An Experiment Named Fabiola: Health Care Takes Root in Oakland

posted on October 12, 2017

 

Lincoln Cushing
Heritage writer

 

“Fabiola Ends Experiment in ‘Feminism’” -Oakland Tribune, October 16, 1932.

Original Fabiola Hospital and staff, circa 1924, from collection donated by nurse Helen Dahl Collier.

This was the provocative headline for a story about the closing of the Fabiola hospital, originally named for the Roman nurse and matron who founded the world’s first hospital in the fourth century. Henry J. Kaiser would assure funding for the purchase and refurbishing of this building in 1942 (but we’ll get the that later).

The author of the Oakland Tribune story was Nancy Barr Mavity, a well-known crime writer and journalist. She described how the institution was founded by eighteen women in 1876 with provisions that management “must always be in the hands of a woman” and that “every staff doctor must also be a woman“ — provisions which were revolutionary in their day and had been maintained unbroken for 56 years.

Mavity continued:

Photocollage of new Fabiola maternity hospital and Association women, Oakland Tribune, 1923.

“These pioneer women foresaw the need – now one of the most-discussed social problems of medical men and laity – of providing adequate hospital care for those of limited means who were yet not eligible in admittance to the county hospital. With this end in view, it has carried on its work of providing free and reduced-rate care for those who need it, supported by voluntary contributions and by those patients able to pay in full.”

The model of care crafted by the women of the Oakland Homeopathic Hospital and Dispensary Association forecast modern methods and theories long before they became generally accepted. They established the first training school for nurses in the East Bay in 1887; the first district nurse in Oakland, in 1895; the first children’s hospital, the first kitchen under the charge of a trained dietitian; the first ambulance service, contributed by Mrs. J. R. Folger; and the first health insurance program, founded in the 1890s by the mother of Mrs. J.P.H. Dunn (Fabiola Hospital Association’s president for 16 years) as the Fabiola Health Mutual.

Fabiola Hospital, before Permanente purchase and initial remodel, early 1942.

In 1886, Oakland water systems entrepreneur Anthony Chabot donated the broad field at Broadway and Moss Avenue for building the Fabiola Hospital. The expansive turreted facility burned down in 1900 and was replaced with a surgical building (1907) and a 50-bed maternity hospital (1923) at the corner of Moss Avenue and Broadway. Moss was renamed MacArthur Boulevard in 1950.

That hospital that would become the first Permanente (now called Kaiser Permanente) Hospital.

Vacant and unused, the facility had been donated to Merritt Hospital when Fabiola closed its doors in 1933. Henry J. Kaiser personally guaranteed the $350,000 bank loan needed to purchase and refurbish the hospital. While it was being remodeled, Dr. Sidney Garfield contracted for 20 beds at Merritt Hospital. The revived building was dedicated as the Permanente Hospital on August 21, 1942.

Architectural drawing of expansion at the Permanente Foundation Hospital, 1944

In 1961, the original Fabiola building and the adjacent two-story WWII expansion facilities were given a fresh exterior, and the building was demolished in 2005, replaced with a parking lot and patient drop-off and pickup site.

The Kaiser Permanente Fabiola Medical Office Building at 3801 Howe Street was built in 1993, continuing the proud name in Oakland’s health care. The “experiment” from 1876 that shone a light on the importance of providing affordable health care, by and for women, lives on.

Oakland hospital, 1961; Fabiola building and WWII expansion have been upgraded with new siding.

 

 

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Give Me Liberty – Wartime Ship Launch Honors Immigrants

posted on October 5, 2017

Lincoln Cushing
Heritage writer

 

During World War II, diversity was a media weapon against the Axis forces.

Small scale Statue of Liberty at Richmond shipyard #2, at launching of the last Liberty ship built on the Pacific coast, the SS Benjamin Warner

Our diversity – our “melting pot” of ethnicities, races, religions, and creeds – distinguished us positively from the purity and exceptionalism espoused by our foes. The Office of War Information promoted every instance in which our military and home front work force reflected the rich mosaic that is America, and the Kaiser shipyards offered fertile ground for content.

The Liberty ship Booker T. Washington, built at the California Shipbuilding Corp. at Terminal Island, Los Angeles, and launched in 1942, was the first major U.S. oceangoing vessel to be named after an African-American. Several cargo ships were named after what we now call historically black colleges or universities, but back then were “Negro colleges.” When the SS Tuskegee Victory was launched at Oregon Shipbuilding on May 8, 1945, her invocation (a traditional elements of a ship launching, also known as the Prayer of the Invocation) was offered by Father Thomas Tobin, pastor of All Saints church, “who has championed the interests of minority groups all his life.”

The second ship named after an African American was the SS George Washington Carver, built in the Kaiser Richmond shipyards.  She was the first Kaiser-built Liberty ship to be named for a famous African American, and many of the men and women who built her were African Americans.

The SS Pendleton was the 49th “T2” model tanker built at the Kaiser Swan Island shipyard, on the Willamette River in Portland, Ore.; her launching at the beginning of 1944 honored the role of Native Americans in the military and the home front.

Admiral Vickery (Vice-Chairman of the U.S, Maritime Commission) at launching of the SS Benjamin Warner, from Fore ‘n’ Aft, 7/14/1944.

Six Liberty ships were named for labor leaders, many of whom were European immigrants. And seven other Liberty ships launched in 1944 were named for Jewish American labor leaders, doubly sticking it to Hitler’s doomed Reich.

The launching of the SS Benjamin Warner on the 4th of July weekend, 1944, honored an immigrant, and the event was decorated with a giant replica Statue of Liberty. America’s film industry became a testament to the Allied moral high ground, as a place where even Polish Jewish immigrants could rise to fame and fortune.

The Warner was named after the father of Hollywood’s Warner brothers. Henry J. Kaiser, himself the child of immigrants, proclaimed “Benjamin Warner was a plain man, unknown and unsung until he entered the new world of hope and opportunity which he found in America.”

She was the 1,147th ship of this class built in the Kaiser shipyards and launched on the West Coast—and the last. A few Liberties are still being finished at East Coast yards. The Liberty class was being replaced by the larger and faster Victory class ships, and the Kaiser shipyards were already building them. A reporter for Time magazine described the event as “the melancholy end of a shipbuilding era.”

Benjamin Warner’s sons, Hollywood motion picture producers Harry M. and Colonel Jack Warner, were present at the ceremonies. The craft was sponsored at the launching by Miss Lita B. Warner, 19-year-old granddaughter, a Stanford University student.

Rabbi Rudolph I. Coffee conducted the Warner’s invocation. Between 1921 and 1933, Coffee had been the rabbi at the oldest Jewish congregation in the East Bay, Temple Sinai, at 28th and Webster streets in Oakland. After that he became the chaplain at San Quentin Prison until he retired in 1954. Rabbi Coffee had been selected for this honor because he’d performed wedding ceremonies for Harry Warner and his third brother, Albert.

A 13-foot-tall replica of the Statue of Liberty was unveiled as a gift from Warners to the builders. The fate of this replica is unknown.

Yes, send us your huddled masses yearning to be free. Modern diversity messaging favors the “salad bowl” concept rather than the “melting pot” (mixing together yet retaining individuality) but the concept is the same – In addition to making us stronger, diversity and inclusion enable us to achieve the vision our founders had when they started it all.

 

A short news film by Paramount Pictures of the launching can be seen here.

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Harbor City Hospital – Beachhead for Labor Health Care

posted on September 29, 2017

Lincoln Cushing
Heritage writer

 

Painting of proposed Harbor City hospital, circa 1955

When the Permanente Health Plan was made available to West Coast members of the International Longshore and Warehouse Union in 1950, it was a classic example of “be careful what you wish for.”

The Permanente plan, robustly serving workers and families for Henry J. Kaiser’s home front industries, expanded to the public on July 21, 1945, less than a month before the end of World War II. It was a heady and challenging period, and labor unions were to become major group members of the postwar Permanente. Why? Because, for the first time, unions could negotiate health coverage.

The key legal ruling was the 1948 decision by the Seventh Circuit United States Court of Appeals in the case of Inland Steel Company vs the National Labor Relations Board. This precedent affirmed the legal obligation of employers in unionized companies to include health and welfare benefits as part of labor negotiations.

Harbor City Hospital under construction, 1959

In 1950 The International Longshoremen and Warehouse Union and the Pacific Maritime Association requested the Permanente Health Plan provide care for all 22,500 of their workers up and down the West Coast; The ILWU became the first major group enrolled in the Health Plan.

At the insistence of ILWU leader Harry Bridges, Permanente was the only choice for the union members. This exclusivity violated Permanente policy that membership should be voluntary, which understandably caused some dissatisfaction with ILWU members. It wasn’t until 1954 that ILWU members were offered a choice of a second plan after Permanente consultant and economist Avram Yedidia convinced Bridges of the importance of dual choice; only 10 percent would leave Permanente.

But there was a problem with capacity. Bridges brought in thousands of new members to a plan that was recovering from a postwar slump and had limited facilities.

For the major ports of Oakland and San Francisco, where the Permanente hospital and clinics were already established, that wasn’t a problem. Looking north, ILWU members in Seattle got care through an agreement with the Group Health Cooperative of Puget Sound and other providers while Portland-Vancouver union members were served by Northern Permanente. Southern California would involve an estimated membership of more than 11,000 longshoremen, but the only Permanente hospital was at the Fontana Steel Mill, 60 miles from the ocean. Not exactly longshore territory.

First LA South Bay clinic, 599 W. Ninth St. (and Grand Ave.).

Bridges wanted a Permanente facility in the San Pedro harbor area where there was a high concentration of members. His promise convinced Permanente that this is the time and the place to expand. Enter the Harbor City Hospital, proud pioneer of the Los Angeles South Bay service area.

Temporary facilities began immediately. A history compiled for the 60th anniversary of the South Bay area described the first San Pedro clinic:

Dr. Ray Kay (founder of the Southern California Permanente Medical Group) and Medical Director Dr. Ira “Buck” Wallin found a working clinic at 599 W. Ninth St. (and Grand Avenue) already occupied by doctors who were, at first, willing to share space. They even agreed to help take care of the longshoremen after hours. That arrangement was short-lived, however. Spooked by the economic threat posed by group practice, the doctors in the community gave the cold shoulder to Wallin’s staff and anyone who associated with them professionally or socially. The three fee-for-service doctors with offices in the shared clinic buckled under the pressure and vacated the premises.

Permanente promised the ILWU that they would build a new hospital in the Wilmington-San Pedro area, but progress was slow. The new Kaiser Foundation Hospital in downtown Los Angeles broke ground in late 1951, and drew institutional resources away from the Harbor City facility.

Aerial photo with lot boundary marked, Harbor City Medical Center, 1100 West Pacific Coast Highway, circa 1957

Things came to a head when 5,000 cannery workers in the San Pedro area signed up with the Permanente plan at the end of 1953. The workers’ employers had wanted them to sign up with the California Physicians’ Service, a competing prepaid plan offered through the California Medical Association. This was during the period where the medical establishment disapproved of Permanente physicians, who were barred from facilities such as San Pedro Community Hospital. The ILWU had been waiting more than two years for their promised hospital, and were getting cranky.

1953 was also the year the scrappy Permanente clinic in Pittsburg, Calif., opened to serve the labor unions and local community.

By early 1955 a site had been purchased, a complex deal involving three parcels, each held by different owners. Clarence Mayhew, the most prominent architect of Kaiser Foundation hospitals, drew up plans for a bold and innovative 66-bed hospital. It featured “vast amounts of glass,” separate corridors for staff and the public, and the famous “baby-in-a-drawer.” The groundbreaking ceremony November 4, 1955, included elected officials, leaders of the ILWU, and the PMA.

On January 14, 1957, the Kaiser Foundation Hospital in Harbor City at 1100 West Pacific Coast Highway, opened. It was hectic. At a 30-year celebration, Medical Administrator Pat Crowe reminisced “The day before we opened, carpenters were still making last-minute changes and final clean-up was not yet complete. Eighteen patients were admitted that afternoon and evening.” One of them was about to deliver her second child. At 1:54 a.m. on January 15 she gave birth to a healthy baby girl.

Aerial photo, Harbor City Medical Center, 1100 West Pacific Coast Highway, expansion construction, circa 1975

The ILWU Dispatcher newspaper of February 15 added this under “Local 13 Man Launches New Harbor Hospital”: First patient in the new $1,000,000 Kaiser Foundation Harbor Hospital was ILWU Local 13 member Oscar Roberts, covered through the ILWU-PMA Welfare Program.

As with all the Permanente facilities, demand always pushed capacity. Sixteen beds were added in late 1958, and a two-story clinic at 1050 West Pacific Coast Highway was built in 1959. Additional expansion happened in 1964, bringing bed capacity up to 121. 1969 saw further clinic expansion. A serious fire destroyed a section of the adjacent Parkview Medical Office Building in 1973.

Harbor City Hospital, ER nurses’s station, 1966

Harry Shragg, MD, served at Harbor City from 1957 until 1968 as a surgeon, chief of the Department of Surgery, administrator of a community health care program for indigents, and medical director. In his oral history he recounted an epiphanic moment about Permanente medicine:

I was on call in the hospital one evening, and a black girl from Compton ─ which is a lower socio-economic level area ─ came into the emergency room with abdominal pain. I think she was sixteen years old. And she was seen by a board-certified pediatrician, examined by a board-certified gynecologist, and examined by me, a board-certified surgeon. We took her to the operating room ─ she had appendicitis ─ and we operated on her. And the whole sequence of that one episode, to my mind, crystalized the merits, and the value, and the philosophy of this kind of practice, where the issue of whether one could afford it or not never arose… She was just a sick person who came in and needed help, and we just gave her what I thought was outstanding quality care… That was, to me, a very dramatic and very memorable occurrence, and I think that’s what it’s all about.

 

Service to working communities. Yes, that’s what it’s all about.

 

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Upstart Health Plans Vs. the Medical Establishment in the 1950s

posted on September 14, 2017

Lincoln Cushing
Heritage writer

 

Part 2 of 2: The Permanente Health Plan responds to legal charges by the medical establishment and the similar experiences of Group Health (originally called Group Health Cooperative of Puget Sound) in Washington state. In 2017, Kaiser Permanente acquired Group Health, making Kaiser Permanente Washington our newest region, the first in over 30 years.

During the late 1940s the medical establishment tried mightily to eliminate health plans that it saw as competition. As we saw in part 1 of this article, two of the biggest targets were the Permanente Health Plan (Kaiser Permanente) and Group Health.

Henry Kaiser speaking in New Orleans, 1957.

 

Henry J. Kaiser takes the high road

During these challenges with the medical establishment, Henry J. Kaiser consistently took the high road. When he spoke to a group of physicians in San Francisco on June 9, 1948, he let them know he was “… astounded and horrified to be informed by our attorneys that a group of Alameda County doctors have declared war on the Permanente health program.” He outlined his many legal options, but then offered a more cooperative path because “… we must be sobered at thinking what an all-out fight on the issue of more medical care for more people could mean.” He sought an amicable solution:

I want to believe that tonight is the beginning of a real conscientious effort on the part of everyone here to strive to fulfill the common objectives not only for group medicine, if it be lower in cost, but for that type of medicine which so many want, called private medicine, although it is higher in cost … until the earning power of the nation is greater, all the people cannot participate in private medicine.

His appeal to civility fell on deaf ears. Rather than accept the olive branch, fee-for-service practitioners rolled up their sleeves to knock out the competition.

A legendary event etched into Kaiser Permanente history was the 1953 competition for plan sign-up by 4,000 United Steel Workers of America members in Pittsburg, Calif. Local private practice physicians mounted an all-out campaign, which included provocative leaflets, newspaper ads, billboards, and even a sound truck. On September 3, 1953, the union members voted overwhelmingly for the Kaiser Foundation Health Plan.

Henry J. Kaiser defends Dr. Sidney Garfield, 10/26/1947.

That December, delegates at the annual California Medical Association meeting tried the carrot rather than the stick approach by announcing a pilot prepaid plan to compete with Kaiser Foundation Health Plan. They offered the 9,000 members of the International Association of Machinists at Santa Monica’s Douglas Aircraft plant “free choice of physician and hospital to its subscribers” through the California Physician’s Service. The CMA had established the CPS in 1939 as statewide prepaid medical care organization.

The proposed plan would cover hospitalization and surgical care for all workers earning below a certain salary threshold, charging more for those earning above it. (Newspaper coverage noted that the Kaiser plan had no income ceiling provision.)

Private practice physicians were on the ropes. Dr. Francis Rochex of San Francisco was quoted as saying “Organized medicine has lacked vision in anticipating the extent of penetration of political and socialized pressure groups.” But measures to develop a comprehensive alternative stumbled; CMA delegates were unable to agree on a plan which would cover both prepaid medical care and still observe “the doctors’ traditional independence and maintain professional standards.”

By 1960 the “Long Beach Physicians Health Plan” through CPS had been adopted for all Douglas aircraft workers throughout the world, and Long Beach city employees and school district employees came under the plan in 1959. On its own terms it was successful; the Long Beach Independent bragged that it was “the only plan that has had wide acceptance by so large a number of the people who are seeking a workable medical insurance plan under the free enterprise system.”

 

Group Health Cooperative wins ruling against local medical establishment, 11/16/1951.

The experiences of Group Health

A letter to editor in the Port Angeles Evening News April 16, 1965, presented the story from a proud member’s perspective:

As a member of the Group Health Cooperative of Puget Sound during the Forties, I well remember the efforts of the AMA to put Group Health out of business. Methods used included, denial of membership in local medical societies to Group Health doctors, denial of hospital privileges to Group Health doctors and their patients, and plenty of good old fashioned slander. Needless to say, as a true cooperative, the services of Group Health physicians were not being ‘sold at a substantial profit by a third party.’ Convicted of criminal conspiracy under the antitrust laws, the AMA fought the case to the U. S. Supreme Court — and lost.

The landmark legal decision in this fight was Washington Supreme Court case of Group Health Cooperative of Puget Sound et al., Appellants, v. King County Medical Society et al., November 15, 1951. Group Health fought back after it experienced “unfair and illegal fetters placed upon its service and growth.” In November 1949, it brought this suit asking for an injunction and damages.

An Associated Press news item in the Walla Walla (Washington) Union-Bulletin, November 16, 1951, “Court Ruling Hailed”:

Group Health Cooperative of Puget Sound Friday hailed as a “victory for free enterprise” a state Supreme Court ruling that King County Medical society policies toward the co-op violated the anti-monopoly law.

The Washington Supreme Court ordered the King County Medical Society to stop boycotting Group Health Cooperative. Organized medicine was indicted for violating the Sherman Antitrust Act in its efforts to suppress Group Health. Eventually, both plans established a more collegial relationship with their private practice peers. One of the founding Permanente physicians, Dr. Cecil Cutting, explained:

… the American Medical Association set up a committee to study provision of medicine in the country. They came out and examined us and gave a report that we were providing as good or better medical care as in the community. That sort of set them back a ways and now, we are fully accepted and I think in many times envied because of the practice, the coherence, the fundamentals of our group practice pre-payment that has tested the time and I think proved an excellent way of practicing medicine.

Dialogue about the “best” form of health care remains a vibrant topic of national conversation. Physicians, staff, and resources of the now-joined pioneering health care organizations Kaiser Permanente and Group Health are leading the conversation.

 

Part 1 of this article
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