CONTACTS 

SUBJECTS
Default Null Subject Account for Blank Record

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS B8 0000. ref SDS B5 0000.
040502 -
040503 -
040504 -
040506 -  ..
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 87
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 87 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 88 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 89 HH4I
040920 -  ..
040921 - On 100502 2143 Kaiser confirms that some patients respond well to new
040922 - "targeted" therapies. ref SDS 91 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 91 MZ4N
040926 -  ..
040927 - On 100503 1522 Millie notifies medical team that time of the essence
040928 - to get the next treatment going. ref SDS 92 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 93 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 94 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 95 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 96 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 97
040958 - L54I
040960 -  ..
040961 - On 100512 0730 Millie received 3rd treatment for 3rd cycle of
040962 - Abraxane. ref SDS 98 KE4K
040964 -  ..
040965 - On 100515 1415 Millie departed 2-week trip to Europe. ref SDS 99 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 A0 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 A1 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 A2 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 A4 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 A5
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 A6 036C  Advised Diane to
041013 - use Millie's statement of claim submitted to Kaiser on 100527.
041014 - ref SDS A6 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 A6 UN4M  Requested that Eileen read he claim and then make a
041018 - good faith determiantion. ref SDS A6 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 A6 UN5P
041023 -  ..
041024 - On 100603 1112 Linda called to schedule a visit for Hospice social
041025 - support. ref SDS A8 036C
041027 -  ..
041028 - On 100604 1350 Linda visited to begin case management for Millie's
041029 - Hospice care. ref SDS A9 036C
041031 -  ..
041032 - On 100606 1243 Judy visited Millie to begin Hospice social support,
041033 - covering from Linda. ref SDS B1 036C
041035 -  ..
041036 - On 100611 0900 Linda visited again.  She has not read the record to
041037 - verify understandings. ref SDS B2 036C  Linda doubled Millie's pain
041038 - medication with morphine. ref SDS B2 QK5O
041040 -  ..
041041 - On 100618 1451 Linda continued current pain medication; she ordered
041042 - medication for digestion to help Millie avoid coughing up food.
041043 - ref SDS B3 036C
041045 -  ..
041046 - On 100623 1452 Linda visited a day ahead of schedule.  Millie's pain
041047 - level is averaging 1 - 2.  She reported current pain medication is
041048 - satisfactory. ref SDS B5 QK5O
041050 -  ..
041051 - On 100706 1452 Linda visited, ref SDS B8 036C, and learned Millie's
041052 - pain level remains below 3 with current medication, including 60 mg
041053 - morphine and 2 oxycodone pills per day.  Millie reported being
041054 - satisfied with pain control. ref SDS B8 QK5O  Phlebitis has subsided in
041055 - both legs. ref SDS B8 2F9K  Left arm and hand are visibly swelled.
041056 - ref SDS B8 ON9K  Linda took vitals which are excellent for anybody, and
041057 - commented that "Millie looks wonderful." ref SDS B8 2F9F  In a few
041058 - weeks Linda will perform re-certification analysis for Millie to
041059 - remain in Hospice.  Millie advised that she intends to stay in Hospice
041060 - until Kaiser responds to her claim requesting treatment to recover
041061 - from UCSF medical mistakes that caused 11th relapse of cancer, and
041062 - with treatment that does not cause pain and suffering. ref SDS B8 2F5F
041063 - Linda is off-work next week, and so will see Millie again in 2 weeks.
041064 - ref SDS B8 QL56
041066 -  ..
041067 - On 100723 1030 Linda here to provide pain medication; she met with
041068 - Millie and her children, Pam and Ron Jr. ref SDS 0 036C
041069 -
041070 -
041071 -
041073 -  ..
0411 -
0412 -
0413 - Progress
0414 -
041401 - Linda called this morning and asked about visiting this afternoon.  We
041402 - scheduled the visit for between 1300 - 1400.  When she arrived about
041403 - 1500, Linda apologized for having a hectic schedule today.
041405 -  ..
041406 - This meeting followed the visit a few weeks ago on 100706 1452.
041407 - ref SDS B8 036C
041409 -  ..
041410 - Linda asked Millie about her pain level?
041412 -  ..
041413 - Millie said her pain remains below 3.
041415 -  ..
041416 - Linda asked if Millie is satisfied with her pain control, or would
041417 - she like to increase morphine?
041419 -  ..
041420 - Millie advised that her pain level is very tolerable, and so she does
041421 - not want to increase medications.  Millie advised that she has
041422 - increased to oxycodone to 2 pills on some days, and yesterday she took
041423 - 4 oxycodone supplementing morphine pills, control breakthrough pain.
041424 - She explained again that her pain subsides when she lays down.
041426 -  ..
041427 - Linda proposed increasing Decadron to better control "pressure" pain
041428 - across Millie's chest.
041430 -  ..
041431 - Millie is getting low on oxycodone, and she needs Compazine.
041433 -  ..
041434 - Linda decided that taking 4 oxycodone pills, indicates Millie would be
041435 - more comfortable increasing morphine from 30 mg to 60 mg, so she does
041436 - not need so much oxycodone for breakthrough pain.
041438 -  ..
041439 - Linda called the Hospice pharmacist, and he approved increasing
041440 - decadron.
041442 -  ..
041443 - Linda called the Hospice doctor, and he ordered more oxycodone, and
041444 - morphine treatment with 60 mg tablets.  She asked for 100 morphine
041445 - tablets.  The doctor the most Hospice can order is 50, which is enough
041446 - for almost 4 weeks.
041448 -  ..
041449 - Millie needed several other things, Siena, and mouth spray.
041451 -  ..
041452 - Linda explained that getting morphine 60 mg tablets gives Millie
041453 - flexibility to increase treatment to 90 mg, if necessary in the weeks
041454 - ahead, by taking both 30 mg and 60 mg.
041456 -  ..
041457 - Millie reported using the electric cart at Costco a few days ago, and
041458 - this made shopping a lot easier, and fun.
041460 -  ..
041461 - Millie asked for a wheel chair.
041463 -  ..
041464 - Linda will order a lightweight wheelchair for delivery on Monday.
041466 -  ..
041467 - There was also discussion about Coumadin.  Linda plans to bring up
041468 - Millie's Coumadin at a Hospice team meeting on Monday.
041470 -  ..
041471 - Linda noted again swelled left arm and hand are most evident symptoms
041472 - of IBC cascading out of control due to delayed treatment.  Linda did
041473 - not examine Millie's chest which is severely infected with cancer.
041475 -  ..
041476 - Millie's breastbone is the worst area, causing puss and bleeding to
041477 - flow onto her clothing and when showering.
041479 -  ..
041480 - Linda asked if Millie has fallen, and whether she would like Hospice
041481 - assistance to send some for personal bathing and grooming, for example
041482 - to take a bath.
041484 -  ..
041485 - Millie said she has not fallen.  Millie explained she has been taking
041486 - showers as usual without incident.  She declined getting Hospice for
041487 - personal care.
041489 -  ..
041490 - Millie reported having no further problems.
041492 -  ..
041493 - Linda took vitals...
041494 -
041495 -        BP..................... 126 78
041496 -        Pulse.................. 63
041497 -        Temperture............. 97.5
041499 -  ..
041500 - Linda used a stethoscope, and commented again that Millie has
041501 - excellent breathing today, following up similar report on 100623 1452.
041502 - ref SDS B5 QL41
041504 -  ..
041505 - Linda advised again that Millie seems in excellent health, noting how
041506 - "great you look," following up the past few meetings, most recently on
041507 - 100706 1452. ref SDS B8 VE4W  Linda smiled and told Pam, who sat in on
041508 - the meeting that Millie was doing so well, because she is an athlete,
041509 - who has taken good care of her body.  Linda said Pam, her siblings are
041510 - lucky to have such a strong, vigorous mom, because Millie's children
041511 - are likely to live similar lives.
041513 -  ..
041514 - Millie mentioned that Pam has a great love of dogs, like Linda.  Pam
041515 - explained getting two greyhounds from the Rescue Foundation.  Linda
041516 - related having several dogs, and recently rescuing a dog from an owner
041517 - who did not provide good care,  She became instantly attached, and
041518 - started getting the dog shots, restoring the dogs health and at
041519 - considerable expense.  Then the former owner asked for the dog back.
041520 - Linda objected, and this wound up involving calling the police.
041521 - had to return the dog, but a month later the woman brought the dog
041522 - back to Linda, realizing the dog was too big a responsiblity.
041524 -  ..
041525 - Pam was pleased that Linda got her dog back, and that the dog has a
041526 - loving owner.
041528 -  ..
041529 - Millie noted the meeting was held upstairs today, because she is
041530 - having trouble walking upstairs now, because she does not have the
041531 - strength to lift herself.
041533 -  ..
041534 - Linda scheduled to see Millie again in 2 weeks, and said to call if
041535 - Millie needs anything sooner.
041537 -  ..
041538 - Millie thanked Linda, and said she feels a visit in 2 weeks will be
041539 - okay.
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