CONTACTS 
0201 - Kaiser Permanente - Shadelands       925 906 2200
020101 - Walnut Creek
020102 - Ms. Christy D. Adams
020103 - Physical Therapy Department

SUBJECTS
Medical, Kaiser
Knee Examination Shows Problem on 990625
Knee Examination Shows Problem on 990816
Physical Therapy

0706 -    ..
0707 - Summary/Objective
0708 -
070801 - Follow up ref SDS 52 0000, ref SDS 51 0000.
070802 -
070803 - Physical therapy provided additional evaluation of knees.  Exercise
070804 - was suggested to strengthen leg muscles which relieves some stress on
070805 - knee joints, but does not improve cartilage loss.  Cursory review of
070806 - medical chart indicates missing history.  There is no evident
070807 - submission of medical history and knee treatments, to orthopedist.
070808 -
070809 -     [On 990829 received notice of meeting with orthopedist on 990910.
070810 -     sent letter to Christy confirming understandings today.
070811 -     ref SDS 54 0001]
070812 -
070813 -     [On 990907 Christy called. ref SDS 54 7387]
070814 -
070815 -
070816 -
0709 -
0710 -
0711 - Progress
0712 -
071201 -  ..
071202 - Physical Therapy Review Shows Knees Require Treatment
071203 -
071204 - Follow up ref SDS 52 4346.
071205 -
071206 - Met with Christy Adams, a physical therapist.
071207 -
071208 - Received meeting record. ref DRT 1
071209 -
071210 - Paid $10. ref DRT 1 3808
071211 - ..
071212 - Christy examined my knees.
071213 -
071214 -     She had me do knee bends while sitting, and then squatting.
071215 -
071216 -     She manipulated the lower legs left laterally, while holding the
071217 -     knee stable, similar to the examination by Sylvia on 990625.
071218 -     ref SDS 36 0882
071219 -
071220 -     There was no pronounced pain experienced during these tests.
071221 -
071222 - Christy asked if the knees hurt when sitting for an extended period of
071223 - time, and I explained this does not cause pain.
071224 -
071225 -     [On 990910 Craig did similar exam. ref SDS 56 4822]
071226 -
071227 - Christy advised that my knees exhibit ware, but not within the range
071228 - that typically requires replacement.  She recalled that Kaiser has a
071229 - lot of experience with knee replacements.  Kaiser has less experience
071230 - with preventive treatments.
071231 -
071232 - She reviewed the medical chart, and noted Sylvia's examination on
071233 - 990625 citing knee pain after exercise. ref SDS 36 4420  There is also
071234 - a recommendation to increase exercise to lower cholesterol, as
071235 - conveyed by Tracy on 990714. ref SDS 42 5074
071236 -
071237 - I mentioned pending review by an orthopedist, based on xrays taken on
071238 - 990813, ref SDS 52 1716, per Syed's call on 990811. ref SDS 51 6781
071239 - Christy said the medical chart does not have this information. see
071240 - review below. ref SDS 0 2601
071241 - ..
071242 - Today, Christy recommended exercise to strengthen the front and
071243 - back muscles of the leg.  Christy advised that improved strength can
071244 - help overcome loss of cartilage in the knee joints, but cannot reverse
071245 - continued ware that causes pain from exercise.
071246 -
071247 -     [On 990910 Doctor Boulris confirmed this point. ref SDS 56 9633]
071248 -
071249 -     [On 000124 Doctor Vincint Yamamoto concurred. ref SDS 57 4160]
071250 -
071251 - She provided a brochure...
071252 -
071253 -     Physical Therapy Department
071254 -
071255 -                Knee Exercises
071256 -
071257 -     ...showing 8 exercises for leg muscles.
071258 -
071259 - Christy wrote in the brochure to...
071260 -
071261 -        •  use 2# - 5# weights in performing exercises
071262 -
071263 -        •  ride stationary bike 3 - 4 times per week, for 20 minutes
071264 -
071265 -        •  swim, but avoid "frog" kick
071266 -
071267 -        •  ice the knees after tennis to reduce swelling
071268 -
071269 -
071270 - I asked Christy to submit a letter explaining the results of her
071271 - examination, showing findings and recommendations.
071272 -
071273 - Christy advised there isn't enough time to report on results of
071274 - examinations.  She said the brochure with her handwritten comments is
071275 - her report and provides adequate medical history required by Kaiser's
071276 - Healthwise Handbook, reviewed on 990625. ref SDS 36 0806
071277 -
071278 -
071279 -  ..
071280 - Christy to Follow Up on 990813
071281 -
071282 - Christy wants to know the results of the meeting with the orthopedic
071283 - doctor.
071284 -
071285 - She will call on 990913 OA 1145 to get results.
071286 -
071287 -     [On 990829 meeting with Craig Boulris, MD, set for 990910, suggest
071288 -     in a letter to Christy that she schedule her call for 990920,
071289 -     rather than 990913, to provide Craig sufficient time to complete
071290 -     his review. ref SDS 54 7387]
071291 -
071292 -     [On 990907 Christy advised she does not need the results of the
071293 -     meeting with Craig. ref SDS 55 3572]
071294 -
071295 -
071296 -
071297 -
071298 -
0713 -

SUBJECTS
Medical Chart Missing Information

0804 -
080401 -  ..
080402 - Medical Chart Missing Medical History
080403 -
080404 - The patient medical chart Christy showed today, has a copy of the
080405 - report on 8 new therapies submitted for reivew by the orthopedist.
080406 -
080407 - It seems to be missing following information...
080408 -
080409 -      1.  Patient letter on 990625, with record of meeting Doctor
080410 -          Sylvia Connolly and medical history of prior injuries,
080411 -          surgery and recent symptoms.
080412 -
080413 -      2.  Doctor Sylvia Connolly's letter on 990625, ref DRP 5 1764,
080414 -          received in the record by patient on 990706. ref SDS 40 0001
080415 -
080416 -      3.  Patient letter on 990713 to notify orthopedic people about
080417 -          new treatments. ref DIP 4 7290 issued at ref SDS 42 7332
080418 -
080419 -      4.  Patient letter about Synvisc knee therapy. ref DIP 6 5841
080420 -          submitted on 990731. ref SDS 48 0001
080421 -
080422 -      5.  Doctor Syed Naqvi's letter on 990802. ref DRP 7 4550
080423 -
080424 -      6.  Patient letter to notify orthopedic people about new
080425 -          treatments, ref DIP 7 5810, so they are prepared to meet,
080426 -          issued on 990813. ref SDS 52 1457
080427 -
080428 -      7.  Doctor Syed Naqvi's letter on 990813 indicating not having
080429 -          reviewed the record. ref DRP 8 4550
080430 -
080431 - The chart does not indicate that patient history, and information on
080432 - new knee treatments, have been submitted to the orthopedist to prepare
080433 - for a meeting, as requested in the letter on 990813. ref DIP 7 5810
080434 -
080435 -     [On 000124 Doctor Vincint Yamamoto advised that patient
080436 -     communication is not maintained in the medical chart. ref SDS 57
080437 -     7600]
080438 -
080439 - This may reflect that a specific orthopedic doctor has not yet been
080440 - assigned.
080441 -
080442 - The last letter from Doctor Naqvi on 990813, ref DRP 8 4550, did not
080443 - show evidence of reviewing the record submitted on 990813. ref SDS 52
080444 - 0001
080445 -
080446 -     [On 990829 received notice of meeting with orthopedist on 990910.
080447 -     ref SDS 54 0001]
080448 -
080449 -
080450 -
080451 -
080452 -
0805 -