Experiments in radial hospital design – Denver’s Saint Joseph and Kaiser Permanente’s Panorama City

posted on February 17, 2017

Lincoln Cushing
Heritage writer

 

Kaiser Permanente Panorama City Hospital, California
Built 1962, decommissioned 2008, demolished 2016
Designed by Clarence Mayhew with partner Hal “H.L.” Thiederman, Dr. Sidney R. Garfield as medical consultant.

Saint Joseph Hospital, Denver, Colorado
Built 1964, demolished 2016
Designed by Robert Irwin.

 

st-jo-towers-med

Saint Joseph Hospital, Denver, circa 1970

When I was touring Denver’s Kaiser Permanente facilities in late 2016, my host pointed out a hospital that was being demolished. It was the venerable Saint Joseph Hospital, and what I noticed immediately was that it had two paired cylindrical (or “radial”) towers, just like our former Panorama City hospital, a design universally described as “binoculars.” But taller.

Even though the Kaiser Permanente Health Plan has been operating in Colorado since 1969, and has built numerous state-of-the-art medical office buildings, it has always contracted with local facilities for hospital space. Saint Joseph is one of them.

Although there’s no firm evidence that the Saint Joseph design was influenced by Panorama City, it’s surely not a coincidence. The workflow logic was identical, and the main differences were the stairwell, lobby placement, and lack of an external balcony. It looked more like an overhead view of the Starship Enterprise than a pair of binoculars.

st-jo-blueprint-med

Blueprint, Saint Joseph Hospital, July 27, 1961

“Building started at Saint Joseph,” Rocky Mountain News, Oct. 26, 1961:

Groundbreaking rites were held Wednesday for the new $8,771,560 addition to Saint Joseph Hospital. The new building, to replace most of the north hall of the hospital, will consist of a pair of 11-story circular towers. Each will a have nurses’ stations at the center, and no station will be more than 20 feet from any room.

The new circular towers will be the heart of the 88-year-old hospital. Saint Joseph will be the nation’s largest example of the new hospital design, according to Robert Irwin, architect. The circular concept means patients’ rooms and wards will radiate from the nurses’ stations in the center.

Fourth floor plan of tower, Kaiser Foundation Hospital at Panorama City. 1961 [circa]. [TPMG P1283]

Fourth floor plan of tower, Kaiser Foundation Hospital at Panorama City, circa 1961

Kaiser Permanente’s original Panorama City Medical Center was featured as The Modern Hospital’s “modern hospital of the month” in November 1962. In the seven-page article “Good Nursing is Core of Panorama Plan,” Sidney Garfield, MD, explained the “circles of service” design concept:

It saves steps for the nurses [in this case, patients are within 20 feet of the nursing station]; it reduces the number of special duty nurses; it keeps the nurses to a central area outside the patients’ door, and it is particularly useful for keeping patients under observation at night with a reduced nursing staff.

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Old and new Saint Joseph hospitals, circa 1964

Saint Joseph Hospital Communications Manager Colleen Magorian added these details:

The Saint Joseph Hospital “twin towers” were dedicated in 1964, so they were just more than 50 years old when our new hospital opened. The towers were part of an ever-expanding hospital that had been on the same site since 1898 and were inspired, in part, by the towers of the preexisting structure.

Predecessors to this design were a never-built Kaiser Permanente geodesic-dome-based facility from 1957, followed by the “Atomedic Hospital,” which originated in the early 1960s. But these facilities were never meant to be more than one or two stories tall.

Hospital architecture scholars Stephen Verderber and David J. Fine have noted that there are a few other examples of multistory “radial” layouts in the United States, all built in 1964-1965. These include the Lorain Community Hospital (Lorain, Ohio), the Scott & White Memorial Hospital (Temple, Texas), and the Central Kansas Medical Center (Great Bend, Kansas). The Prentice Women’s Hospital and Maternity Center in Chicago, which opened in 1975, was a unique version of this style with four radial towers. It was vacated in 2011 and was the subject of intense preservation efforts to avoid demolition. It was eventually torn down in 2014.

Prentice was designed by Bertrand Goldberg, who drew on learnings from anthropology and the field of “proxemics” (“the study of our use of space and how various differences in that use can make us feel more relaxed or anxious.”) It was praised for its innovative design and engineering prowess. However, many of the design weaknesses of the wedge-shaped rooms were noted as well. Architect and critic Jain Malkin pointed out that the most heavily trafficked side of the room was the narrowest, and in the case of Prentice, that the rounded exterior wall reflected and amplified sounds in a space that’s supposed to be quiet.

Of all of these architects, it was Dr. Garfield’s Panorama City vision that pioneered this bold experiment in improved workflow and patient care. And, as I saw in Denver that cold October morning, the circles of history closed in on the “circles of service.”

 

Special thanks to Stephen Verderber, and Colleen Magorian and Tiffany Anderson of Saint Joseph Hospital, for their help with this article.

Short link to this article: http://k-p.li/2lVI21V

 

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Mystery hospital device – the TravelLav

posted on February 9, 2017

 

Lincoln Cushing
Heritage writer

 

Travel-Lav compact lavatory, in hospital room setting, 1966 [circa]. [Scan from film negative #62594]

Travel-Lav compact lavatory, in Kaiser Permanente hospital room setting, circa 1960.

Hospitals are highly technical facilities always in search of safe and effective ways of providing health care. Usually the bright shiny objects get the news splash – a brand new X-ray machine, a sleek MRI – but for every big-ticket item, there are dozens far more mundane.

When members come to Kaiser Permanente – whether in Washington, D.C. or California – they expect to experience a brand promise of “Total Health.” The National Facilities Services department is responsible for the physical component of this task, evaluating every aspect of a building – even including the humble toilet.

Project Principal Linda Raker explains NFS’s design goals:

The emphasis is on providing an environment that helps create a warmer, hospitality experience, by contrast to the institutional environments of the past. We are especially mindful of creating what we call a ‘moment of pause’ in these rooms, where our members can achieve a measure of privacy away from the chaos of medical environments. The other objectives – improved lighting, individual mirrors, use of optimistic colors, etc. – are all designed to support this more positive member journey.

“Institutional environment of the past” is a kind reference to some earlier concepts that certainly weren’t focused on a private “moment of pause.”

Travel-Lav compact lavatory, in hospital room setting, 1966 [circa]. [Scan from film negative #62594]

Travel-Lav compact lavatory

While reviewing a set of large format film negatives in our archive, I ran across two photos that showed an unusual device installed in a patient room. On closer inspection it was two versions of a device, one designed to fit in a corner, and one for an open wall. Zooming in on the name plate revealed that these were products of the “TravelLav” (or Travel-Lav) company.

Extensive searching through newspaper archives and online sources revealed very little about these devices.

We know that they were the brainchild of a Philadelphia inventor:

Patent #2,725,575 approved December 6, 1955
“FOLDING WATER CLOSET” by Angelo Colonna, Philadelphia, PA.

The present invention relates to certain new and useful improvements in flush-type water closets which are expressly adapted to be used in wash rooms and similar quarters of limited size on railway cars, airplanes, boats, submarines and similar conveyances and has more particular reference to a hinge mounted toilet bowl or hopper of a so-called folding construction, that is, a structural adaptation wherein the bowl, when it is not in use, is swung up and into a storage and protective compartment provided therefor in a wall cabinet.

US2953103.pdf

Detail of folding toilet in railway car patent illustration, 1960

The Travel-Lav later shows up in a railway car patent:

Patent #2,953,103 approved September 20, 1960

“COMBINATION COACH AND SLEEPING CAR” by George W. Bohannon, Oak Park, and Walter Scowcroft, Palos Heights, Ill., assignors to The Pullman Company, a corporation of Illinois.

The washbowl and water closet or toilet are preferably a combined unit sold under the trademark “Travel-Lav” manufactured by Angelo Colonna of Philadelphia, Pennsylvania. Both the washbowl (72) and the water closet or toilet (76) fold down to a substantially horizontal position when they are to be used.

 

So, we at least know something about these folding water closet contraptions. These two photos imply that at one point, most likely around 1960, Kaiser Permanente installed or considered installing them in some patient rooms. But there’s no evidence that they lasted. It’s easy to imagine that the lack of privacy was a substantial deterrent to their acceptance, and that a device intended for cramped quarters – such as a submarine, or a bunker – would make less sense in a hospital.

 

Short link to this article: http://k-p.li/2kT4j2y

 

 

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Ellamae Simmons – Trailblazing African-American Physician

posted on February 3, 2017

Lincoln Cushing
Heritage writer


overcome-coverOvercome: My Life in Pursuit of a Dream

Ellamae Simmons, MD, with editorial collaboration by Rosemarie Robotham
Mill City Press, Minneapolis, 2016
Available via Google Books | Amazon

 

The arc of social justice relies on courageous individuals and Ellamae Simmons, MD, was one such individual. She was the first African-American woman to specialize in asthma, allergy, and immunology in the United States. She worked at Kaiser Permanente for 25 years, and to this day plays a central role in how Kaiser Permanente embraces diversity and inclusion.

Dr. Simmons’ new biography at the age of 97 is a valuable contribution to that history.  The book details her life and career, including graduating from Hampton (Virginia) nursing school in 1940, serving in the Army Nurse Corps during World War II, medical school at Meharry Medical College (Nashville) in 1954, and her Kaiser Permanente career.

Dr. Simmons’ chapter titled “The Interview” is about her coming to work at Kaiser Permanente during the summer of 1965. Dr. Simmons had been training in chest medicine at National Jewish Hospital in Denver, at which Irving Itkin, MD, was her supervisor and mentor:

When I told Dr. Itkin of my plan to move west at the end of my residency, he was full of advice. “If you’re going to California,” he told me, “there are only two places you should consider. One is the Scripps clinic in La Jolla in Southern California, and the other is Kaiser Permanente in Northern California. Now,” he continued, warming to the subject of my future training as an allergist, “Scripps is just another National Jewish. They write the same papers and conduct the same research. You’d basically be doing the same thing you did here.

At Kaiser, on the other hand, you’d round out your experience in a well-established outpatient allergy center, where asthmatics are well maintained on an established anti-allergenic regimen. And I recommend Ben Feingold, the chief of asthma-allergy at Kaiser. He’s a good allergist, does fine research. Of course, he’s difficult…. but I recommend you go there and learn everything he has to teach you about asthmatics whose condition is well controlled, who are ambulatory, who go to school or to work. After that you’ll be well set up to take care of anybody in this field.”

Ellamae Simmons school graduation Hampton nursing school, 1940, from Overcome book

Ellamae Simmons graduation Hampton nursing school, 1940, from Overcome

Dr. Simmons’ job interview with Ben Feingold, MD, has become legend in Kaiser Permanente history:

Dr. Ben Feingold sat back in his large bronze-studded black leather chair, scrutinizing me. He questioned me about my previous residencies, always calling me “Miss,” never “Doctor.” He asked me about my asthma-allergy fellowship, and more superficially about my chest medicine residency.

After about 30 minutes, he tented his fingers on his desk and said, “Well, I have my doubts about hiring anyone whom I have not trained, but please go out and see my secretary. We’ll have to continue this another day, as I have another meeting.” He told me to make an appointment with his secretary for the following Tuesday, which was five days away. I could ill afford the expense of additional nights at my hotel, plus meals, but I did not say this. Instead I made the appointment and spent the next few days exploring downtown San Francisco and biding my time.

I returned the following Tuesday for the continuation of our interview and entered Dr. Feingold’s office as scheduled. Again the department chief sat back in his chair and viewed me intently. He asked a few questions about specific allergic reactions and how they might be treated at the institution of my residency. I answered easily and in meticulous clinical detail. At last he said,

“Well, I see you know your stuff, but I’m afraid I cannot hire you, as I’ve never hired anyone whom I have not trained.”…

“Dr. Feingold,” I said, my voice steady, my gaze direct, “I’ve never applied for a job for which I was not fully qualified. In fact, I’ve usually been overqualified. So tell me, is the real reason you’ve decided not to hire me the fact that I’m black?”

She asked Dr. Feingold if there were any other black physicians at the Kaiser Permanente San Francisco hospital; it took him a while, but he finally remembered Granville Coggs, MD, a radiologist who’d joined the staff just a few months before. Dr. Simmons met with Dr. Coggs, and they shared experiences of racial discrimination pursuing their respective professions. She then returned to Dr. Feingold’s office, resigned to not getting the position.

Dr. Feingold didn’t respond at first. He just stared at me in that fixed way I was already becoming used to. I realized he was wrestling with a decision.

Finally, he spoke. “Stop by my secretary on your way out and sign your contract,” he said. “I’ll take you after all.”

Dr. Ella Mae Simmons, first black female physician in Northern CA

Dr. Ellamae Simmons, circa 1980

 

Among Dr. Simmons’ battles was that of housing discrimination. Even in the relatively progressive San Francisco Bay Area of the late 1960s, covenants and real estate practices perpetuated racially segregated neighborhoods.

This discrimination also was experienced by another early Kaiser Permanente physician, Eugene Hickman, MD. His unpublished memoir includes a chapter titled “House Hunting While Black”:

My major problem in Oakland was with housing…I would phone all numbers regarding places within a radius that would afford reasonable access to the hospital where I was going to work. I was up front with my racial identity, after which I would summarize my credentials, etc. The response was always the same: “I am very sure you would be a very desirable member of our community, but we promised our neighbors we would not rent or sell to Negroes.”

After several frustrating months, someone informed me of a place in Berkeley where I could go and apply for one of the homes that had been condemned to make way for the Grove-Shafter Freeway [California Highway 24]. We obtained an old house on 53rd St, near Children’s Hospital. I was then able to move our family here. Then we began the search for a permanent residence. My wife would go out with an agent during the day while I was working; the children were not yet in school. Some idiots frequently mistook my wife for a southern European. One agent…suggested that if I wanted to see the house, I should come around after dark.

And if that wasn’t discouraging enough, Dr. Hickman experienced discrimination about his choice of a job from an unexpected source. The Sinkler-Miller Medical Association in Oakland (named in honor of two outstanding black physicians) accepted him for membership, but insisted on characterizing him “as some sort of traitor to the black physician community” because of his affiliation with Kaiser Permanente.

 

Dr. Simmons’ personal story is a tribute to persistence and vision overcoming adversity. Although we have come a long way in building social justice, there is always more to do – and pioneers such as Dr. Simmons inspire and guide us.

 

Short link to this article: http://k-p.li/2l4yt05

 

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Japanese-American Doctors Overcame Internment Setbacks

posted on January 27, 2017

Lincoln Cushing
Heritage writer

 

Poster announcing Executive Order 9066 - 1942

Poster announcing implementation of Executive Order 9066 (detail), May 15, 1942

Ten weeks after the Japanese attack on Pearl Harbor, U.S. President Franklin D. Roosevelt signed Executive Order 9066. This law, enacted February 19, 1942, authorized the incarceration of Americans of Japanese descent and resident aliens from Japan. This measure only affected the American West; the U.S. military was given broad powers to ban any citizen from a fifty- to sixty-mile-wide coastal area stretching from Washington state to California and extending inland into southern Arizona. The order also authorized transporting identified citizens to military-run “internment” camps in California, Arizona, Washington state, and Oregon.

This controversial action was undertaken in the name of national security and affected almost 120,000 men, women, and children. The Order was suspended at the end of 1944 and internees were released, but many had lost their homes, savings, and businesses. Subsequent efforts by community and legal groups in the 1970s resulted in rescinding the Order and offering compensation to those affected, and legislation was passed to try to ensure that such a broad disruption of civil liberties would not happen again.

The impact of the war, and of the suspension of basic human rights, personally affected two of Kaiser Permanente’s first Japanese American physicians. Once hired, they remained here their entire professional careers.

 

Dr. Isamu "Sam" Nieda

Dr. Isamu Nieda, circa 1955

Isamu Nieda, MD (1918-1999)
Hired as a radiologist at Kaiser Permanente in 1954, retired 1987

Isamu “Sam” Nieda was born in Ashland, Calif. (a small community in the central East Bay of San Francisco) in 1918 to Japanese-born parents. He was an undergraduate at the University of California, Berkeley, and then went to medical school at U.C. San Francisco. Partway through his studies he heard the news of Executive Order 9066.

According to Dr. Nieda’s late sister, the family held a meeting with Sam and determined together that he would leave the evacuation area to continue his studies. Family lore stated that he had to sell his microscope to pay for the journey, and that the rest of his family chipped in as well. He then departed for Salt Lake City, where he worked briefly as an orderly, before continuing to Temple University in Philadelphia. The American Friends Service Committee (Quakers) helped Sam through the National Japanese American Student Relocation Council. This program worked with colleges and universities in the Midwest and Eastern States to admit qualified students from the camps, and placed four thousand students before war’s end.

Dr. Isamu "Sam" Nieda

Dr. Isamu Nieda, circa 1975

Dr. Nieda completed medical school in 1944 at Temple University, and after World War II he served as a Venereal Disease Control Officer in Japan, working for the Public Health and Welfare department of the U.S. Army Medical Corps during the American occupation (1945–1952).

Dr. Nieda returned to the U.S. and worked as a radiologist at Kaiser Permanente’s San Francisco Medical Center for 33 years.

Dr. Nieda always identified as a U.C. student, so it was meaningful to the family when in 2009 UCSF granted honorary degrees to all Japanese American students from the Medical, Dental, and Pharmacological schools who had to stop their studies due to internment. (Sam had passed away ten years prior.)

 

Planning for Health newsletter 1962-Fall

Dr. Ikuya Kurita, Planning for Health, 1962

Ikuya T. Kurita, MD (1922-2005)
Hired in respiratory medicine at Kaiser Permanente in 1957, retired in 1999.

Ikuya “Eek” Kurita, MD, was born in San Francisco in 1922 to Japanese-born parents. He attended U.C. Berkeley for two years until 1942, when he and his parents were relocated to an internment camp in Topaz, Utah. Internees could leave Topaz if they had a job or were admitted to school, so Kurita was able to complete his undergraduate degree at the University of Utah. He then served in the army from 1944 to 1947 and returned to the University of Utah where he graduated from medical school in 1950.

Dr. Kurita worked at Kaiser Permanente hospitals for 42 years, first in Oakland where he began as Chief of Emergency from 1957.

KP Reporter, 1975-06-13

Dr. Ikuya Kurita, KP Reporter, 1975

He was appointed chief of the Department of Emergency Services at the Oakland hospital in 1965, and in 1975 ran the new rehabilitation and educational clinic for patients with chronic obstructive pulmonary disease (COPD). An article in the KP Reporter described that program:

According to lkuya Kurita. MD., Emergency Department Chief at Oakland, and physician consultant for the Respiratory Care Clinic, the purpose of the program is to bridge the gap between acute hospital care and home management, with primary emphasis on reaching and helping patients before their condition erodes to the point of warranting hospital admission. “The clinic helps to fill the gap between acute care and what is often fragmented care,” says Dr. Kurita, who is a specialist in pulmonary diseases.

Dr. Kurita began working at the Martinez Medical Center in 1977 and retired from there in 1999.

 

Special thanks to the family of Isamu Nieda, retired Permanente physician Michael Gothelf, Dr. Ken Berniker of the TPMG Retired Physicians’ Association, scholar Elaine Elinson, and video producer Robert M. Horsting for their help with this article.

Short link to this article: http://k-p.li/2kBCMPj

 

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