
041970 - She was unable to get recovery from the unscrupulous real estate
041971 - agent, because he skipped town with the money.
041972 -
041973 - [On 100603 0603 Millie's letter wishes Arlette well
041974 - recovering from difficulties losing her home, and getting
041975 - resettled. ref SDS A9 036C
041977 - ..
041978 - [On 101110 2025 letter to Arlette asks how she is doing in
041979 - her new apartment. ref SDS C2 U19X
041981 - ..
041982 - A friend who works at Kaiser put her up for a week. Yesterday,
041983 - Arlette finally found an apartment to rent, so her next big problem is
041984 - getting everything moved in, and finding storage, selling, giving or
041985 - throwing away everything that was in her forer home, that won't fit in
041986 - her small apartment. She hopes over the next 6 months to buy a
041987 - foreclosure property, so all the finances will work out.
041989 - ..
041990 - Arlette feels she is finally starting to get over the shock of
041991 - everything, and see her way forward.
041992 -
041993 - [On 100603 0603 Millie's letter wishes Arlette well recovering
041994 - from difficulties losing her home, and getting resettled.
041995 - ref SDS A9 DA3W
041997 - ..
041998 - Millie stood up and hugged Arlette, and said she hopes everything
041999 - works out. Millie asked if there is anything she can do to help
042000 - Arlette wheather this storm?
042002 - ..
042003 - Arlette said no, and feels she is on the road to recovery now that
042004 - she has a place to stay, and will be moving into an apartment.
042005 -
042006 - [On 100602 1525 Millie received sympathy letter from
042007 - Arlette on ending treatment to recover from UCSF medical
042008 - mistakes. ref SDS A7 036C
042010 - ..
042011 - Arlette left.
042013 - ..
042014 - Doctor Johnson returned, and said everything is set up for Millie to
042015 - start Hospice. He commended Kaiser for making this transition fast
042016 - and easy for doctors and patients.
042018 - ..
042019 - Doctor Johnson said he's sorry that lining up treatment for Millie to
042020 - recover from cancer is not fast and easy. He is very disappointed
042021 - that Doctor Rugo has not returned his calls and email on a work plan
042022 - for Millie to recover from UCSF medical mistakes, per above.
042023 - ref SDS 0 4F6I The doctor feels Millie will get good care to avoid
042024 - pain in Hospice. He commended the Hospice pharmacist, Bob, for
042025 - excellent work controlling patient pain.
042026 -
042027 -
042028 -
042029 -
042030 -
042031 -
042032 -
0421 -
SUBJECTS
Default Null Subject Account for Blank Record
0503 -
050401 - ..
050402 - Medical Chart
050403 -
050404 - Follow up ref SDS 87 R45K, ref SDS 86 R45K.
050405 -
050406 - 1. Subject: Visit 06/01/10
050407 - Patient presents with: RECHECK
050408 - Received: 6/1/10 9:17 AM
050409 - To: Mildred A Buck
050410 - From: ROBERT ALLSTON JOHNSON MD
050412 - ..
050413 - 2. History of Present Illness:
050414 -
050416 - 74 Y female with a history of IBC of left breast who was
050417 - initially diagnosed 03/04/02. S/P AC x's 4 from 04/23/02
050418 - through 07/01/02 followed by Taxotere ending 12/04/02. She had
050419 - recurrent disease noted initially in the cervical LN's
050420 - 03/03/04. On E2100 Study with Taxol/Avastin, but she had a PE
050421 - noted on CT 11/03/2004. Then, because of progression of
050422 - disease, the patient was started on Taxotere and Xeloda
050423 - 4/15/05. She had a total of 8 cycles ending 9/16/05. She had
050424 - a palliative left mastectomy performed 10/21/05. Then her left
050425 - chest lesions began expanding again. The patient started
050426 - Taxotere and Xeloda again 07/21/06 for 7 cycles. She was
050427 - started on a Clinical Trial 02/01/07 at UCSF and was randomized
050428 - to the Erbitux only (no Carbo) Arm. She had weekly Carboplatin
050429 - added 03/13/08 because of progression of disease. Her disease
050430 - progressed again and she began a Phase I/II Study of Sunitinib
050431 - (SU11248) at UCSF 11/14/08. Lengthy discussion about current
050432 - status and response to therapy. Because of cytopenias, MTX to
050433 - be D/C'd and Sutent and CTX held and then dose reduced. The
050434 - patient started hyperthermia/XRT at UCSF 02/19/09 and completed
050435 - it 03/17/09. She has started the MPA Clinical Trial at UCSF
050436 - 06/16/09 but this has been D/C'd. She started Gemzar 07/28/09
050437 - and received Cycle #4 11/05/09. Because of evidence of
050438 - progression she was switched to Navelbine 11/18/09. However,
050439 - she then developed erythema and nodularity on her right breast.
050440 - Because of this and a rising CA 15-3 she was switched to
050441 - Abraxane 03/03/10. She states that lymphedema continues to
050442 - increased in the right arm. Neuropathy pain persists across
050443 - right forehead, head, and down neck to across upper back. She
050444 - went on cruise May 15. She is here for FU. She c/o pruritis
050445 - of her skin lesions. Also has tenderness of veins LLE.
050447 - ..
050448 - 3. Current medications:
050449 - HYDROCODONE/ACETAMINOPH 5-5
050450 - WARFARIN 4 MG TABLETS
050451 - LUMIGAN 0.03% EYE DROPS (2.
050452 - TIMOLOL MALEATE 0.5% EYE DR
050453 - OXYCODONE W/APAP 5-325 MG T
050454 - AEROCHAMBER Z-STAT/PLUS W/O
050455 - QVAR 80 MCG ORAL INHALER
050456 - ALBUTEROL HFA 90MCG ORAL IN
050457 - GUAIFEN/CODEIN 100-10MG/5ML
050458 - LORAZEPAM 1 MG TABLETS
050460 - ..
050461 - 4. Review of systems:
050462 -
050463 - Constitutional: Appetite and energy level are improving. Plans
050464 - on taking trip to the Mediterranean in May; 12 day cruise
050466 - ..
050467 - Eyes: Seen by Ophthalmology 01/11/10
050468 - ENT: No nose bleeds.
050469 - Cardiovascular: No SOB, palpitations or chest pain
050470 - Respiratory: No hemoptysis or cough. No DOE noted.
050471 - GI: No nausea, vomiting or diarrhea
050472 - GU: No hematuria or dysuria
050474 - ..
050475 - Musculoskeletal: Left neck spasm and right shoulder pain stable
050476 - with Robaxin
050478 - ..
050479 - Skin: Pruritis of chest wall resolved
050481 - ..
050482 - Neurological: Persisting mild postherpetic neuropathy
050484 - ..
050485 - Psychiatric: No evidence of anxiety or depression today
050487 - ..
050488 - 5. Physical Exam:
050489 - ECOG Performance Score 0
050490 - BP 178/88 | Temp (Src) 97.9 øF (36.6 øC) (Oral) | Wt 136 lb 12.8 oz (62.052
050491 - kg) | SpO2 97%
050492 - Head: shingles right side of forehead largely gone
050493 - Eyes: normal conjunctiva
050494 - Mouth: normal mucosa
050495 - Lymph: no nodes palpable in neck or axillae
050496 - Breasts: evidence of erythema to other breast. Less edema in both arms
050497 - Lungs: clear to percussion and auscultation
050498 - Heart: regular without murmur or gallop
050499 - Abd: soft with normal bowel sounds. No masses or organomegaly
050500 - Ext: Edema increasing in both arms now
050501 - Bones: no tenderness
050502 - Neuro: awake, alert, and oriented. Moves all extremities well. Normal gait.
050504 - ..
050505 - 6. Lab:
050506 - PT, Patient H 35.4 Sec
050507 - PT INR 3.3 Ratio
050508 - Bili, Tot Adult 0.4 mg/dL
050509 - Creatinine 0.65 mg/dL
050510 - ALT (SGPT) 15 U/L
050511 - WBC 10.7 K/uL
050512 - RBC 3.80 M/uL
050513 - Hemoglobin L 11.4 g/dL
050514 - Hematocrit 34.9 %
050515 - MCV 92 fL
050516 - RDW H 15.4 %
050517 - Plt 243 K/uL
050519 - ..
050520 - 7. CA 15-3
050521 - -----------
050522 - 520 H
050523 - 424 H
050524 - 367 H
050525 - 384 H
050526 - 369 H
050527 - 426 H
050528 - 328 H
050529 - 275 H
050530 - 212 H
050531 - 248 H
050532 - 211 H
050534 - ..
050535 - 8. Imaging:
050536 -
050537 - 02/18/10 CT THORAX W CONTRAST - 1. Mild interval improvement of
050538 - the patchy ground glass opacities bilaterally. There are still
050539 - a few patchy densities noted predominantly in the bilateral
050540 - lung bases. New area of subsegmental atelectasis vs
050541 - post-inflammatory scarring right upper lobe. Resolution of
050542 - small left pleural effusion.
050544 - ..
050545 - 9. 01/19/10 MRI BRAIN WO/W CONTRAST(STD) - No significant abnormalities.
050547 - ..
050548 - 10. 09/19/09 CT THORAX W CONTRAST - No pulmonary emboli on a
050549 - technically good study. The lungs show multiple areas of
050550 - groundglass opacity and multiple small areas of more confluent
050551 - density. Tiny left pleural effusion. S/P left mastectomy. A
050552 - few additional minor findings, as described above. Since July
050553 - 20, 2009 CT scan of the chest, there has been resolution of
050554 - many of the pulmonary opacities but there are now many new
050555 - ones, especially in the left lower lobe and in the right upper
050556 - lobe. The left pleural effusion is much smaller. Otherwise,
050557 - no change.
050559 - ..
050560 - 11. 09/19/09 CHEST, SINGLE
050562 - ..
050563 - 12. 07/31/09 RIBS, UNILATERAL, 2 VIEWS - Right ribs appear intact
050565 - ..
050566 - 13. 07/20/09 CT THORAX W CONTRAST -
050567 -
050568 - 1. Negative for pulmonary embolus.
050569 -
050570 - 2. New small left pleural effusion. No pleural enhancement or
050571 - evidence of loculation.
050573 - ..
050574 - 3. Otherwise stable chest CT compared with recent examination
050575 - from one month earlier.
050577 - ..
050578 - 14. 06/12/09 CT THORAX, ABDOMEN, PELVIS W CONTRAST
050580 - ..
050581 - 15. 06/12/09 CT NECK W CONTRAST
050583 - ..
050584 - 16. 03/17/09 DXA BONE DENSITY, AXIAL -
050585 -
050586 - 1. Bone mineral density
050587 - calculated for the LUMBAR SPINE is
050588 - statistically consistent
050589 - with osteopenia.
050591 - ..
050592 - 2. Bone mineral density calculated for the
050593 - TOTAL HIP is statistically consistent with osteopenia.
050595 - ..
050596 - 17. 01/22/09 SHOULDER, COMPLETE 2+ VIEWS - Orthopedic follow up.
050597 - See Orthopedic note for details. S/P reduction of anterior
050598 - shoulder dislocation.
050600 - ..
050601 - 18. 01/22/09 SHOULDER, ONE VIEW - Dislocation, right shoulder.
050602 - Fracture right humeral head
050604 - ..
050605 - 19. 01/22/09 CT CERV SPINE W/O CONTRAST - Degenerative changes of
050606 - the cervical spine without evidence of acute C spine fracture
050607 - or loss in alignment.
050609 - ..
050610 - 20. 01/22/09 CT HEAD W/O CONTRAST -
050611 -
050612 - 1. No evidence of acute infarct or hemorrhage.
050613 -
050614 - 2. Sinus disease. Mild nasal septal deviation to the right.
050616 - ..
050617 - 21. Assessment:
050618 -
050619 - 1. Persisting mild postherpetic neuropathy. Pruritic now.
050620 -
050621 - 2. Metastatic breast cancer (IBC) lung, lymph node and chest wall
050622 -
050623 - 3. Cancer pain controlled better on MS
050625 - ..
050626 - 4. Lymphedema slightly worse on right; has compression garment
050628 - ..
050629 - 5. Anticoagulation monitoring
050631 - ..
050632 - 6. Pruritus of skin lesions
050634 - ..
050635 - 22. Plan:
050636 -
050637 - 1. D/C Abraxane 100 mg/m2 or 150 mg/m2 iv qw x 3 weeks every 4
050638 - weeks
050639 -
050640 - 2. Try Atarax (for pruritis) [reduce IBC itching]
050642 - ..
050643 - 3. Add Relafen (for phlebitis)
050645 - ..
050646 - 4. Hospice referral; eConsult sent
050647 -
050648 - [On 100601 1531 Sharon called to schedule meeting for
050649 - Millie to get Hospice care. ref SDS A4 OL77
050650 -
050651 - [On 100602 0913 Liz arrives to start Hospice support.
050652 - ref SDS A5 036C
050654 - ..
050655 - [On 100602 1046 Eileen reports that Kaiser denied
050656 - Millie's claim; after reading the claim, denial was
050657 - withdrawn, and the matter forwarded to Claims
050658 - Resolution Department for processing. ref SDS A6 UN5P
050660 - ..
050661 - 5. RTC one month
050662 -
050663 -
050666 -
050667 -
050668 -
050669 -
050670 -
050671 -
050672 -
050673 -
050674 -
050675 -
050676 -
050677 -
0507 -