Clozapine RX 4 Ecstasy: April 2018

Blogger Title

Referral and Linkage Part-II – Keith Torkelson Partners with Rimal B Bera (2018) – For The Common Good & Clozapine Management

Google Plus Information

Health & Human Services – Rimal B Bera Experiment - Core Competency – Referral and Linkage – Fleshing About – By Keith E Torkelson MS – UC Davis Pathology

Blogs

Clozapine & Brand New Day

Cover Image – The Kelly Thomas Affair - Revisited

Possibly Inappropriately Served - Definitely Over Served

A Reminder: What the doctors do matters

Objective Up Front (OUF) – What Others Say About Doctor

20180320-TU: Current Summative – For Rimal B Bera, MD

Rate A Doctor - Search For Yourself

“webmd rimal b bera”

“vitals rimal b bera”

“healthgrades rimal b bera”

Sample Link

https://www.healthgrades.com/physician/dr-rimal-b-bera-2xn5c

Sample Hit

Dr. Rimal B Bera MD Reviews | Orange, CA | Vitals.com

https://www.vitals.com/doctors/Dr_Rimal_Bera.html

Dr. Rimal B Bera, MD

20180320-TU: Rated 3.3/5 by patients. 11 reviews

Introducing Dr. Dobos Our Control

Doctor Dobos Said (A FAV Out of Fifteen)

“Sometimes the client knows best”

“Being critical can indicate improvement”

Doctor Chandler says about his colleague: “Dobos is remarkable”

How is it Dr. Dobos?

The Torkel Saga 2059: Keith E Torkelson - MS Introduces Dr. David M Dobos (2016)

http://the-torkel-saga-2059.blogspot.com/2016/06/keith-e-torkelson-ms-introduces-dr.html

Jun 4, 2016 - 20160604-SAT A Model Doctor On Call - Psychiatrists in Orange County California are sitting on a treasure trove of data.

Dr David M Dobos, MD Kaiser Psychiatrist in Aliso Viejo, CA – Doctor On Call - Stats by TheDAG and Keith E Torkelson, MS (2016) - Friday, May 13, 2016

http://the-torkel-saga-2059.blogspot.com/2016/05/dr-david-m-dobos-md-kaiser-psychiatrist.html

Refresh Hope with Legacy Reports

Early on we wrote reports shedding a positive light on our doctors. Dr. Dobos (Kaiser) came out on top as one of our best Behavioral Health Doctors (BHDs). His medication management system was superior. What follows are links to our Rimal B Bera MD legacy reports. The reason we are spending so much time on our Referral & Linkage is this is a once and a lifetime opportunity and danger.

20180312-M: Legacy Reports Up Front (LRUF) – Due Attention

Rimal B. Bera, MD Evaluated by Keith E Torkelson MS as a Doctor On-Call (2016)

http://the-torkel-saga-2059.blogspot.com/2016/11/rimal-b-bera-md-evaluated-by-keith-e.html

Initialize a Relationship with Doctor - Results Up Front

Profiling and Evaluating Doctor Rimal B Bera as a Replacement Doctor (2016)

Rimal B Bera Profile 2016

By Keith Torkelson Master of Comparative Pathology (UCD) LiveX = Lived Experience

Brand New Day HMO: Keith Edward Torkelson – Treatment Preferences (2017)

http://brandnewdayhmo.blogspot.com/2017/12/keith-edward-torkelson-treatment.html

Dec 14, 2017 - Behavioral Health Medication - Treatment Preferences by Keith E Torkelson M.S. for Doctor Rimal B Bera Advanced Directives - You visited this page on 3/4/18.

Brand New Day HMO: Referral and Linkage Part-I – Keith Torkelson Partners with Rimal B Bera MD (2018).

http://brandnewdayhmo.blogspot.com/2018/01/referral-and-linkage-part-i-keith.html

Blogger Title. Referral and Linkage Part-I – Health & Human Services – Core Competency – Referral and Linkage – Objectivity and Strengths – By Keith E Torkelson MS – UC Davis Pathology.

Table of Protections and Protective Factors (Brief)

Table – Protections and Protective Factors – Last Reviewed: 20180330-F:

Protecting Against What?

In short these Protective Factors and more buffer us against Catastrophic Loss.

Part II of III

1-Abstract – Executive Summary

As you can see previously Rimal B Bera (RBB) has been rated on three Online Rate Your Doctor sites. A total of twenty (20) people as of March 20, 2018 rated Dr. Bera. From these people Dr. Bera earned an average of 2.8 Stars (5.0 is the best possible) from these objective raters. Since we first began tracking Dr. Bera Online his raters have been offering harsher ratings. We here at Mentalation Solutions Group assessed Dr. Bera across multiple latitudes. Out of our derived assessments we hope to select about three to use routinely. The most important thing with our initial Linkage Appointment was to get our Clozapine medication right.

Experimentation

In this report we use Doctors Andrew Inglis and David Dobos as Controls. Dr. Bera is our experimental doctor. With Dr. Bera we hope to define our Markers of Mental Health (MMH) and improve upon them. We hope to grow a therapeutic partnership as we did with his predecessor Bum Soo Lee (2012-2017). A few of our goals with this report are: Process our observations about Dr. Bera, establish baseline scores, and help Dr. Bera improve his online ratings. We hope that if he gets his ratings up our insurer Brand New Day can get their CMS ratings up as well. Dr. BS Lee our Behavioral Health Doctor (BHD 2012-2017) indicates that Dr. RB Bera is nothing remarkable. We wonder what is usual and customary because Dr. Chandler indicated that his colleague Dr. David Dobos was remarkable.

Dedicated To

We dedicate this paper to Dr. Arnold P Deutsch our fourth (4^th) Behavioral Health Doctor (BHD). Dr. Deutsch (1989) helped us return to the School of Veterinary Medicine at UC Davis after our initial bout with Anxiety and Sleep Disturbances. Because we were private pay we had fifty minutes per session to work things out and move ahead. His only error was that he did not help us determine causation. It is very difficult to prevent things if you cannot identify what is causing it.

[INSERT PHOTO OF APD #1]

Arnold "Arnie" P Deutsch - 1989 - Experimentation Series

In Memory Of – In Honor Of

This paper is in honor and memory of some of our comrades. All of them have service experiences with Brand New Day including psychiatrists such and Dr. Bera. Mark and Dug died too young. Mark Allen and Dave Dart are holding theirs own. Dave Dart has higher expectations about his care than does Mark Allen.

[INSERT PHOTOS OF DUG AND MARK]

Douglas "Dug" K

Died too Young

Brand New Day Client

"Metal" Mark Died Too Young

Brand New Day Client

List - Tables – Figures - Matrices

Figures – Community Partners

Objective Up Front (OUF) – What Others Say About Doctor

Table of Protections and Protective Factors (Brief)

List - Tables – Figures – Matrices

Table – A Guide to Practice - Provisions Provided

List - Linkage Appointment - Preparations (Brief) Visit #1 Preparation

List - Linkage - Visit #2 Preparations

Table - Charter Information for Referral II Of III

Table - Acronyms – Brief

Dr. Rimal B Bera MD – Objective Findings (Time Series) [HELD]

Table - Comparing Doctors Lee (BSL) V Bera (RBB)

Table - Assessment Inventory List (AIL)

Table - CAHPS Assessment

Table - Vitals – Subjective - Shopping for the Best

Table of Virtues - BSA Brief Comparison

Figure “Good People…”

Table - Procedures Prowess Evaluation (PPE) as Indicated at Intake

Table - Strengths Assessment – Medication Management – 3 Prescriptions

[FIGURE INSERT LAST LETTER IN SERIES - BERA]

Table – Coverage Determination - Clozapine Solutions (2017)

Table - 2018 Coping Time Line > Step Summary

Matrix – Medication Determination - Safety Net Comparisons

Matrix - Profiling Effectiveness of Rimal B Bera, MD

Table of A History About Rimal B Bera MD

Tables - Comparing Doctors – Inglis (Control) V Bera (Experimental)

List of Achievements with Dr. Lee (2012-2017) – A Sampling

Figure – Experimental Bunny Rabbit

Qualities to End a Referral as a Linkage (BSL > RBB)

Table – Quality Map of When To End Referral Stage – Last Updated: 20180402-M:

Table – A Guide to Practice - Provisions Provided

Establishing Rapport & High Expectations

Limited Appointment V Comprehensive Consult

Table – Provisions A Guide to Promising Practice – Context of Rimal B Bera MD - Last Reviewed: 20180330-F:

[INSERT CASA YOUTH SHELTER STATS]

Performance Earned Value

Professionals Beginning to See The Light

List - Linkage Appointment - Preparations (Brief) Visit #1 Preparation

Table – Preparing for Our Linkage Appointment with Dr. Rimal B Bera MD: Last Reviewed: 20180331-SAT:

List - Linkage - Visit #2 Preparations

Table – Preparing for Our Linkage Appointment #2 of 3 with Dr. Rimal B Bera MD: Last Reviewed: 20180331-SAT:

Direct Share – Solicitation - Errors

How is it that we do not share this and our previous reports with Dr. Bera directly? Mostly we avoid direct sharing because this report and information herein is unsolicited. We know that Health Practitioners have little capacity for considering unsolicited information. Free form reports are not part of the Cookie Cutter Method (CCM) that doctors have come to rely on. In addition if we distract RBB too much during the appointment his chance for making an error again increases. We will consider sharing more directly after his error rate goes down. Because we have listened to him talk for more than an hour and a half he has a listening backlog also to address. We will share our opportunities to listen later in this report.

Table - Charter Information for Referral II Of III

-
Specification	Detail	Note
-
Title (Brief)	Behavioral Health Referral	Part-II
Blog(s)	Brand New Day HMO	Secondary Clozapine
Core Assignment	Referral & Linkage
Discipline	Health & Human Services	Paraprofessional Health Worker
Inspired By	Gary Zager, MS	CIM – Referral & Linkage
Number of Pages	About 40
Number of Images	About 15
Principle Author	Keith E Torkelson	MS – UC Davis Pathology
Editor	AVEY
Driven By	DELL
Date Published	20180404-W
Links to MSG Legacy Publications	About 5	“A ProSumer Report”
-

Table – Referral II – Charter Information: Last Reviewed: 20180331-SAT:

Table - Acronyms - Brief

-
AcroCode	Meaning
-
BHD	Behavioral Health Doctor
BHDC	Behavioral Health Doctor in Charge
BSL	Bum Soo Lee - MD
C/O	Care Of
CMS	Centers for Medicare & Medicaid Services
CCCHC	Central City Community Health Center
COD	Co-Occurring Disorder
COP	Co-Occurring Problem
CS	Customer Service
HRE	Health Related Engagement
MOMs	Meeting Of the Minds
QL	Quantity Limit
RBB	Rimal B Bera - MD
STR	Structured Temporal Reconciliation
TGTU	Things Greater Than Us
LOP	Level Of Power
PBM	Pharmacy Benefit Manager
SPC	Single Point Contact
#BFF	Big Fat Foot
-

Table – Acronyms – Last Updated: 20180218-SUN:

Table - Comparing Doctors Lee (BSL) V Bera (RBB)

Ratings – Rapport Evaluation (Brief)

-
Rating	Control Doctor (BSL)	RBB
-
Overall Rating	>20 Visits AVG 20 Visits = 4.0	1/1 Visit = 3.0 Better than what others awarded him: Visit: 20180103-W
Explains Conditions	Satisfactory
Explains Treatments	Satisfactory
Takes time to answer my questions	Good	Solicited no questions
Provides follow-up as needed	Little	Missed boat on Clozapine Determination
-

Table – Qualitative & Quantitative Review Behavioral Health Doctor (BHD) Rapport

Control Doctor(s)

Here our Control Doctor (CMD) is Dr. Bum Soo Lee MD (BSL). We saw BSL from 2012-2017. In that time we participated in more than twenty (20) Face-to-faces (F2F). Our summative appraisal of BSL yields 4.0 Stars of 5.0 Stars. He only made about two (2) errors during our 2012-2017 therapeutic window. We actually submitted a formal Grievance about him. He was impressed yet not overjoyed.

Bera - Improving Score(s)

Three things that we here at MSG would help Dr. Bera (RBB) improve would be: His Flawless Medication Management System (FMMS), his offering a Satisfaction Survey for each encounter, and maintaining the BSL standard appointment frequency by seeing us every three (3) months. He could really use some help proving concepts about his practice. We gave him a 3.0 Rough Star Score (RSS) that is better than what our objective raters gave him. If RBB is perfect for the rest of the year (2018) he can earn 4.5 Stars from us here at MSG. We would really enjoy seeing his CV including marks for grades in Medical School.

Table - Assessment Inventory List (AIL)

-
Assessment	Measures	Selected
-
1-Vitals – Objective	Satisfaction	Full
Satisfaction – Ours	Perception	Held
Smart Shopper	Value Value Added
BSA	Virtues	Brief
CAHPS	CMS - Satisfaction	Brief
Evaluate Teladoc	Utility	Brief
Procedures Prowess Evaluation (PPE)	Mechanics	Brief
Rapport	Rapport	Brief
Mental Status Examination (MSE)	Illness	Held
Satisfaction - BND	Insurer	Held
Satisfaction – His	Consumer Satisfaction	Not Available
Stars	Service Quality	PRN Embedded
-

Table – Assessment Inventory List – Last Reviewed: 20180331-SAT:

Table - CAHPS Assessment

Consumer Assessment of Healthcare Providers and Systems (Brief)

-
CAHPS Features	RBB	PCP	BND	Team CCCHC
-
Your Health Care in the Last 6 Months	SoSo	Good	SoSo	Better
Your Personal Doctor	SoSo	Good
Getting Health Care From Specialists	SoSo	Good	PCP Referrals
Your Health Plan			Conflict of Interest
About You (In context of)	SoSo	Good	Better	Better
-

Table – CAHPS Brief Results – Last Reviewed: 20180331-SAT:

FYI - About CAHPS | Agency for Healthcare Research & Quality

https://www.ahrq.gov/cahps/about-cahps/index.html

“Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The acronym "CAHPS" is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).”

FYI

CMS Stars = HEDIS + CAHPS + HOS

“Consumers Best Qualified to Assess”

Quality @ A National Level

Table - Vitals – Subjective - Shopping for the Best

Smart Shopper Assessment - Psychiatrist Choices – Psychiatrist Elimination

-
Doctor Identity	Appropriately Served	Current Issue
-
Alan Vu	No	Still cleaning up wreckage
Clayton Chau	Yes – Informal	Set the bar for a great BHD too high
Ravinder P Singh	SoSo	Initially misled – thinking she was better
Rimal B Bera	Getting off to a Slow start	Medication Management Probation for the rest of this year
Raphael Waknine	No - Eliminated	We agree with Vitals (Objective) 2.0 Stars Score (Poor)
KH De Silva	No	Everyone is Bipolar Approach
-

Table – Qualitative Features of Behavioral Health Doctor (BHD) Shopping List: Last Reviewed: 20180330-F:

FYI - Page The Doctor (PTD)

Objective Update – Waknine Eliminated

Dr. Raphael Waknine MD Reviews | Garden Grove, CA | Vitals.com

https://www.vitals.com/doctors/Dr_Raphael_Waknine.html

Dr. Raphael Waknine, MD

20180216-F: Rated 2/5 by patients - 2 reviews - Psychiatrist in Garden Grove, CA.

FYI – Vitals Take on Waknine - Interpretation

“The overall average patient rating of Dr. Raphael Waknine is Poor. 2 patients have rated Dr. Raphael Waknine. From those 2 patients 0 of those left a comment along with their rating. The overall rating for Dr. Raphael Waknine is 2.0 of 5.0 stars.”

Is This Protective?

We ask ourselves often is are these report we research about, write, and share Protective. How is it that report writing can keep us healthy and out of the hospital. We will ferret about this quandary and present our findings in our next report addressing Dr. Bera.

Table of Virtues - BSA Brief Comparison

-
Merit	BSL	RBB	Teladoc
-
Helpful	Yes	SoSo	No
Friendly	Yes	Yes	No
Trustworthy	Yes	SoSo	No
Thrifty	Yes	Yes	Can’t see us saving any money It may not even be for free
Respectful	Yes	SoSo	SoSo
-

Table – Select Virtue Scale – Last Reviewed: 20180331-SAT:

Teladoc - Expected – Independent Consultation System

Our program Brand New Day (BND) is promoting the Teladoc Online Service. We were hoping that Teladoc were an independent resource. We created an account just to find, Teladoc would associate with our BND network doctors. In addition we may incur fees for their services: “cost of a Teladoc visit varies”. Our Online doctors are Roizen [SPELLED] and Oz who serve us free via ShareCare. We really do not recommend Teladoc at this time. Our BSA Virtue assessment indicates virtues and values that make good people.

Something of which to make note

Distraction - Check it Out: How would you rate Teladoc?

FYI - Frequently asked questions | Teladoc

https://www.teladoc.com/frequently-asked-questions/

Frequently asked questions on Teladoc

“These are the most common questions we get asked. General Medical How much does it cost? The cost of a Teladoc visit varies, depending on your plan design. Do I talk to “real doctors”? Yes. Teladoc members only talk to actual doctors who are U.S. board-certified…”

Doctor of Choice – Doctor’s Forte Investigation Matching

Dr. Rimal B Bera, MD - Garden Grove, CA - Psychiatry - Healthgrades...

https://www.healthgrades.com/physician/dr-rimal-b-bera-2xn5c

20170926-TU: Rating: 2 - ‎4 reviews

Dr. Bera is now accepting new patients. Dr. Bera's Experience

100% - Experience Match: 32 - Conditions Treated

Table - Procedures Prowess Evaluation (PPE) as Indicated at Intake

-
Procedure	ProSumer	Sold
-
Family Psychotherapy	Ready	No
Psychiatric Evaluation – Brief Not Paper Driven	Ready	Updated Diagnosis
Psychiatric Evaluation – Extended 30 Minutes	Ready	Not Done
Psychotherapy	No	No
Psychophysiological Therapy (Inc Biofeedback)	No	No
-

Tables – Procedures @ Linkage (Intake) – Consumer Keith Torkelson – BHD Rimal B Bera

Solicitation Paradox

20180331-SAT: Updated Solicitation Dilemma

For Referral II Report

We here at MSG have been writing reports about the psychosocial aspect for Health & Human Services since 2009. We find that if an Agency or Individual does not solicit our findings they lack the resources to consider them in depth. Our current unsolicited report addresses Team Rimal B Bera about the topic Referral. One of the reasons we here at MSG continue to publish unsolicited reports is that they help appreciate where we are and how far we have come for setting things Right. We have sent some prior complaints to Centers for Medicare & Medicaid Services (CMS) who does solicit exhaustive input yet we are taking a non-CMS mediated route with RBB associated quandaries and disappointment.

Number Treated V Mastery – TQN Model Doctor

Our in BND Network Dermatologist (TQN) indicated a couple years ago the number of unduplicated cases that he treated. He also indicated that all of them were not satisfied. Yet, with observing his clients and us: We are satisfied! Our satisfaction is an indication that he has after more that thirty-years (30) mastered his profession. Hats off to you doctor TQN.

Vitals Plus Theta – Subjective

Legacy Link - Rimal B. Bera, MD Evaluated by Keith E Torkelson MS (2016)

20171031-TU: Page Views = 35: Chartered - 11/20/16

http://the-torkel-saga-2059.blogspot.com/2016/11/rimal-b-bera-md-evaluated-by-keith-e.html

Note - At the end of our 2016 report we invoiced RBB

Comparative Page Views

Some of our publications get over 2000 Page Views. Our highly accessed reports tend to be general in nature. As you can see above on 20171031-TU there were thirty-nine incidences of viewing for our (2016) report regarding Dr. Bera. Not many people appear to know or are interested in Dr. Bera’s work. At this time this (MSG’s) conclusion is a weak one

Table - Strengths Assessment – Medication Management – 3 Prescriptions

-
Medication	BSL MD	RBB MD	Other MD
-
Lorazepam	1 Error 10 prescribed for 30 days	Failed to Prescribe @ Referral #1 Appointment	No Errors
Clozapine	No Errors	Questionable (LOT/LOS)	Daniels MD Error (RIH)
Lithium	No Errors	No Errors	No Errors

Clozapine Determination	2017 – Argued in favor	2018 – No support in favor	2007-2016 – Never an issue
-

Table – Outcomes Before 2^nd Appointment: Last Reviewed: 20180330-F:

Triple LO_w

LOA-Lack Of Accountability

LOT-Lack Of Transparency

LOS-Lack Of Support

RIH-Resulted In Hospitalization

Quote – APD MD

When we hired doctor APD to take over our case in 1989 one of the first things he said was: So you fired De Silva! When you private pay you have more choices. We are just fortunate that Dr. Bera took us on as an account.

[INSERT 2^nd PHOTO OF APD]

The Report is Dedicated to

Dr. Arnold P Deutsch

For Having High Expectations for Us

Changing Our Clozapine – Risky Business

Carried Over From (About 8 Pages)

Metadata: Clozapine Practical 2.0_Determination_161110602 V2018

20180225-SUN: Update – Progress Note

At 317pm today an automated system from MedImpact called us on our cell phone. The Automated Voice announced: “Your prior authorization for Clozapine has been denied”.

20180308-TH: Update – Bera’s Position – Unless we follow up directly the letter below will be our last correspondence about this 2018 Clozapine Determination issue. It looks like our new Behavioral Health Doctor (BHD) Rimal B Bera (RBB) will not support us with our preferred treatment. What RBB is implying is that our previous BHD in managing Clozapine is wrong. The chronological order for our Clozapine related BHDs is: Singh, Inglis, Vu, Daniels (Made an error), and Bum Soo Lee.

[FIGURE INSERT LAST LETTER IN SERIES - BERA]

Figure - Irritating Letter

Denial for our 50mg Clozapine Prescription

20180309-F: A Note to Doctor - Dear Dr. Bera,

It looks like in the letter that you do not agree with the chain of Psychiatrists that came before you. It took more than ten years to get our primary psychotropic medication Clozapine “Right”. Incidentally, we did not submit and appeal. It looks like in the letter you deny us of what we need without proposing and viable alternative. If you asked us in our initial Medication Management Appointment (January 3, 2018) we were ready to discuss our medications with you. As we near the end of this report - All along the way we were downplaying your part. We are nearing a “Fix” on our own. Then boom you jump in supporting the “Denial”. We settled for a “Poor Choice”.

Table – Coverage Determination - Clozapine Solutions (2017)

Treatment Preferences Revisited (Do Over)

-
Alternatives	Prescription(s)	Amounts	Harmony	Note
-
Stay the same (2017 – Solution)	50mg 4 x at night	120 oral tablets per month	Quantity Limit (QL)	Needs demonstration Takes an exception (2017)
Best second choice	50mg 2 x at night 100mg 1 time at night	100 50mg oral tablets per month 30 100mg oral tablets per month		Needs potential negotiation and change of Prescription
Poor choice	100mg 2 x at night	60 100mg oral tablets per month	Probably most preferable to Harmony	Needs Change of Prescription
Poorest choice (2018 – Fix)				Any solution that troubles us with no Clozapine (2018)
-

Table – Coverage Determination - Clozapine Solutions (2017) – Treatment Preferences - Carried from 2017: Last Update: 20180302-F:

Treatment Preferences – Do Over –Action Item

Even though we thought we had promoted our Treatment Preference enough for 2017 we now find we must commit to a “Do Over”. Healthcare Reform Measures (HRMs) indicate Consumer-driven Treatment Preferences (CTPs) are desirable. Actually promoting them has proven to be a hard sell. In 2016 our Behavioral Health Doctor (BHD) indicated that our preferences would not be honored in an inpatient setting. Basically, he said he would not honor them in an inpatient setting. This BHD is about 77 years old – he will be retiring soon. He retires without publishing anything that proves his “Practice” was successful. That is sad a whole life and nothing as a doctor to be proud about and survive him.

Treatment Preferences Link

Brand New Day HMO: Keith Edward Torkelson – Treatment Preferences (2017)

http://brandnewdayhmo.blogspot.com/2017/12/keith-edward-torkelson-treatment.html

Dec 14, 2017 - Keith Edward Torkelson – Behavioral Health Medication - Positions Mental Health - Doctor Rimal B Bera Advanced Directives - Difficult to Apply - You visited this page on 3/4/18.

Treatment Preferences Schedule – Advocacy

When we set out some five (5) year ago we thought that promoting Treatment Preferences would be a no brainier. Advocating for consumer-driven Treatment Preferences has been hard work. After dozens of experiments about psychotropics since 1989 the doctor should be eager to embrace the results – results that help formulate current and cutting edge Treatment Preferences. The cost for us to discover and have preferences is conservatively in excess of $100,000.00.

Syncope Side Effect – Minded Medication (MSG, 2018)

Syncope is listed as a side effect for Clozapine (CLOZARIL). Syncope might be described as a temporary loss of consciousness caused by a fall in blood pressure. Clozapine associated Syncope increases our risk for a fall. We determined that “Dividing” our Clozapine doses reduces our risk of falling. This is the reason we prefer the 50mg tablets titrated up to 200mg each night. In addition our titration method tests our Mindful Medication Model (MSG, Triple M, 2018). One day we will get around to publishing our findings about Triple M. Triple M promotes optimism and self-efficacy. As Dr. David Dobos (Kaiser) stated: “Sometimes the patient knows best”.

Problem with Medication (Clozapine) Management – Clozapine Determination

Table - 2018 Coping Time Line > Step Summary

Event Timeline – Time Series – Structured Reconciliation (STR)

-
Time Stamp	Step (Action)	Persons & Notes
-
20180215-TH	Call Gilbert Pharmacy for Routine Refill on Clozapine	Brand New Day (Harmony Dual Access) Clozapine QL Issue
20180215-TH	Gal says OK She calls back later	We cannot fill prescription as written – ReactMan Will take 3 days to sort it out
20180215-TH	I ask for emergency supply	They deliver 5 days worth (Patched) Lab work only 22 days old - From 20180124-W
20180217-SAT	Revived Report	Determination (2017)
20180217-SAT	Call Gilbert @ 10am	“Has our Clozapine been worked out” Response “No – nothing from doctor” I will call back Monday
20180219-M	Call Gilbert	Pharmacist say he will not fill our prescription for Clozapine
20180219-M	Call Gilbert for SPC “Nick”	We agree on 100mg tablets Say he will deliver tonight
20180225-SUN	Incoming Call @317pm	MedImpact “Denial”
20180301-TH	Received Letter	MedImpact “Denial”
20180308-TH	Received Unexpected Letter From Brand New Day	Brand New Day and Dr. Bera “Close” File on issue
20180312-M	Give Gilbert 3 days lead time	Call on Monday for prescription on Thursday (20180315-TH)
20180314-W	Emergency Drop-in	Need to see Doctor Bera Clozapine is not on track by 20180313-TU
20180315-TH	Wait for delivery	Key Event - Hope for the best Clozapine Reworked on track
20180316-F	Publish findings	Actually earlier to begin closure of Determination Report - 20180309-F
20180316-F	New Report	Referral II (This)

Table - 2018 Time Line > Step Summary: Last Update: 20180401-SUN:

Matrix – Medication Determination - Safety Net Comparisons

Context Medication – Balanced Scorecard

Table – Balanced Score Card – 2017 V 2018 Clozapine Determinations: Last Reviewed: 20180330-F: S&S = Services and Supports

XENONET – Low level of consumer control

MedNet – High level of consumer control

Mindful/Minded Medication (MSG, 2018)

Link to Treatment Preferences

[AN UNSOLICITED LEGACY DOCUMENT]

Brand New Day HMO: Thursday, December 14, 2017

Keith Edward Torkelson MS - Mental Health Treatment Preferences for Keith Edward Torkelson M.S.

http://brandnewdayhmo.blogspot.com/2017/12/keith-edward-torkelson-treatment.html

Matrix - Profiling Effectiveness of Rimal B Bera, MD

Positions and Promises @ Meeting Of the Minds Conferences

Scores for Engagements with Rimal B Bera MD

-
Timeframe	Engagement	Efficacy QSM Stars	Theme
-
20180103-W	1st Appointment	4.0	Limited Appointment Our expectations too high
20180103-W to 201804	Interval	3.0	Clozapine Determination Issue No Consultation
20180314-W	Emergency Appointment	N/A	Not necessary because our negotiations with Pharmacy yielded a “Fix”
20180411-W	2^nd Appointment	Pending	Use Vitals Plus Method And Select Forms from this Report
-

Matrix – Scoring an Engagement with Your Behavioral Health Doctor: Last Reviewed: 20180330-F:

QSM-Quick Score Method

If we ran our full Vitals Plus (Theta) test on doctor Bera he would likely score lower.

Note: Satisfaction Stars differ from CMS Stars

Table of A History About Rimal B Bera MD

-
Year	Event	Quick Score (4.0 = A)	Note
-
2012-2017	Word of Mouth		Clients say he is OK
2015	MOMs	4.0
2016	MOMs	4.0
2017	MOMs	4.0	Promoted Cognitive Development & Family Involvement
-

Matrix – Scoring an Engagement with Your Behavioral Health Doctor: Last Reviewed: 20180330-F:

MOMs-Meeting Of the Minds

Doctor David Dobos (Control Doctor) Time Spent

Since our need for Behavioral Health Medication (BHM) began in 1989 we have linked to about one-dozen (12) Behavioral Health Doctors (BHDs). Some of the Referrals & Linkages we made ourselves. When it comes to linking and other practice features Dr. Dobos with Kaiser comes out on top.

Meeting Of the Minds (MOMs)

We first caught wind of Dr. Bera about the Brand New Day (BND) office and the Central City Community Health Center (CCCHC) office. In 2012 we began asking clients: What do you think of Dr. Bera? In 2015 at the annual Meeting Of the Minds in Anaheim California we had chance to sit in on one of Dr. Bera’s workshops. We have observed Dr. Bera along with his partner in crime (Kami) now on three occasions as presenters. When Dr. BS Lee MD referred us to Dr. Bera he indicated that Bera was not remarkable. That burst our bubble because we were just coming to believe Dr. Bera was remarkable.

Note - Address Positions and Promises in Referral III Report

MOMs for the ProSumer

“What are the measurable behaviors that the workshop attendee will demonstrate or achieve? Typically, one to three objectives can be identified phrased as such, “At the end of the presentation, the attendee will be able to…“identify,” “describe,” list,” “explain,” “demonstrate”

“Measurable Behaviors” – Record and Calculate

Dr. Bera is on the roster to present at the 2018 Annual Meeting Of the Minds. The workshop proposal form asks about measurable behaviors. We take notes when we see Dr. Bera teach. We are sure that we could “identify” “list” etc. We hope he takes it up a notch by asking us to record his performance statistics and calculate something meaningful. Our false hope needs to be refreshed as Tangible New Hope (TNH).

Tables - Comparing Doctors – Inglis (Control) V Bera (Experimental)

Bera – Formative Evaluation


	Quality		Quantity

	Performance Earned Value (Calculate PEV-Practice)		1.3/12
	Percent (PEV) =		10.8%
	Star Equivalents =		0.5

Table – Performance Earned Value (Practice) – Dr. Bera (Experimental) – Last Reviewed: 20180330-F:

Inglis – Summative Evaluation


	Quality		Quantity

	Performance Earned Value (Calculate PEV-Practice)		7.0/10
	Percent (PEV) =		70.0%
	Star Equivalents =		3.5

Table – Performance Earned Value (Practice) – Dr. Inglis (Control) – Last Reviewed: 20180330-F:

List of Achievements with Dr. Lee (2012-2017) – A Sampling

Table – Achievements with MD (2012-2017) – Bum Soo Lee – Last Reviewed: 20180330-F:

MSO-Most Significant Other

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Situational Awareness - Joan Our Most Significant Other Ever

Discussion Items To Follow

20171030-M: Initiating the Referral

We detected that our BHD (2012-2017] may be retiring soon while we were profiling him. He is definitely over 65. His name as we have mentioned earlier in this report is Dr. Bum Soo Lee (BSL). Dr. Lee holds office hours at Central City Community Health Center (CCCHC). Basically we had Drs Waknine and Bera to choose from. Dr. Lee (and Nurse Bethany) instrumented our referral to Dr. Bera. While doing so Dr. Lee wished us “Luck”. Dr. Lee never said” Oh! You will like Dr. Bera he is a good doctor. With Dr. Lee our routing Clozapine day were Tuesdays. Our new routine Clozapine Day with Dr. Bera now centers about Wednesdays. We really hope our next appointment, April 11, 2018, with Dr. Bera goes without a hitch. We wish to move forward with Diagnostics.

Progress Note – Action Item

To repeat, for the last five (5) years our medication management and CBC cycling has centered about Tuesday Mornings. Last year Dr. Lee referred us to move ahead with Dr. Bera (RBB). We have been informed that Dr. Bera is at CCCHC on Wednesdays. Our first appointment RBB is On January 3, 2018. We are requesting that schedulers be mindful that our Clozapine associated CBC lab tests now are best run on Wednesday in the AM. Teams Bera and Lee thank you for your time and consideration.

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Major Milestone: 20171024-TU:

Routine Medication Management Appointment - Referral

As Established Patient

We presented Doctor BS Lee a similar note/memo to the one above. In response her referred us to Doctor RB Bera per our wishes. Again, Doctor BSL is retiring soon. We had hoped that we would leave him with a stronger Digital Presence. Possibly after he retires he will write and publish his memoirs. For closure about Doctor Lee we will recall our Christmas Report Cards and other pertinent assessment information from our records. We will emphasize his strengths more than any deficits. Strengths Up Front. We will mention one deficit for the purpose of preventing it with Doctor RB Bera.

Advanced Planning – MdSearch and Availability

During the summer of 2017 we here at MSG had a notion that our Behavioral Health Doctor (BSL) would be retiring soon. While researching his performance on-line we found him to be in his mid seventies. On October 18, 2018 (W) we began shopping for a replacement with equal or better performance figures. We had been tracking Doctor RB Bera’s performance and promises since the 2016 Meeting of the Minds. Meeting of the Minds (MOMs) occurs once a year in Orange County California. After eliminating several doctors we partnered with previously we selected RBB. RBB shows the most promise. We called “Amanda” at Brand New Day – Universal Care Customer Services. Amanda indicated RBB was accepting new clients. She did not know his days in the office or the hours he kept. From Central City Community Health Center (CCCHC), the location where RRB holds office hours, we found he is in on Wednesdays. At his point we were ready to apply our findings for a Referral Appointment with Doctor Bum Soo Lee.

Must have Clozapine

Since 2007 we have been completely dependent on Clozapine to sleep. In 2012 Clozapine was taken away by Dr. Daniels and replaced with an experimental medication. While we were adjusting she prescribed us a Barbiturate for three days. We she stopped the Barbituate we stopped sleeping. Seventy-two hours later without adequate sleep we were back in the Psych Ward. The benefit of that hospitalization was that we met Dr. Bum Soo Lee.

Effective and Well Tolerated - 2006-2011 and 2012-Present

For the most part for us Clozapine has been effective and well-tolerated. Up and till 2012 we always thought that it would be nice to have the benefits (drowsyness) of Clozapine without the side effects. That falling down (related to syncope) is for the birds. Falling backwards is one thing while falling face first has been quite harmful. In our article collection we still have the blood rag from a face first fall while in Huntington Beach Hospital. While a staff member yanked us to our feet he caused severe bruising in our armpit.

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Figure - Blood Rag from Clozapine Mediated Fall in Hospital

We used it to wipe the blood off our face

Time Spent Solving Problems V What Our Readers’ Want

We only have so many hours in a day to write. Our Non-Brand New Day publications get more readers. Yet since we take a risk each month about our Clozapine we have to surrender to the fact that each month it is in our best interest to address Clozapine Management. We hope to close out our Referral to Doctor Bera next month (April) with our second appointment. Make note this paper is just an invitation for him to defend his practice/practices. Eventually he may come to value Consumer Input about Quality Assurance. He would come a long way by offering Consumer Encounter Satisfaction Surveys (CESSs).

APD’s Reverse Titration Method

At our first appointment (20180103-W) Dr. Bera failed to renew our Lorazepam prescription. In 2012, we replaced Restoril [SPELLED] with Lorazepam because the later is more cost effective for us. Due to medication errors in the past, mediated by Central City Community Health Center the location for Dr. Bera’s office, we semi-compulsively check appointment information before we leave. To tell you the truth we were considering stopping our checking behavior this year (2018). Then we uncovered a potential error. One of our medications Lorazepam was not renewed. Doctor David Chandler (Kaiser) tried an abrupt dis-continuation back in the early 2000s. He stopped Ambien [SPELLED] completely in one day. We ended up in the hospital. If we hadn’t done our checking with Dr. Bera we were faced with a one-day cessation about lorazepam. Dr. APD always followed a reverse titration protocol when we worked to discontinue a Med.

Clozapine Dependence

Ever since 2006 we have been highly dependent on Clozapine a generic for Clozaril [SPELLED]. Clozapine is not to be confused with Klonopin [SPELLED]. At times the pharmacy may think we are addicted to Clozapine. We are at our worst - when someone or something is interfering with our daily flow for this our Drug Of Choice (DOC). For some reason we cannot sleep without Clozapine. If we do not sleep our risk for harm gets progressively worse until we have to get admitted to the Behavioral Health Ward (BHW) to be protected until we get Clozapine induced sleep. A gap in what we call the Monthly Clozapine Cycle (MCC) or 28-day Clozapine Maintenance Cycle (28-CMC) can incur substantial costs even death. Clozapine has a side-effect - drowsiness. For us this means Sleep!

Status Life-threatening

One again a chain of causality can link issues with our Clozapine to life-threatening situations. The last time we were at danger for accidental death was 2012. One of the reasons we were safe from 2013-2017 was because our Clozapine pipeline was kept intact. Problems with Clozapine put us at risk by breaking our Continuity Of Care (COC). We would like to find the Contract Administrator with Brand New Day (BND) who is in charge of the MedImpact (Denial) contract. There is really not chance BND will replace MedImpact because in other cases the benefit to BND most likely far outweigh the cost to retain MedImpact.

Rework – Do Over

Last year, 2017, we were given a bit of lead-time because the Determination Conflict came by mail. When the 2017 Determination challenged our Clozapine interests we did not publish a report because the issue was fixed. Our Clozapine supply continued without interruption. We were for the most part Satisfied. We put the stress and reactivity behind us. We had planned to Publish a report on Medication Determinations in due time. And now how fast a year passes. This year, 2018, we did not get a letter in advance with regards to the same issue as last year. We found out from our pharmacy, Gilbert Drugs, that they could not refill our Clozapine Prescription as written.

Age of Confidentiality

The unrecorded atrocities we have witnessed. As early as 1989 we witnessed first hand consumers being abused in an inpatient setting. Confidentiality in Health & Human services has covered up for inappropriate treatment. For the time being it looks like it is up to the consumer to disclose meaningful information. Confidentiality may actually promote Stigma.

As APD Puts It: Fire Him!

Dr. Deutsch we cannot fire Bera because he is the best choice we have.

What is the project?

The project for 2018 with regards to Dr. Bera is that he slides some non-monetary compensation our direction. Indirectly, Dr. Clayton Chau (Circa 2010) set the standard for helping us out with food stipend cards.

Conclusions

Bera - Improving Score(s)

Three things that would help Dr. Bera (RBB) improve would be Flawless Medication Management (FMM), offering a Satisfaction Survey for each encounter, and maintaining the BSL frequency by seeing us every three (3) months. He could really use some help proving concepts about his practice. We gave him a 3.0 Rough Star Score (RSS) that is better than what our objective raters gave him. If RBB is perfect for the rest of the year (2018) he can earn 4.5 Stars from us here at MSG. As we did with the Offices of TQN (Dermatology) we here at MSG can help practitioners record and improve their Service Scores.

Redirect Discovered

In March (20180 we were retracing some steps. We discovered that the link to one of our Bera related resources had a redirect. Our niece is ASKAhnika MD PhD. When we discussed Medical Doctors and performance she said that the doctors could hack “the system(s). We don’t know who how and why someone hacked one of our resources.

http://toproadrunner5.info/uaezcrv-rimal-b-bera-md.asp [REDIRECT ADDRESS]

Will You Remember Me And What I Did?

We are always interested in prominent people in our lives Digital Presence. We would rate Dr. Bera’s Digital Presence at low. Low is much better than absent. For the most part our Principal Mr. Torkelson was absent from the Digital Record before 2012.

20180311-SUN: “rimal bera keith Torkelson” Hit Page

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