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Sexually Transmitted Diseases in the World War II shipyards

posted on April 26, 2017

Lincoln Cushing
Heritage writer

 

VD posters in Fore’n’Aft, 3/3/1944.

During World War II, venereal diseases were called “the enemy in your pants,” and soldiers were warned that “your carelessness is their secret weapon.” But ordinary workers on the home front also confronted these communicable diseases, and the Permanente Health Plan stepped up to confront it.

April is designated STD (Sexually Transmitted Disease) Awareness Month by the Centers for Disease Control and Prevention. Most of the research on pre-AIDS World War II focuses on venereal diseases in the military, but home front workers suffered as well.

Some of this threat appears to have been exaggerated at the time. An article in the Portland, Ore., area Kaiser shipyard newspaper The Bos’n’s Whistle dated April 14, 1944, about venereal disease on the home front reported an alarming – but false – statistic:

Health experts report syphilis and gonorrhea near top of list of most common communicable diseases; the toll since the war began is greater than total battle casualties.

Reviewing the actual numbers, this claim was both inaccurate and alarmist. U.S. military deaths for that war was 416,800. Home front data found in Vital statistics of the United States, published by the U.S. Bureau of the Census under “General Tables – Deaths from Selected Causes” gives us a total death toll for syphilis (the only STD singled out, which is unfortunate, since gonorrhea was also prevalent) between 1942 and 1945 as 58,698. Still, that was a lot of people to see dying from a preventable disease.

“VD vs. Victory” in the Richmond, Calif., Kaiser shipyard paper Fore’n’Aft in early 1944 warned of the danger:

Four in every 100 industrial employees have syphilis… venereal disease is one of the greatest enemies of industry. The [California] State Federation of Labor considers it so important that the executive board has recommended a compulsory blood test for all union members.

A quack cannot cure you. You cannot safely treat yourself. The only way you can be sure you do not have syphilis is by a blood test. You should have a test once a year. If you find that you have caught the disease, it will still be in the early stages and a doctor can treat and cure you.

Blood test for VD in The Bos’n’s Whistle, 4/4/ 1944.

In the early years of the war the standard treatment for syphilis and gonorrhea were sulfa (sulfonamide) drugs, the first and only effective antibiotics available. The best cure – penicillin – wasn’t proven until 1943, when doctors at a U.S. Marine Hospital on Staten Island in New York successfully used it to treat four patients. And even then, this “wonder drug” was rationed for military use. It first was made available to home front workers in May 1944 to treat pneumonia, due to the efforts of Kaiser shipyard physician Dr. Morris Collen.

In language foreshadowing the challenge of treating the AIDS epidemic in the 1980s, the Bos’n’s Whistle article concluded that the biggest obstacle in attacking the problem of venereal disease was the stigma attached to it.

The important thing to remember is that to have a venereal disease does not constitute a crime, but to transmit it to others is definitely criminal. Authorities emphasize that most of the individual problems of persons having a venereal disease can be handled without resorting to law enforcement.

VD didn’t just affect men- the new shipyards were full of women as well. Hannah Peters, MD, was the Kaiser Richmond shipyard gynecologist and she co-authored Gynecology in Industry” in the Kaiser Foundation Medical Bulletin, July, 1945. There she outlined what she’d learned during her first two years serving a workforce composed of as many as 23,000 female employees.

Dr. Hannah Peters, Kaiser shipyard gynecologist

Her section on VD education explains the scope of the problem and efforts to reach out to women. She noted that during the period between March 1, 1944, and February 28, 1945, 2832 new cases were seen in the Gynecology Department of the Permanente Field Hospital in Richmond alone. Among these, there were 390 cases of gonorrhea. This meant that 13 per cent of all new gynecological cases proved to be infected with gonorrhea. The article goes on to report that the high percentage of infected women led physicians to introduce an educational outreach program in the shipyards:

Venereal disease educational material was placed in all women’s rest rooms in the yards. Literature, folders as well as booklets, supplied by the Public Health Department, were made easily available in wooden racks which were hung in conspicuous places in every women’s rest room. We were encouraged to find how quickly the literature disappeared. We know that the pamphlets were not only taken out of the rack, but they were actually read. We cannot measure their educational value; however, innumerable women have come into the clinic asking to be examined for a venereal disease because they think they might have some of the symptoms described in the literature which they found in the rest rooms.

The struggle for quality, affordable health care was vital to the war effort, which included the crop of STDs that debilitated the home front workforce. And just as the Permanente health plan rolled up its sleeves and took on that battle during World War II, it continues to do so today. Last year, Kaiser Permanente led the nation in 21 quality measures, including screening for chlamydia. On top of our preventive testing practices, our doctors encourage a healthy conversation about STDs. A recent Total Health Radio podcast “So . . . This is Awkward” by a guest expert from Sexual Health Innovations offers helpful advice on how to talk about STDs to friends and loved ones.

 

Special thanks to Michael Sholinbeck, Outreach & Instruction Librarian at the Sheldon Margen Public Health Library, University of California Berkeley, for guidance on U.S. Census data.

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

 

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The Permanente Richmond Field Hospital – Proud Reminder of Health Care’s Role in World War II

posted on April 17, 2017

Lincoln Cushing
Heritage writer

 

Richmond Field Hospital matchbook cover, circa 1944; gift of retired Permanente physician John Igo.

A sprawling, single-story structure with a small tower sits at 1330 Cutting Boulevard in Richmond, Calif. Forlorn and all but forgotten, few know that it played a proud role during the World War II home front and in the subsequent history of the region. It was a humble, working-class hospital that opened August 10, 1942, and served thousands of patients until it closed in September 1995, when the new Kaiser Permanente Richmond Medical Center opened several blocks away.

When the United States was drawn into World War II in December 1941, Henry J. Kaiser was already running two shipyards in Richmond building cargo ships for Great Britain. Not only would the existing workforce composed primarily of healthy white men soon go off to war, the tidal wave of replacement workers were new to the shipbuilding trade, were performing under high-pressure conditions, and were often in poor health to begin with. Some 90,000 workers and their families migrated to the Richmond shipyards during the war, swamping all existing medical facilities. Enter the Field Hospital.

Lobby, Richmond Field Hospital, circa 1943. “Illness knows no color line here.”

There were six first aid stations in Kaiser’s Richmond shipyards for immediate care, and the newly refurbished, 70-bed flagship Permanente Hospital in Oakland was the health plan’s biggest facility. But in between, just blocks away from the yards, was the Permanente Richmond Field Hospital.

At first it only had 10 beds, but the demand for services was so high that before the year’s end a 75-bed expansion was underway. Sidney Garfield, MD, who was in charge of the medical program, later reflected on the nearly constant expansion during the war: “Most of our mistakes . . . came from underestimation.”

“They would be 20 deep in the hallways every day,” remembers Mrs. Bernice Brooks, who went to work at Richmond in January 1943.

Richmond Field Hospital under construction, 1942.

Mrs. Brooks was one of seven 25-year veteran Kaiser Permanente workers interviewed in a 1967 article celebrating the 25th anniversary of the hospital.

“We had five station wagons and three ambulances,” explains Ruth Schornick, a senior medical receptionist who spent 20 years in Emergency, starting in June, 1943. “Invariably, we couldn’t find a driver. I had a chauffeur’s license, so I would have to go down to the shipyards to pick up the injured. And we also had to use the station wagons to bring the nurses and other employees to work and to take them home.”

“It became routine for the ambulance driver to stop by and pick up the X-ray technician or anesthesiologist whenever he picked up a patient at night that might require one of us,” adds Olive Boyd, supervisor of Radiology.

Shipyard workers being treated, circa 1943.

The hospital was a significant asset to the Richmond community. An exhaustive survey of the Field Hospital produced in 2000 by the National Park Service includes this description:

The addition begun in the spring of 1943 allowed for families of the shipyard workers to be taken care of in the Field Hospital by their own physicians [on a fee-for-service basis, since they were not yet included in the Permanente Health Plan]. This provided a great service to the city, as its population was quickly outgrowing existing medical facilities. Up to this point, the hospital had been serving workers’ families only in cases of emergencies. The new facilities included “complete gynecology, obstetric, surgery, medical, orthopedic and all allied clinics,” which operated on a twenty-four-hour basis. Additionally, as an experimental program, families living in the Harbor Gate and other residential developments were invited to visit the hospital for emergency treatment and office appointments on a fee-per-service basis.

Recall that in 1942 many institutions, including all branches of the military, the United Service Organizations, and hospitals, were segregated. Not the Permanente facilities. “Illness knows no color line here,” wrote a reporter from the San Francisco Bulletin in 1943 about the racial diversity of patients in line for treatment and in neighboring hospital beds: “Red-helmeted men, women welders, Negroes, lined up for a checkup by the busy young doctors.”

Exterior, circa 1943.

An article titled “Berkeleyan Victim as Zoot-Suit Riots Spread” in the June 10, 1943, edition of the Berkeley Daily Gazette noted some of the racial tensions at the time, and the role of this stalwart care facility:

A young Berkeley Negro, Carl Oliver, said one of three unidentified sailors objected to his zoot suit garb and struck him on the forehead. Fearing serious trouble, he fled from the Richmond restaurant. At Richmond Field Hospital, Oliver was given emergency treatment and released. The victim is employed at Richmond Yard No. 1 as a burner, police said, and had stopped at the cafe on his way from work.

The commitment to inclusive care continued after the war’s end when the Richmond Field Hospital was again certified as a general treatment facility, accepting all inpatients regardless of race.  Black physicians returning from military service needed hospital privileges, and could get them at Kaiser because it had the beds.

In October 1945, Health Plan membership reached its lowest point – 14,500. Richmond hospital resources and staff were diverted to the Oakland hospital, which served most of these members. For a period of several months the hospital was run on an outpatient basis only with a skeleton staff of not more than 20-25 employees. Later, a laboratory for comparative biology research was set up under the supervision of Ellsworth Dougherty, MD, in February 1959, with a staff of 30 people.

Richmond Field Hospital renovations, circa 1953.

The hospital got a new lease on life in 1966, when it became the site of the Kaiser Foundation Psychiatric Center. One section was remodeled and refurbished to accommodate a 12-bed intensive care unit offering individual, group and occupational therapy. The center provided both inpatient care and day-care.

Eventually the hospital’s condition degraded, and in December 1973 the Kaiser Company purchased five acres in downtown Richmond to build a new hospital, a doctors’ office building and a parking structure.

The new medical offices opened in 1979, with many departments moving there from the Field Hospital. Remaining at the old facility, now referred to as the “Richmond Medical Center,” were an emergency department, inpatient services, physical therapy, a pharmacy, a laboratory, radiology department, and night and weekend clinics.  In September 1995, with the completion of the last segment of a new $56 million four-building Kaiser Permanente medical complex in downtown Richmond, the Field Hospital was finally closed, and its remaining services were moved into the new structure.

The site was purchased in 1999 by the Islamic Community of Northern California, which planned to renovate it into a community center and mosque, complete with Islamic architectural features. However, that conversion never happened and the site remains mostly vacant.

A nomination for the Field Hospital to the National Preservation Registry was drafted in 2004, and although it is not listed by itself, the facility is registered as an element in of the Rosie the Riveter/WWII Home Front National Historic Park. The Historic American Buildings Survey concluded with a powerful appraisal of the importance of the Richmond Field Hospital:

As one of the remaining World War II-era structures in Richmond, it represents an important historical moment, when thousands of workers converged on the small city to produce the hundreds of Liberty ships that helped to lead the Allied forces to victory. The Field Hospital is an outstanding contribution to the important narrative of the World War II American home front, demonstrating the great efforts made to provide social services to the thousands of men and women who labored in the defense industries during the war.

Ordinary people, doing extraordinary things.

 

Short link to this article: http://k-p.li/2nWzXP8

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Scooter Too – Henry J. Kaiser’s Monster Speedboat

posted on April 6, 2017

Lincoln Cushing
Heritage writer

 

Henry J. Kaiser at wheel of Scooter Too, 1955.

What has 24 cylinders and goes 180 miles an hour?

One of Henry J. Kaiser’s hydroplanes, of course.

The industrialist founder of Kaiser Permanente and his son Edgar loved racing boats at Lake Tahoe, and in 1955 hired famed water speed artist Bartlett “Bart” Carter (a Kaiser employee) to build something extra special. At the boat’s heart was a veritable beast of a powerplant – a 24-cylinder Allison V-3420 capable of putting out a staggering 2,885 horsepower. For comparison, muscle cars of the 1970s pumped out between 400-500 horsepower; the triple-expansion steam engines that powered Kaiser’s World War II Liberty ships put out 2,500 horsepower. Kaiser’s new water rocket was named the Scooter Too.

Scooter Too engine, Allison 3420 cubic inch 24 cylinders.  Auburn, Calif.; Gary Larkins photo.

After World War II, many kinds of military airplane engines were readily available at a bargain, but this was special. It was an experimental design built by General Motors, a Frankensteinian jam-up of a two Allison V-1710 12-cylinder engines with a common crankcase. The 12-cylinder, water-cooled engine had been used in American fighter aircraft such as the Curtis P-40 Warhawk, the Lockheed P-38 Lightning, and the initial versions of the North American P-51 Mustang.

Only 150 of the V-3420s were built, as aircraft power became more effectively produced by jet engines. Kaiser dropped one of them into the 28-foot-long U-10 Scooter Too (the “U” stands for “unlimited,” a racing class with fewer restrictions than standard hydroplane racing).

This boat began as Henry J. Kaiser’s Scooter, powered by two powerful Cadillac engines and described as a “real plush boat.” But when Scooter was smoked by a “little kid with a B-class hydro” Henry resolved to amp it up. He added a larger engine, but the boat couldn’t handle it.  Famed driver Jack Regas (also a Kaiser employee, who’d worked for Kaiser Rock, Sand and Gravel) said this about her first race:

Scooter Too in Pasco, Wash., warehouse, circa 1960.

“After I won the 1954 Mile High Gold Cup, I brought the boat in and she sank. The Allison shook the seams all apart… So Mr. (Henry) Kaiser Sr. said, ’Don’t worry about that, boys. We’re going to build a new boat.’ So we built the Scooter Too.  We built it in the shop at Livermore, California.”

One challenge was linking the V-3420 powerplant to the single 13-inch propeller. The two engine output shafts aimed forward, fed a custom gearbox that tripled the rotation speed, whereupon the single drive shaft ran back under the engine and cockpit. The torque was enormous. After several shafts broke, Kaiser ordered one made out of titanium. And those 24 cylinders were very thirsty – on one of her first races she ran out of gas just shy of the finish line. They promptly added two lateral auxiliary tanks.

Alas, this beast never performed as hoped. She threw propellers, sank six times, was derisively nicknamed “the submarine,” and never won a race.

Gary Larkins in his workshop.

Regas described her qualities in an interview with Thunderboat magazine:

“The Scooter Too had too much weight. The boat weighed close to 8000 lbs. I had that big engine and all the extra fuel I had to carry and gas is 8 pounds a gallon. It was just a heavy boat…The problem with the Scooter Too was that I was throwing props all the time — just too much power on and off the throttle too fast… But the Scooter Too was a good riding boat.”

The Kaisers sold her in 1957 to Stanley Adams and John Owsley for $4,500 and she was trailered to Pasco, Wash. The sale include numerous spare parts, including 72 pistons, 18 connecting rods, and an incomplete second engine.

She was raced as the U-10 but renamed Adios, and later still under a third owner as the U-26 Miss Moses Lake and the Miss Tri-Cities. She ended up with her engine gutted and ignominiously mounted on a pole at Columbia Park in Kennewick, Wash.

Scooter Too rebuild, Auburn, Calif.; Gary Larkins photo.

But rotting as a seagull perch was not to be her final fate.

This boat is being lovingly restored by Gary Larkins in Auburn, Calif. Gary’s not really a boat guy – he’s a renowned airplane salvage expert who’s traveled all over the world rescuing vintage planes from swamps and glaciers. But the Scooter Too has an aviation heritage beyond just the engine, and Gary embraced this project with all his passion. Aircraft components abound – Gary was amused to discover that the external oil tank was pulled from a P-51 Mustang.

What’s more, Gary appreciated Henry J. Kaiser’s spirit of innovation. He commented on a recent blog post about Kaiser’s foray into postwar civil aviation: “It doesn’t surprise me though, that he would tackle the aviation industry, he was fearless and always pushed the very limits of everything he did. Thus we have the Scooter Too which was as large a piston engine as anyone has ever put in a race boat.”

Open frame of Scooter Too under restoration, auxiliary fuel tank in foreground and gearbox in center.

Gary was drawn into the project by his neighbor Richard Carter, son of the original builder and young pit crew member of the Scooter Too. Gary bought the gutless hulk, found another Allison V-3420 engine, and is in the final stages of restoring her to her midcentury glory. Gary wryly comments, “The original goal was to just preserve it but that has grown to restoring it, if I live long enough. LOL.”

She’s been displayed at Lake Tahoe’s South Shore Boat Show, and is seeking a museum for permanent display.

Henry J. Kaiser and his son Edgar would have been proud of Gary’s efforts.

 

 

 

Short link to this article: k-p.li/2oILP6Y

World War II Shipyard Artist Sketched Physicians with Care

posted on March 30, 2017

 

Lincoln Cushing
Heritage Resources

 

 

Dr. Sidney Garfield, by Reginald “Reg” Machado, circa 1943.

A framed set of caricatures hangs in the lobby of the Kaiser Permanente Division of Research in Oakland, described with this caption: “Drawn in 1943 by Mr. Machado, a Richmond, California, Kaiser shipyard employee treated for a hernia repair.”

The beautifully drawn and painted figures depict three key physicians who provided care for Henry J. Kaiser’s World War II shipyard workforce in Richmond, Calif. – Dr. Sidney Garfield (1906-1984), Dr. Morris Collen (1914-2014), and Dr. Cecil Cutting (1911-2008).

Dr. Collen’s oral history explains how he discovered these pictures while he was in the company of Dorothea Daniels, the first female hospital administrator at the Los Angeles Permanente Foundation Hospital in 1953 and first director of the Permanente Foundation Hospital School of Nursing in Oakland:

Dr. Morris Collen, by Reg Machado.

One day on rounds [probably in 1952, at the Oakland Hospital], Miss Daniels and I went through the basement storage area. In a dusty corner I saw a stack of pictures. It turned out that they were about fifteen framed caricatures drawn by the cartoonist for the shipyard paper while he was a hospital patient in Oakland. He sketched all the physicians he had met, and they all hung in the Oakland doctors’ dining room for several years. One day, they painted the dining room and must have put all the pictures down in the basement, where we found them. Most of them were now broken or stained with dirt. I took them, of Dr. Garfield, Dr. Cutting, and myself, and had them restored. They have been hanging in my office since that time.

 

Dr. Cecil Cutting, by Reg Machado.

The Kaiser Richmond shipyard newspaper Fore ‘n’ Aft reveals more about the artist, Reginald “Reg” Machado (1911-2004). He designed silk screened posters and launch programs, and was an artist for the newspaper. A biography on him published February 5, 1946, explains further:

Reg Machado probably has advanced in his own line of work as far as anyone in the shipyards. He has always been an artist. Reg came to the yards in December of 1941 with an idea … and in order to get his idea across, went to work in Yard Two as a sign painter. But it wasn’t long before he had developed what is known as the large and valuable Graphic Arts Department of which he is the Director. Born in the San Joaquin Valley, Reg swears he has never been farther north than Sausalito, nor farther south than Carmel. “However,” he said, “I hope to make a long trip soon.” We checked on the possibilities of this and learned he is slated to leave for the Kaiser-Frazer automobile plant at Willow Run. He will be in charge of a bigger and better Graphic Arts Department there.

Reg Machado painting posters, Fore ‘n’ Aft, 9/3/1942.

Reg Machado at his desk with launching program for SS Marine Leopard, Kaiser Richmond shipyard, 1945.

 

Mr. Machado later returned to the San Francisco Bay Area and operated the Reg Machado Advertising Art studio for 20 years before retiring. He returned to the Monterey Bay Peninsula with his then-wife Betty, built his own home and others, and took up landscape painting. He eventually moved to the Sierra foothills.

Further research in the Kaiser Permanente archives revealed no support for the hernia operation part of the framed images caption, and a physicians group photo with Machado’s caricatures on the wall of the doctor’s dining room is dated 1942. But at least we now know more about Reginald.

Just like noted California artist Emmy Lou Packard, Reg Machado used his artistic skills in the service of winning World War II while working in the Kaiser Richmond shipyards. His contribution will not be forgotten.

Permanente physicians, Oakland Hospital doctor’s dining room, circa 1942. Machado’s caricatures hang on the wall.

Launch program cover by Reg Machado for SS Marine Leopard, July 27, 1945; C4 ship, the largest cargo vessel class built by the United States Maritime Commission. Arthur S. Hatch was the Western Regional Manager for the Ford Motor Company.

 

Short link for this article: http://k-p.li/2nkjWgN

 

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Kaiser Permanente and Group Health Cooperative – Working Together Since 1950

posted on March 22, 2017

Lincoln Cushing
Heritage writer

 

“Permanente pediatric clinic at 515 Market St, San Francisco – nurse giving Patricia Nisby, daughter of ILWU Local 10 member Wiley Nisby, a shot.” ILWU Dispatcher, 10/13/1950.

It’s official. Kaiser Permanente has acquired Group Health Cooperative, making Kaiser Permanente Washington our newest region, the first in over 30 years.

Although this merger is brand new, the two organizations began collaborating more than 65 years ago. Group Health Cooperative of Puget Sound (they dropped the “of Puget Sound” in 1995), like Kaiser Permanente, was always a mission-driven organization that approached health care in a very different way from traditional fee-for-service medicine.

In fact, few know that our common roots go as far back as 1950, just three years after Group Health Cooperative’s founding.

The relationship began in 1949 when the International Longshore and Warehouse Union [ILWU] approached Kaiser Permanente (then called the Permanente Health Plan) about taking on their membership. Initially it was the 20,000 members in the San Francisco Bay Area, with the understanding that it would soon be all of their members on the rest of the coast, from Seattle down to San Diego. Permanente and the ILWU had been in discussion since 1945. Among the many advantages raised was “The hospital’s facilities are open to all groups with no segregation of patients because of
creed or color.” Imagine that.

“Permanente Health Plan Recommended by Oakland Council for Future Contracts,” ILWU Dispatcher, 6/15/1945.

In a 1974 interview, Kaiser Permanente founding physician Sidney Garfield, MD, reflected on this earliest relation between Kaiser Permanente and Group Health Cooperative:

We were rather anxious to get the membership of course, but we couldn’t spread our service that far. We did have a service up in Portland, so that was fine. We got the doctors up there to accept those members, they wanted to do it too. In Los Angeles we had no service. We had it in Fontana, which is quite a distance away, maybe 70 miles from San Pedro. In San Diego we had no service.

[In the Northwest] what we did was arrange with… a prepaid plan up in Seattle, Group Health Association [Cooperative] I think they call it, so we talked them into taking on Longshoremen up there and there was a prepaid plan down in San Diego, a small one, and we talked them into taking on the Longshoremen, and we tackled the Los Angeles, San Francisco, Bay Area and the San Pedro area…

An article in the ILWU newspaper The Dispatcher January 6, 1950 proclaimed: “ILWU Coast Longshore and Shipsclerks Welfare Plan Goes Into Effect.”

The Pacific Maritime Association began making a 3 cents per man hour contribution to the Welfare Fund on December 26, 1949.

Hospital plans go into effect as of February 1, 1950. Permanente Foundation’s Health plan will cover the San Francisco, Los Angeles and Portland – Vancouver areas. There is already a setup in Portland similar to the one in the San Francisco Bay Area. Permanente will open a clinic in Wilmington, Calif., immediately upon the ratification of the Welfare Plan by all locals.

In Seattle, Wash., the Group Health Cooperative of Puget Sound made the offer of medical care on the same basis and at the same price as Permanente.

By year’s end, 90 percent of eligible ILWU member had signed up for the plan. It was voluntary; the Permanente Foundation Health Plan was committed to offering “dual choice” to groups, so that no member would feel resentful at having something forced on them.

Group Health Cooperative communicator Pat Bailey adds this point:

This contract for 2,200 ILWU enrollees for Group Health came at a time when the Cooperative was cash-starved. But as already noted, with the new enrollees came pent-up health needs. Before long, the waiting list for hernia operations numbered as many as 50.

“Anne Waybur of the ILWU Research Department interviewed more than 125 longshoremen, clerks, foremen and their wives in San Pedro, Calif. to find out what they think of the Permanente Health Plan coverage and service.” The Dispatcher, 1/5/1951.

It’s hard to overstate the deep impact that this contractually-negotiated benefit made in the lives of the ILWU members.

When the plan began, there was a big rush for treatment of such illnesses as hernias and hemorrhoids, conditions the men had suffered with and lived with for many years. They hadn’t been able to pay for medical care on their own. A 1951 brochure produced by the ILWU about the Multiphasic testing examination noted that “…many of our members have not been to the doctor until they practically collapsed on the job.”

A March 10, 1950, article in The Dispatcher put it this way:

“The Welfare Plan is the greatest thing since the hiring hall.” That’s the opinion of D.N. (Lefty) Vaughn, Local 13 longshoreman, hospitalized here under Permanente. Vaughn told Local 13 visitors last week that if it wasn’t for the Welfare Plan he would have had to sell his home in order to pay for the major operation he’s getting for nothing through the Plan.

An editorial three weeks later further explained:

Life can be beautiful if you’re healthy is the way the ad men put it. There’s no doubt they’ve got a point, though it’s oversimplified. Health is no fringe issue, not when you are required to make a choice between an operation which will allow you to go on working and living, and the home you must sell to pay for that operation. Longshoremen no longer have to make such choices. More than one home has been saved since the medical coverage section of the Welfare Plan became effective two months ago.

Kaiser Permanente and Group Health Cooperative– partnering to help working American families get good health care since 1950.

 

Short link to this article: http://k-p.li/2mUqseU
T
hanks to Robin Walker, ILWU archivist, for help with this article.

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Screening for Better Health: Enter the Computer

posted on March 15, 2017

Lincoln Cushing
Heritage writer

 

The Automated Multiphasic Examination
Second part, follows “Screening for Better Health: Medical Care as a Right

 

IBM 1440 computer processing room at Kaiser Permanente, circa 1964

Last summer a major medical news story splashed across the world: “Historic Kaiser Permanente Data to Aid in Long-Term Study to Determine Extent of Ethnic Disparities in Brain Health and Dementia; new $13 million study funded by National Institute on Aging will revisit patients who were first screened as long as 50 years ago.”

Where did this remarkable trove of data come from?

In 1961 the U.S. Public Health Service awarded the Kaiser Foundation Research Institute a grant to study the automation of the multiphasic health testing it had been conducting manually for 10 years. Members would now go through the screening stations with computer cards that got marked along the way.  At the end of the session, which took a couple of hours, there would now be a computerized medical record of their current health status. The Automated Multiphasic Health Test was born.

Multiphasic stations, from “The Multitest Laboratory in Health Care,” by Drs. Morris Collen and Lou Davis, Journal of Occupational Medicine, July 1969.

The first AMHT center was at a new building on the Oakland Hospital campus at 3779 Piedmont Ave. By the end of 1966, Kaiser Permanente had enlarged and updated its testing facility and laboratories nearby at a state-of-the-art center at 3772 Howe Street, and expanded the computer center and offices in the Piedmont building. A second center in San Francisco was linked to the mainframe computer in Oakland.

Dr. Collen, in the Journal of the American Medical Association (1966), accurately predicted that “The advent of automation and computers may introduce a new era of preventive medicine … [The computer] will probably have the greatest technological impact on medical science since the invention of the microscope.”

AMHT questionnaire card about occupational health

The AMHT continued to be seen as a vital tool in the diagnosis and treatment of occupational and industrial illnesses. A 1967 article in the Archives of Environmental Health discussed the employment data gathered, which included a list of 170 occupational titles and a battery of work-related health questions. “The computer storage of data on more than 40,000 adults annually permits extensive epidemiological research, especially directed toward the preventive aspects of chronic disease.”

It wasn’t just union members who benefitted. The Modern Hospital, May 1966 called the periodic health examinations to more than 4,000 patients monthly “… an impressive investment in the concept of ‘health medicine.’”

AMHT station 4 skin fold thickness test, a much more accurate indicator of obesity than BMI.

The test expanded to about 20 stations, measuring everything from hearing to heart function. It even went beyond mere testing – if recommended, a patient could get a tetanus booster via the new high-pressure injector system.

A 1970 article by Dr. Garfield in the prestigious New England Journal of Medicine with the provocative title “Multiphasic Health Testing and Medical Care as a Right” began with this abstract:

Although no long-term evidence exists that the course of disease is influenced by multiphasic health testing, this is largely irrelevant. Such programs are essential for other very important reasons. The existing and spreading concept of medical care as a right, with its elimination of personally paid fees, is creating a demand for periodic health checkups and health appraisals. This demand cannot be met by traditional methods totally involving the physician without great waste of doctor time.

Multiphasic health testing can help separate the entry mix of patients into the well, the asymptomatic sick and the sick. This separation makes possible optimum use of physicians’ services, which can be devoted to the area where they are most needed: the care of the sick.

The efficiencies of the AMHT were sufficient that these programs were sometimes adopted by private practice, large companies, and public health agencies. Dr. Collen remarked:

It is still of great interest to me and much personal satisfaction that the AMHT is still flourishing in Japan, Taiwan, and in China; and in the past when I visited them I found the AMHT centers in Japan to be primarily employer-sponsored for employees. I found the newest AMHT centers in Taiwan and China to be for-profit, marvels of efficiency and associated with health education centers open to the public, and with a high level of provider and patient satisfaction.

“Multiphasic Screening Comes to Portland,” Healthgram, Winter 1976

But despite the AMHT’s popularity, it was discontinued by Kaiser Permanente by the late 1970s when a federal grant supporting the work dried up and Kaiser Permanente declined to commit further resources.

Dr. Collen himself noted some of the challenges to quantifying the benefits of screening:

…Epidemiologists required us to report on gross mortality, and since the potentially postponable conditions comprised only about 15 percent of all the causes of death, most people died from other conditions … some of the criticism of urging checkups is based upon the fact that one does not decrease total gross mortality. That is, everyone eventually dies from something.

Gary Friedman, MD, former director of Kaiser Permanente’s Division of Research, recently explained additional medical limitations to the AMHT:

Kaiser Permanente silent film showing the Automated Multiphasic Health Test process, circa 1970. Click to play.

Initial enthusiasm for multiphasic health screening was tempered by experience in using it and by scientific studies that did not confirm benefits vs. costs of specific screening tests.  For example, it was initially hoped that routine chest x-rays, included in AMHT, would lead to early detection and increased curability of lung cancer.  Studies did not confirm this benefit.  A yes/no question about chest pain provoked by exercise and relieved by rest was included in the AMHT symptom questionnaire.  Although a yes answer seemed almost diagnostic of angina pectoris, this often did not prove to be the case in the follow-up examination by the physician, who could question the patient in greater detail, consuming valuable time.

Clearly however, the value of some screening tests has been amply confirmed.  Finding and treating high blood pressure in asymptomatic individuals prevents strokes.  And screening for colorectal cancer by the various tests available can lead to early detection and cure, or the removal of polyps that could later progress to cancer.

Despite these issues, Dr. Collen defended the value of the AMHT in a 1986 UC Berkeley oral history by Sally Smith Hughes:

…The study [on AMHT] did clearly demonstrate that for those conditions that are potentially postponable, there is a significant decrease in mortality.

He went on to note larger policy and commercial impediments to the AMHT:

Blue Cross/Blue Shield and other indemnity insurers to this day still do not pay for checkups. They take the position that periodic health checkups are schedulable and elective, so are not insurable events. Medicare to this day does not pay for checkups. The contrast, in other countries, like in Japan and in France, their social security and governmental supportive systems pay for periodic health checkups for well people, but do not pay for sick care. Just the opposite from the U.S. So if our Public Health Service is so interested in

Dr. Morris Collen at Multiphasic registration counter, circa 1966

preventive medicine, why do they fail to support the financing of checkups? A very key reason that multiphasic testing has not proliferated in the United States is because it is not reimbursed by any of the insuring agents. That has been reported by vendors who try to sell the systems.

I should point out that the Public Health Service had asked us to patent the system because it was an invention. Whether I was right or wrong, I refused to do so. I felt that it should be in the public domain, and it is. It’s never been patented.

Dr. Collen concluded with deep pride in the accomplishments:

We actually developed the most comprehensive inpatient and outpatient medical information system in the world. And this book, Hospital Computer Systems, describes that. There were only a half-a dozen others in the world that were doing that.

 

As the 2016 medical news story about the persistent value of the AMHT data shows, this was a significant accomplishment in medical practice. Thank you, Dr. Collen.

 

 

Short link to this article: http://k-p.li/2n00mcW

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Beatrice Lei, MD: From Shantou, China, to Richmond, California

posted on March 7, 2017

Alix Sabin, guest writer

 

Beatrice Lei, MD, circa 1930

“An inspiration to . . . women physicians.”

That was the shout-out to Beatrice Lei, MD, in 2002, as she was posthumously inducted into the Kaiser Permanente Diversity Hall of Fame.

“Through her quiet demeanor, excellence and dedication to quality care delivery and clear focus on what was required to be successful, she served as a role model and inspiration to the women physicians and Asian American physicians and employees who would follow.”

 

Dr. Lei arrived in San Francisco in the late 1930s from her native Shantou, China, determined to learn effective treatments for tuberculosis. She had intended to return to China, where the disease had become prevalent, but she was unable to go home after Japan seized Shantou during World War II.

Dr. Lei stayed in the United States, passed the California Medical Boards, and went on to work for Sidney Garfield, MD, at the Kaiser Richmond shipyards. In 1946, she became one of the 16 founding partners of The Permanente Medical Group, becoming TPMG’s first female and first Asian physician.

Several founders of The Permanente Medical Group have been well chronicled over the years, including Dr. Garfield, who created Permanente medicine; Cecil Cutting, MD, TPMG’s first executive director; and Morris Collen, MD, known for his pioneering work in applying computer technology to modern medicine. Dr Lei’s story is lesser known.

Born in Shantou, China in 1910, Pooi Tuen (Beatrice) Lei was one of 11 children. While it was highly unusual at that time for girls to attend school, Lei’s father wanted all of his children to get an education.

Beatrice Lei, MD, with infant patient, 1947. Kaiser Permanente hired Chinese immigrant Beatrice Lei as its first woman physician in 1946.

In 1928 she entered the Hackett Medical College for Women — the first (and at the time, the only) medical school in China for women — determined to help her family and her community of Shantou, which had no physicians. She received her medical degree in 1932, completed her residency in Shanghai in 1935, and returned to Shantou to practice medicine.

Once in the United States, Dr. Lei was recruited in 1944 to work for Dr. Garfield who was caring for the employees at the Kaiser Richmond shipyards.

When World War II ended, the shipyard workforce diminished significantly and many doctors left. But a core set, committed to the concept of prepaid group practice, remained. One was Dr. Lei.

“When the shipyards closed after the war, so many people moved out of the area that we thought we might have to close the facility,” Dr. Lei recalled during an interview in 1974. “Many of our doctors left the program and started private practice. Some of them asked me to join them, but I refused. There was still a need here. Besides that, I wanted to continue practicing in Richmond. It has always been like home to me.”

In 1945, Henry J. Kaiser and Dr. Garfield made the Permanente Health Plan available to the general public. The following year, Dr. Lei became a founding partner of The Permanente Medical Group.

Dr. Lei with Dr. Sidney Garfield at her 30 year service celebration

Dr. Lei served as chief of Pediatrics at the Kaiser Permanente Richmond Medical Center from 1946 to 1966, and continued practicing there until she retired in 1975. Frederic Geier, MD, who was physician-in-chief at Richmond Medical Center from 1955 to 1974, said, “Dr. Lei has always been one of the most popular pediatricians here. She has a wonderful rapport with children and their parents.”

During her tenure with TPMG, Dr. Lei also distinguished herself for her commitment to helping others. For instance, she hired and mentored many residents, provided free health care for people in need of assistance, and regularly helped and counseled Chinese students studying in the United States.

After Dr. Lei retired, she continued to dedicate herself to improving the health of her community by providing free medical treatment to family, friends and others who needed care but could not afford it. She died in 2002, at the age of 92.

At Dr. Lei’s induction into the Kaiser Permanente Hall of Fame, she was quoted as having offered this perspective on her immigrant story: “It is hard for Chinese to come to this country… nothing comes easy. We have to work very hard and appreciate what we have. It is critical that we study hard, work hard, contribute to the community, and make all Chinese people look good and feel proud.”

We honor Dr. Lei’s contributions on March 8, International Women’s Day.

 


Alix Sabin is a Senior Communications Consultant for TPMG – The Technology Group. A version of this article appeared in the Winter, 2017, issue of Permanente Excellence, a new quarterly magazine published by The Permanente Medical Group and distributed to TPMG Physicians. Research materials for this article were provided by Kaiser Permanente Heritage Resources.

Short link to this article: http://k-p.li/2lZhqN1

 

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Screening for Better Health: Medical Care as a Right

posted on March 1, 2017

Lincoln Cushing
Heritage writer

[Part one of two]

Permanente's First and Largest Coastwise Group", Planning for Health, 1951-Fall

“This local 10 longshoreman is having an electrocardiograph taken to detect any heart irregularity. This is one of the many tests in the recent program conducted for the ILWU by Permanente.” Planning for Health, Fall, 1951.

For many years a hallmark of Kaiser Permanente’s preventive health care program was a battery of tests, designed to alert doctors to trends and red flags in a patient’s health. And it started with service to industrial workers.

Lester Breslow, MD, published a seminal article in the March 1950 American Journal of Public Health titled “Multiphasic Screening Examinations: An Extension of the Mass Screening Technique.” Dr. Breslow, who worked for the California State Department of Public Health in Berkeley, challenged the limitations of periodic health examinations, and proposed the value of an integrated battery of preliminary examinations – a “multiphasic examination.” The advantages included one combined medical record, cost savings, and improved diagnoses. One passage in Dr. Breslow’s article stood out:

“This survey can be conducted in a time not much greater than would be required for screening for a single disease. Where such screening procedures are carried out among industrial populations the time element is especially important.”

At that time, the Permanente Health Plan was expanding to the public after having only served Henry J. Kaiser’s World War II employees, and much of that growth was from unions.  Dr. Breslow had been a college classmate of Kaiser Permanente’s Dr. Morris Collen, and the AJPH article offered a solution to the challenges of bringing in large numbers of industrial members with physically demanding jobs and poor health care.

"Are you ship shape?" brochure about ILWU member health testing; 1951; supplied scan, source of original unknown

“Are you ship shape?” brochure about ILWU member health testing; 1951

Since the main medical competitors, Blue Cross/Blue Shield, did not provide health checkups unless one had a medical complaint, the Permanente facilities saw a surge in well-patient testing that began to drain the system. Searching for solutions, Dr. Collen spoke with Dr. Breslow, who suggested setting up a multiphasic screening for a large new member organization – the International Longshore and Warehouse Union. Although the screening was coordinated under Permanente’s leadership, it included the cooperation of the United States Public Health Service, the California State Department of Health, the San Francisco Public Health Department, the Bureau of Vocational Rehabilitation, and the San Francisco Tuberculosis Association.

The screening was seen as a groundbreaking step public health. The ILWU Dispatcher article May 11, 1951 proclaimed:

The longshoremen’s program represents pioneer work in preventive medicine—the science of keeping people healthy. Multiple health tests for such a large group are a new procedure, in use only since 1948 and scientifically proved to be effective in detecting disease while there is still time for treatment.

Dr. Collen proceeded try his first group test at the ILWU’s Local 10 hall at pier 18 in San Francisco, and screened several thousand longshoremen. An article in The Dispatcher from August 17, 1951, was titled “ILWU Waterfront Health Tests ‘Complete Success’; 4,002 Go Through” boasted:

Follow-up tests and treatment are now being given to members whose test results showed any signs of disease by a special team of Permanente doctors assigned to the ILWU under the ILWU·PMA [Pacific Maritime Association] Welfare Plan.

At a dinner for all the people who worked on the project, Permanente Health Plan, Director Dr. E. Richard Weinerman said the health test program was a “complete success . . . The fact that this program was the first to be organized by a union, the first to provide so comprehensive an array of tests and the first to assure complete medical follow-up through the health plan made it an outstanding contribution to the field of preventive medicine.”

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Longshore worker signing up for Multiphasic exam, 1961

Dr. Weinerman also noted the role of what we now call “culturally competent care.” In a Dispatcher article July 6, 1951, he said “In order to condition [our physicians] to do the best possible analysis, the union is taking them on a tour of the waterfront to observe working conditions. Then they will be able, to understand clearly how longshoremen work, and they can interpret symptoms more accurately.”

Dr. Collen later recalled the next steps of expanding the screening to all Permanente members in his oral history:

We started our multiphasic program in the Oakland clinic [on November 29, 1951]… After the clinics closed at five-thirty, we used the existing office space in the surgery clinic. We developed a whole series of arrows and put colored tapes on the floors so that patients would go in through the various rooms and have their height, weight, blood pressure, and other physiological measures taken, and then fill out a history form. Then they would be directed to the laboratory for blood and urine tests, to the x-ray department for a chest x-ray, and to the electrocardiography department for an electrocardiogram. In that way, we didn’t require any extra equipment or any extra facility space. We developed a team of personnel that would work in the evenings from about five-thirty to eight, and we examined some twenty-five to thirty patients every evening that way at a very low cost.

In 1952, the Kaiser Permanente clinic at 515 Market Street in San Francisco also opened a Multiphasic Health Test facility in a space that had formerly been used as an orthopedic clinic.

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Longshore worker taking Multiphasic exam, 1961

The process consisted of about 15 procedures and only required the presence of a single physician, assisted by paramedics. Dr. Collen went on to explain the beautiful medical logic of the testing:

. . . Health is the only condition in life when you find people are medically similar. That is, healthy people have a relatively normal distribution of their tests and measurements so that you can develop routine repetitive procedures to do these tests. The health checkup, the evaluation of a normal well person, is the most routine, repetitive procedure in medicine.

As soon as one has a variation from normal, which is the basic definition of being ill or sick, then one becomes unique. Every diabetic is different; every hypertensive is different, and a diabetic with hypertension is even more complicated. So it is difficult to develop routine rules for sick people. But for normal people, and by definition 95 percent of healthy people are within normal limits, you can develop routine repetitive procedures. And that is the secret of the efficiency and economy of a programmed, systematized, multiphasic checkup.

An article in the Permanente newsletter Planning for Health touted the Multiphasic:

A broad stride in the practice of Permanente’s fundamental principle of preventive medicine was accomplished with the recent inauguration of the Multiphasic Health Check-up program at the Oakland and San Francisco medical centers. A new type of general medical examination, Multiphasic Check-up, is based on the premise that early diagnosis and adequate treatment can materially reduce the ill effects from significant diseases.

By the mid-1950s, 30 to 40 percent of all new members were choosing the multiphasic on their first visit.

However, in the early 1960s changes in technology would transform the examination. And the future was . . . computers.

Part 2: The Automated Multiphasic Examination

Short link to this article: http://k-p.li/2mtLDb6

Special thanks to ILWU archivist Robin Walker for her help with this article.

 

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The Kaiser Dishwasher

posted on February 23, 2017

Lincoln Cushing
Heritage writer

 

Henry Kaiser with dishwasher and model

Henry J. Kaiser with dishwasher and model, circa 1946

World War II was not yet over, and Henry J. Kaiser was already anticipating the need for postwar housing – and houses need appliances. Henry J. Kaiser was one of the prominent American industrialists of the early 20th century who built everything from dams to ships to airplanes. Did his range extend to humble home appliances? Yes, it did.

The news broke on October 16, 1946:

“First Kaiser Cars Go on Display Here,” Berkeley Daily Gazette:

In the appliance line Kaiser Motors soon will distribute a machineless [motorless] dish-washer, now in production at Bristol, Pa. The dish-washer, which operates entirely by water pressure, is being produced in two models – a “chassis” type that will cost about $176 and can be made a permanent fixture of the home, and a “cabinet” dish-washer that can be moved from house to house. The “cabinet” dish-washer will sell for approximately $101.

The Kaiser-Frazer dealers have been offered franchises on the appliance and farm equipment lines in order to have something to sell the year round until new cars become plentiful.

Raymond Wilson’s dish washing machine patent, 1943

As with most of his accomplishments, Henry J. Kaiser didn’t invent the dishwasher – he looked at what was needed, found out who knew how to make it, and did it better.

The origins of the Kaiser dishwasher begin with Raymond W. Wilson, an inventor in Glendale, Calif. In 1943 Wilson was granted a patent for a dishwashing machine whose primary feature was that it was entirely operated by water pressure – no electricity was needed. “As easy to install as a new sink – your plumber will gladly make three simple connections.” The washer used standard municipal water pressure and hot water from a residential hot water heater (assumed to be 140 degrees F.) A basket would raise for loading and lower for washing with spray jets at the bottom.

Wilson began producing these machines under the “Q.E.D.” brand name in 1939 and applied for his patent in 1940. The patent rights were later purchased by Mr. W. J. Schworer of Alhambra, Calif., and the product name changed to “Steril-Dry.”

Unfortunately for the new dishwasher, soon the United States was deeply involved in World War II, and manufacturing capacity for consumer products was marshaled for the war effort. But by September 1944, Kaiser had started partnering with real estate developer Fritz B. Burns to build modern housing projects, and Burns wanted to include the Steril-Dry in new homes. So, in November they installed and tested one of the dishwashers in their Latham Square Building offices in Oakland.

qed-dishwasher-med

Q.E.D. item in Popular Science, November 1944

Although Schworer had begun negotiations with the Crane Company, the Kaiser Company managed to beat them out and buy the rights on November 10, 1944.

Arrangements were made to assemble and purchase six Steril-Dry machines from Schworer for installation at test locations including the Kaiser Steel mill in Fontana, Calif.; the Kaiser Cement plant in Permanente, Calif. (south of San Francisco near Cupertino); and the Fleetwings aircraft plant in Bristol, Penn. One was also set up at the residence of Eugene Trefethen, Jr. (1910-1986), a longtime Kaiser Industries employee who later rose to become president and vice chairman of Kaiser Industries.

And another one was installed at the Kaiser Richmond shipyard number 3 cafeteria, where it ran for more than 300 hours and washed 129,106 dishes. A report on that test included these findings:

The dishes are washed satisfactorily when the water is at the proper temperature (150-170 degrees F.), and they dry immediately. The same results occur when washing glassware. There has been absolutely no breaking or chipping of the dishes or glasses. If the water gets below 150 degrees the dishes are not washed as satisfactorily. The dishes and glassware come out clean with the exception of those that have lipstick on them. Other types of grease are easily removed, however.

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Steril-Dry brochure cover, circa 1945; uses same photo as Q.E.D. item above.

The pressure of the water does not seem quite sufficient. It is about 60 to 65 pounds. The only objection to the pressure is not from the dishwashing angle, but from trouble with the hydraulic lift.

Results were very satisfactory considering that the operators were untrained, unskilled people. They had no difficulty in operating the machine. It only takes a few minutes of instruction to the most unskilled person for her to understand the operation of the machine.

Another model kitchen and laboratory were set up to further test the machines. An extensive list of proposed modifications was drawn up, including everything from design (locating knobs in the front, making the top flat and square to serve as a working surface) to technical (jet redesign to minimize clogging, automatic soap dispenser).

By early 1946, the Kaiser Fleetwings Division of Kaiser Cargo in Bristol began manufacturing four models of the long-awaited Kaiser dishwasher.

Kaiser dishwasher ad, Better Homes and Gardens, 1948-02 [Web grab]

Kaiser dishwasher ad, Better Homes and Gardens, 1948

Research by dishwasher historian (yes, you read that correctly) Mike Haller of Peoria, Ill., describes what happened next in the “automaticdishwasher forum“:

Two major flaws existed: (1) Distribution was turned over to the Kaiser-Frazer Sales Corporation (the car division of the Kaiser conglomerate). The Kaiser-Frazer division was ill prepared to market and demonstrate the dishwasher. (2) Lack of adequate field testing did not pick up on the fact that not all water sources were able to deliver the required minimum water pressure [or temperature] for adequate operation.

Mainly because of customer dissatisfaction and the high cost of the dishwashers – upwards of $200 plus freight and taxes, — the sales started to decline…in early 1948, Sears Roebuck & Company was searching for an automobile that could be sold as a house-branded item. As part of the deal, the Dishwasher line became part of the package, along with factory floor space. However, Sears needed the floor space for other contract work, so the Kaiser Dishwasher line had to go.

In 1948 Fleetwings was renamed Kaiser Metal Products, where they continued to manufacture a range of consumer products. But Kaiser’s short venture into the world of dishwashers went down the drain.

 

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

 

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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.

 

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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.

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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 and his 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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