CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS A5 0000. ref SDS A2 0000.
040502 -
040503 -
040504 -
040505 -
040507 - ..
0406 -
0407 -
0408 - Background
0409 -
040901 - On 010427 0830 meeting at Kaiser - Doctor Johnson notes Millie looks
040902 - so good nobody can believe she has such severe cancer, ref SDS 83
040903 - OJ6I; the doctor explained again Millie's cancer has mutated through
040904 - 11 relapses to resist chemotherapy. The doctor advised that Kaiser
040905 - has a new strategy prescribing therapy that is effective for treating
040906 - cancer as a chronic disease by "targeting" the genetic profile of
040907 - cancer that has mutated in patients, like Millie, to resist
040908 - chemotherapy. ref SDS 83 SJ6N
040910 - ..
040911 - On 100501 1037 Millie letter to medical team confirms understanding of
040912 - new strategy to treat Millie's cancer with targeted therapy.
040913 - ref SDS 84 F25O
040915 - ..
040916 - On 100501 2017 Doctor Rugo reports plans to collaborate with Doctor
040917 - Johnson at Kaiser on work plan for Millie to recover from 11th relapse
040918 - of cancer caused by UCSF medical mistakes. ref SDS 85 HH4I
040920 - ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 87 YX8L Kaiser contends that all of the
040923 - strategies for "targeted" therapies have been executed for Millie,
040924 - which seems conflicting with the record in this case. ref SDS 87 MZ4N
040926 - ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 88 TD5W
040930 - ..
040931 - On 100503 1945 Kaiser notifies Millie to get remaining 2 treatments
040932 - with Abraxane chemotherapy that seems to be failing, and then after 3
040933 - more weeks without treatment, following a trip abroad, the doctor will
040934 - discuss "next steps." ref SDS 89 YL5N
040936 - ..
040937 - On 100503 2338 Millie reports to medical team that she will implement
040938 - Kaiser's guidance to delay changing treatments, and takes Kaiser's
040939 - letter on 010503, as assurance that recovery will be equal to changing
040940 - treatment immediately on 100505. ref SDS 90 6X7S
040942 - ..
040943 - On 100504 1609 Sara, Practice Manager for the UCSF Oncology Breast
040944 - Care Clinic, called and notified Millie that Doctor Rugo will soon
040945 - communicate with Doctor Johnson, or had already done so, to coordinate
040946 - with Kaiser on planning Millie's next treatment to recover from the
040947 - 11th relapse of cancer. ref SDS 91 NT5N
040949 - ..
040950 - On 010505 0730 Millie received the 2nd treatment at Kaiser for the 3rd
040951 - cycle of Abraxane chemotherapy, as ordered by Doctor Johnson.
040952 - ref SDS 92 KE4K
040954 - ..
040955 - On 100511 0900 cancer marker CA 15-3 520 increased another 100 points,
040956 - seemingly on an accelerating rise, which threatens to cascade out of
040957 - control, because Abraxane chemotherapy is not effective. ref SDS 93
040958 - L54I
040960 - ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 94 KE4K
040964 - ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 95 PK9O
040967 - ..
040968 - On 100527 0217 Millie files claim with Kaiser Claims Resolution
040969 - Department for standard of care to recover from 11th relapse of cancer
040970 - caused by medical mistakes getting radiation treatments at UCSF on
040971 - referral from Kaiser. ref SDS 96 IZ7N
040973 - ..
040974 - On 100528 0322 Millie requests support from Medicare to separate
040975 - recovery for medical mistakes getting radiation from UCSF, from health
040976 - care benefits limited by Medicare insurance coverage. ref SDS 97 QQ6N
040978 - ..
040979 - On 100528 1031 called Medicare they have formed a team to review
040980 - Millie's case, and contacted Kaiser's Claims Resolution Department for
040981 - response to Millie's claim. ref SDS 98 4W5F
040983 - ..
040984 - 100601 0830 Doctor Johnson reported that Kaiser has not had time to
040985 - collaborate with UCSF on treatment for Millie to recover from UCSF
040986 - medical mistakes. He discussed treating Millie with MPA, but this was
040987 - not prescribed because Millie was treated with MPA in 2009, and UCSF
040988 - ended the treatment due to fears about blood clot side effects, which
040989 - were believed to cause breathing problems Millie had, though later
040990 - breathing problems were discovered to be caused by defective radiation
040991 - treatment. Since Doctor Johnson said Kaiser has no more treatments
040992 - for Millie, the only way Millie can get relief from pain caused by
040993 - cancer that is progressing without treatment is get treatment in
040994 - Hospice. Since Hospice is the only choice of care offered today,
040995 - Millie accepted this.
040997 - ..
040998 - On 100601 1531 Sharon called to schedule starting Hospice medical
040999 - services beginning tomorrow between 0900 - 1000. ref SDS A1 036C
041001 - ..
041002 - On 100602 0913 Liz provides orientation on Hospice care; she confirms
041003 - Sharon's report yesterday, that if Kaiser performs on the insurance
041004 - agreement to provide standard of care for Millie's patient profile,
041005 - than Millie can elect to recover from 11th relapse of cancer, rather
041006 - than continue with Hospice support for dying peacefully. ref SDS A2
041007 - 036C
041009 - ..
041010 - On 100602 1046 Diane received notice from Medicare to file claim for
041011 - Millie to get treatment for recovering from UCSF medical mistakes; she
041012 - is preparing a statement of claim. ref SDS A3 036C Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS A3 MZ5H Eileen called later and reported that Kaiser denied
041015 - Millie's claim on the grounds that Medicare does not authorize payment
041016 - for treatment to recover from cancer, after a patient starts Hospice.
041017 - ref SDS A3 UN4M Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS A3 I33H Eileen called back after
041019 - reading the claim and advised the denial of claim has been withdrawn,
041020 - and the matter is referred to Claims Resolution Department.
041021 - ref SDS A3 UN5P
041023 - ..
041024 - On 100603 1112 Linda called to schedule a visit for Hospice social
041025 - support. ref SDS A5 036C
041027 - ..
041028 - On 100604 1350 Linda visited to begin case management for Millie's
041029 - Hospice care. ref SDS 0 036C
041030 -
041031 -
041032 -
041033 -
041034 -
041036 - ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Linda remarked initally how wonderful Millie looks. She asked how
041402 - Millie is doing.
041404 - ..
041405 - Millie said she has started to feel better 3 weeks after her last
041406 - chemotherapy treatment. The past 2 days being on treatment with
041407 - Relafen for Phlebitis, prescribed by Doctor Johnson on Tuesday,
041408 - reported on 100601 0830. ref SDS A0 VS5N, the "squeezing" pressure she
041409 - feels mostly in her right chest seems less severe.
041411 - ..
041412 - During the meeting today, Linda sat on the sofa next to Millie; she
041413 - used a laptop computer to write notes of the discussion, and look up
041414 - details on Millie's patient history, similar to Liz on Wednesday.
041415 - 100602 0913, ref SDS A2 UP5O
041416 -
041417 - [On 100607 1243 Judy, Hospice social provider, used a
041418 - notebook computer to write notes that jog her memory on
041419 - what was discussed during the meeting. ref SDS A7 HL7G
041421 - ..
041422 - Linda asked Millie about her biggest concern with the prospect of
041423 - ending life through Hospice?
041425 - ..
041426 - Millie pointed to me, and said "Him." She said, Rod is involved in
041427 - his work. The past 9 years caring for me and managing my doctors has
041428 - gradually become his main focus. The last 12 months has required
041429 - solving one problem after another to sustain my quality of life. I
041430 - worry he will suffer greatly with my loss.
041432 - ..
041433 - Linda asked if I have thought about this?
041435 - ..
041436 - Explained I am thinking about helping Kaiser and UCSF provide promised
041437 - care for Millie to live, shown in Millie's letter to Kaiser on 100601
041438 - 0136. ref SDS 99 1Q6P
041439 -
041440 - [On 100729 0510 Millie died and this was very difficult to
041441 - accept causing total emotional reaction on realization of
041442 - irreversable loss. ref SDS A8 P17N
041444 - ..
041445 - Linda said she will ask Doctor Johnson about this. She was told
041446 - Millie entered Hospice to end care and accept end of life.
041448 - ..
041449 - Millie explained she entered Hospice because Doctor Johnson said it
041450 - was the only way he could control her pain, while he and Doctor Rugo
041451 - worked through getting her next treatment with PARP.
041453 - ..
041454 - Linda asked Millie for pain level from 1 - 10. Millie said about 3.
041456 - ..
041457 - Linda related that Liz entered in Kaiser's records that Millie's goals
041458 - are for pain level of 2.
041460 - ..
041461 - Millie smiled and said her goal is zero pain.
041463 - ..
041464 - Millie related discussion on 100602, telling Liz that she can tolerate
041465 - pain above 3 at 4, even 5, in order to enjoy being alert and able to
041466 - appreciate being alive for the time she has left. ref SDS A2 3W4O Liz
041467 - was insistent that pain level 5 is above Hospice standard of care.
041468 - ref SDS A2 3V53 Liz further advised that Millie can experiment with
041469 - current medications to balance pain and alertness. Millie clarified
041470 - that pain level 5 on Wednesday, was a way of explaining a squeezing
041471 - feeling mostly in right side of her chest. Pain may not be the
041472 - correct description. Liz then indicated that medication prescribed by
041473 - Doctor Johnson for Phlebitis will complement current dose for morphine
041474 - to relieve inflammation pressure Millie feels in the right side of her
041475 - chest from IBC progressing without effective treatment for the past
041476 - year. ref SDS A2 3V7X Liz advised that Millie can experiment with the
041477 - current prescriptions for a few days, until Linda visits on Friday,
041478 - today.
041480 - ..
041481 - Millie recalled that Daniel called from Hospice in the evening on
041482 - Wednesday, and went over pain goals and medication strategy. At that
041483 - time, everybody seemed to be onboard, reported on 100602 0913.
041484 - ref SDS A2 3W5H
041486 - ..
041487 - This work plan was confirmed in a letter to the medical team submitted
041488 - to Hospice through Doctor Johnson on 100603 0449. ref SDS A4 IX8R
041490 - ..
041491 - Linda said she never got a copy of Millie's letter.
041493 - ..
041494 - Linda showed Millie a 3 x 5 card with handwriting, which she explained
041495 - has notes Liz preapred for the meeting on Wednesday. She said it
041496 - looks like Liz wrote Millie's goal is pain level 2. Millie could not
041497 - make out what was written on the 3 x 5 card.
041499 - ..
041500 - Linda explained that Millie can revise this if she chooses.
041502 - ..
041503 - Millie said 3 - 4 is okay, and noted that feeling pain is subjective.
041504 - She may have the same level of pain, but on different days call it 3
041505 - and on another day 6. Millie recalled that even 5 was tolerable, as
041506 - related to Liz on Wednesday, reported on 100602 0913, ref SDS A2 3V53
041508 - ..
041509 - Linda noted that since Millie is pain level 3 today, she is meeting
041510 - her revised goal.
041512 - ..
041513 - Linda feels Millie should not be suffering pain at 3 - 4 - 5. Linda
041514 - said that she can call Doctor Johnson and Bob the pharmacist to double
041515 - Millie's morphine prescription, and this will eliminate taking
041516 - Percodet. Millie explained she doesn't take Percocet all the time.
041517 - The past month or so she has taken 3 - 6 Percocet per day, to offset
041518 - pain and suffering from chemotherapy. Doctor Johnson has approved
041519 - taking 2 Percocet at once, if needed. Millie has done this on a few
041520 - occassions over the past 6 months. The past week, using Percocet to
041521 - supplement morphine has declined after ending chemo 4 weeks ago. The
041522 - past 2 days she has used Percocet once per day, and her energy has
041523 - increased significantly, as reported initially, per above. ref SDS 0
041524 - 036C
041526 - ..
041527 - Linda is concerned that since Millie is not getting treatment for
041528 - cancer, pain will begin to increase even as pain and suffering
041529 - declines from stopping chemotherapy.
041531 - ..
041532 - Millie said that's why she entered Hospice. The medical team has
041533 - delayed treatment due to problems the past month using the telephone
041534 - and email, reported at Kaiser on Tuesday, 100601 0830. ref SDS A0 4F6I
041535 - So, like Noah building the Ark before the rains came, Millie needs to
041536 - be prepared in case the medical team does not provide treatment in
041537 - time to be effective recovering from the 11th relapse of cancer,
041539 - ..
041540 - Linda feels Millie would be better off taking 2 morphone pills twice a
041541 - day to control pain, rather than just 1. She said Millie will likely
041542 - adjust to the higher dose, and be equally active with 2 morphine, as
041543 - with only 1. Linda noted the only side effect of more morphine is
041544 - being a bit more drowsy. Millie explained again that over the past 2
041545 - days the current dose with the new treatment to control inflammation
041546 - from Phlebitis has reduced the squeezing feeling on the right side of
041547 - her chest. Liz advised on Wedensday, that this treatment can be
041548 - increased first to experiment on controlling rising pain before
041549 - increasing morphine. ref SDS A2 3V94
041550 -
041551 - [On 100605 1838 Millie notified Doctor Johnson at Kaiser
041552 - that she was emotional because nobody seems to be listening
041553 - to patient requests for pain relief. ref SDS A6 CG6W
041555 - ..
041556 - Linda agreed. She noticed Millie's prescription to treat Phlebitis
041557 - expires in 2 weeks. She also noticed that Liz did not describe the
041558 - prescription for morphine as Morphine CR, which evidently is for time
041559 - release agent. Linda corrected this in the record.
041561 - ..
041562 - Linda called and left a message for Doctor Johnson on increasing
041563 - Millie's morphine to 2 pills. She then called Bob the Hospice
041564 - pharmacist. He seemed enthusiastic about increasing Millie's morphine
041565 - to 2 pills, and he also extended Millie's treatment for Phlebitis
041566 - beyond the initial 2 week period.
041567 -
041568 - [On 100605 1838 Millie notified Doctor Johnson at Kaiser
041569 - that she was emotional because nobody seems to be listening
041570 - to patient requests for pain relief. ref SDS A6 CG6W
041572 - ..
041573 - Linda also ordered another form of laxetive, which Millie can get at
041574 - the Yellowstone Pharmacy at Kaiser Park Shadelands.
041576 - ..
041577 - Linda noticed in the record that Millie has a Power Port, and that her
041578 - INR has returned to normal. She asked when Millie is scheduled to get
041579 - another blood test?
041581 - ..
041582 - On 100529, Millie received a letter from Gloria in the Coagulation
041583 - Control Clinic at Kaiser in Martinez, scheduling a lab on 100621, to
041584 - test INR.
041586 - ..
041587 - Linda examined Millie's chest to feel for the Power Port on the upper
041588 - right side of her chest. She asked Millie about extensive rash
041589 - exposed to see the Power Port? Linda advised that Millie's rash looks
041590 - like an allergy. She asked if this is new, because there is nothing
041591 - in Millie's medical records about a chest rash. Linda feels the
041592 - doctor should be notified to prescribe treatment right away.
041594 - ..
041595 - Millie explained the rash is cancer - inflammatory breast cancer -
041596 - IBC, which she has had since about December 2002.
041598 - ..
041599 - Linda apologized for not recognizing Millie's cancer right away.
041601 - ..
041602 - Millie advised that delay recognizing her cancer has happened a lot.
041603 - She's been trying to get treatment for IBC "right away," since January
041604 - 2003.
041606 - ..
041607 - Linda asked if Millie wants life sustaining measures on suffering a
041608 - coma in advance of actual death?
041610 - ..
041611 - Millie related discussion with Liz on Wednesday, explaining Advance
041612 - Directive is on file at Kaiser to avoid life sustaining measures,
041613 - reported on 100602 0913, ref SDS A2 PE5L, and citing the call from
041614 - Sharon at Hospice the day before on 100601 1531. ref SDS A1 JY56
041615 - Millie signed the Advance Directive in a meeting with Doctor Johnson
041616 - on 100302 0830. ref SDS 70 P58M
041617 -
041618 - [On 100607 1243 Judy reported that searching the records
041619 - does not show Millie has an Advance Directive on file at
041620 - Kaiser; Judy will investigate and let Millie know if this
041621 - work needs to be done again. ref SDS A7 AO6J
041623 - ..
041624 - Linda took Millie's vitals.
041625 -
041626 - BP............................ 144 80
041627 - Pulse......................... 73
041628 - Temperature................... 98.2
041630 - ..
041631 - She feels Millie is in excellent shape.
041633 - ..
041634 - Linda advised that Millie is doing so well, that she does not need to
041635 - come back next week. She said Millie can call if her condition gets
041636 - worse unexpectedly, but based on assessment today, she feels from
041637 - experience treating other patients that Millie will not need follow up
041638 - for some time.
041640 - ..
041641 - Millie thanked Linda for thorough case management, starting Hospice
041642 - care.
041643 -
041644 -
041645 -
041646 -
041647 -
041648 -
041649 -
0417 -