Posts Tagged ‘Contractors General Hospital’

Dr. Sidney Garfield on Medical Care as a Right

posted on August 15, 2017

Lincoln Cushing
Heritage writer

This post introduces a podcast, our new channel for sharing Kaiser Permanente history. Given the rich set of audio materials in our archives, it makes sense to let viewers hear our stories as told by those who were part of it. With these podcasts we will explore audio sources including World War II shipyard launchings, speeches by key figures, and interviews.

So, without further ado, let’s hear our founding physician talk about what he learned about building a medical plan, starting in 1933.

 

Podcast fulltext for “Dr. Sidney Garfield on Medical Care as a Right”

Hello, I’m Lincoln Cushing. Welcome to Kaiser Permanente’s “Earful of History”

Today we’ll hear from our founding physician, Doctor Sidney Garfield. He had some interesting things to say about medical care as a right – and also about the origin of what we now call Permanente medicine.

Dr. Garfield’s talk comes to us from a 1972 lecture he delivered to community medicine students at the University of Southern California Medical School.

Let’s go way back to the Great Depression, when America’s industries were in shambles, people were out of work, and things were really tough.

Dr. Sidney Garfield at Contractors General Hospital, 1935.

In 1933, Dr. Garfield was fresh out of medical school, and he’d set up a small practice in Southern California’s remote Mojave Desert. He was providing industrial medical care for the workers on the Colorado River Aqueduct project.

Dr. Garfield:

I soon found myself in rather serious financial difficulty. Knowing nothing about medical economics, I had tackled the impossible job in those days of trying to take care of a group of workers with none of the usual crutches. There were no rich to pay for the poor. No subsidy. No philanthropy. There wasn’t even a county hospital to which we could send our charity cases.

Dr. Garfield’s problem was the standard business model of industrial medicine where he got insurance reimbursement for treatment after a worker was sick or injured. So he worked out a new deal with the insurance carrier. Dr. Garfield was prepaid a fixed amount per worker, and in turn he guaranteed he’d provide their needed medical care while on the job. This was a win-win solution. It assured Dr. Garfield a steady income to run his clinic, but more importantly, it gave him the incentive to keep the workers healthy instead of making money when they got injured.

The aqueduct project ended in 1938. He was going to go into private practice, but history intervened. Dr. Garfield went up to care for the workers at industrialist Henry J. Kaiser’s huge dam project on the Columbia River in Washington. Grand Coulee Dam, the largest concrete structure ever built.
[Woody Guthrie sings; he was hired by the Bonneville Power Administration to promote the wonders of the new dam].

Mason City hospital (Grand Coulee Dam) after Dr. Garfield’s upgrade, circa 1939.

Dr. Garfield, reluctant at first, became excited at the prospect of fixing up the decrepit local hospital and bringing in a top-notch staff. There, he learned a lesson – a prepaid health plan for whole families can be effective and affordable.

Dr. Garfield:

In the beginning, we took care of the workers with the health plan. And we took care of the families on fee-for-service.

And we soon found out that it didn’t work at all. It was too painful of a situation. The workers could get their care so easily through their health plan. And they had such problems paying for the care for their wives and children. It bothered not only the workers, it bothered the employer. It bothered the unions. It bothered our physicians. And so pretty soon we were being pressured on all sides to start a family plan… fifty-cents a week for the wife, and twenty-five cents a week for each child. [We] started a family plan.

And that worked beautifully too. From then on we had no concern. No problems taking care of the women and the children. But that rounding out of our employee plan to a complete family plan was Coulee’s contribution – greatest contribution to our lessons in medical care.

Bear in mind that until this point in history, health insurance plans didn’t really exist. If you got sick, you hoped you had enough money to pay a doctor, and you often delayed that until things got really bad.

Dr. Garfield:

Prior to the family plan, walking through the corridors of our Coulee Dam hospital, you would see a fair amount of very sick women and children. Terminal pneumonia. Ruptured appendices. Diphtheria cases and so forth. After the plan had been in operation for several months, that picture changed. The level of illness of these people changed. Walking through the corridors now you would see simple appendices, and early pneumonias. And diphtheria disappeared completely with the immunizations we offered with our health plan. And the solution to that was simple. The barrier of cost being removed, these people were coming in earlier for care. We were able to treat them earlier and prevent them from getting complications. And I’m sure preventing many of them from dying. That was a lesson that we’ve never forgotten.

This was the origin of what we now call Permanente medicine. Speaking to the roomful of community medicine students, he reflected on the important medical model he’d developed through his association with Henry J. Kaiser and the efficiencies of the Kaiser Permanente Health Plan:

Dr. Garfield:

In conclusion, in view of our commitment to medical care as a right in this country, this is – comprehensive health services, of high quality, to every person, the importance of this research and potential benefits is self-evident. We can never achieve the goal of medical care as a right without a delivery system that matches the demand of that right.

This new delivery system [I just described] does just that. It provides increased capacity, increased accessibility, appropriateness of service, comprehensiveness of care, continuity of both health care and sick care, efficiency of resource utilization, and is cost-effective. Its new services are relatively easily staffed, and it promises ready transferability and adaptability to most all forms of practice and geographical areas.

It’s impressive that an industrial health plan from the Great Depression would evolve into a robust and effective model of health care for all Americans.

It’s a testament to the persistence of mission and the dedication of thousands of physicians, staff, and administrators, starting with Dr. Garfield.

Thanks for joining us in this Kaiser Permanente Earful of History.

 

This audio is from a 1972 lecture Dr. Garfield delivered to Community Medicine students at the USC Medical School, recorded by Dr. Robert Tranquada and donated to Kaiser Permanente Heritage Resources.
Podcast producer: Juan Aguilar.

Short link to this page: http://k-p.li/2wb8axr

 

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Celebrating Betty Runyen – Kaiser Permanente’s “founding nurse”

posted on May 6, 2015

Lincoln Cushing
Heritage Writer

Nurse Betty Runyen, Contractors General Hospital, circa 1936.

Nurse Betty Runyen, Contractors General Hospital, circa 1936.

Betty Runyen was the only nurse working for Kaiser Permanente’s founding physician Dr. Sidney Garfield at Contractors General Hospital at the construction site of the Colorado River Aqueduct project serving a growing Southern California, 1933-38. She had recently graduated from nursing school in Los Angeles and was eager to begin a job in her profession during the Great Depression.

Nurse Runyen did not join Dr. Garfield on his next health care project when he partnered with Henry J. Kaiser while building the Grand Coulee Dam in 1938. But Betty Runyen’s skill, dedication, and compassion were significant contributors in the early formation of the comprehensive health care program that we now call Kaiser Permanente.

We honor National Nurses Week (this year it’s May 6-12) with this photo of Nurse Runyen enjoying a well-deserved moment of relaxation from caring for those workers in the remote Mojave desert.

 

Short link to this article: http://k-p.li/1QnmrIF

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Injured on the job! The history of Kaiser Workers’ Compensation care

posted on April 16, 2014

Lincoln Cushing
Heritage writer

Part one of a two-part series

Unless one has the unfortunate experience of being injured on the job, one is usually unaware of a parallel health care system – the medical treatment provided as a benefit through the Workers’ Compensation Insurance system.

Regular health issues (diseases or injuries suffered while not at work) are handled through fee-for-service doctors or their insurance/health plan counterparts. But if something bad happens on the job, another set of rules apply. Employers are legally required to provide benefits to employees, including medical coverage, and treatment for these injuries is carried out by a separate system of insurance or self-insurance. Care is usually delivered by physicians specializing in Occupational Medicine. 

Early in the 20th century industrial injuries were rising, organized labor was becoming more powerful, and legislation was sought to mitigate the medical and legal consequences of on-the-job accidents. California’s first workers’ compensation law was the voluntary Compensation Act in 1911, followed by the Workers’ Compensation, Insurance and Safety Act of 1913 (the Boynton Act). For the first time, employers were required to provide benefits for all employees injured on the job. The employers benefited from expanded limitations on their legal liability. The Act also established a competitive state insurance fund, and it remains the foundation for workers’ compensation in California today.

Dr. Sidney Garfield’s desert experience

Worker-patient at Contractors General Hospital, under the care of Dr. Sidney Garfield, circa 1934.

Worker-patient at Contractors General Hospital, under the care of Dr. Sidney Garfield, circa 1934.

When Kaiser Permanente founding physician Dr. Sidney Garfield (along with partner Dr. Gene Morris) first set up his 12-bed Contractors General Hospital way out in the Mojave Desert in 1933, he wasn’t trying to revolutionize health care practice in America. He was simply a young doctor taking on a reasonably safe business opportunity, serving the medical needs of some of the 5,000 men working on the Colorado River Aqueduct Project who were insured through workers’ compensation.

Dr. Garfield soon found his practice foundering because the workers’ compensation insurance companies handling industrial injuries were sending the most serious – and most profitable – cases to favored Los Angeles hospitals. They also challenged many charges as unnecessary and were often late in paying. In addition, the remote setting of the work camps meant that these hospitals were the only place the workers could be treated for non-industrial diseases – something for which they could rarely afford to pay full fee.

Industrial Indemnity Exchange (which was one-third owned by Henry J. Kaiser) was the largest insurance company affiliated with the aqueduct project, and underwriter Harold Hatch offered a creative and mutually beneficial solution. In exchange for half of the 25 percent insurance premium that Industrial would have paid out for treatment, Industrial would pay that up front to Garfield and he’d promise to provide the requisite industrial care.

Garfield figured out that he could get the workers to also prepay a small, affordable amount (five cents a day), and he’d extend his services to cover comprehensive medical care.[i] 60 percent of Garfield’s income would eventually come from payroll deduction, 40 percent from workers’ compensation. The plan worked very well, and became one of the cornerstones of the Kaiser Permanente model.

Caring for wartime workers

Ambulances at Kaiser Richmond shipyard first-aid station, circa 1944.

Ambulances at Kaiser Richmond shipyard first-aid station, circa 1944.

This unusual integration of industrial and non-industrial medical care under one roof continued when Garfield directly partnered with Kaiser and operated the hospital at Grand Coulee Dam (1938-1941) and later at the seven West coast shipyards and one steel mill (Fontana) during World War II employing almost 200,000 workers.

Health care posed a significant challenge in operating the yards; because most of the able-bodied healthy men (the typical demographic for this industry) were serving in the military, those available for homefront needed job training and medical care.[ii] The option of affordable comprehensive health care was extremely attractive to the new workforce, and demand outstripped availability. Permanente Health Plan organizers struggled to add enough staff and facilities to handle new members.

Despite the superficial appearance to the end user that it was a single health plan, under the hood it still involved the bureaucracy and bookkeeping of two separate entities. The Health Plan Manual for the staff of Sidney R. Garfield, M.D., (circa 1942) clearly stated:

 Q. If a member is hurt while working on the job is he covered under the Health Plan?

A. No. The Health Plan does not cover Industrial accidents. These are covered under Workman’s Compensation.

Q. What is meant by Workman’s Compensation and how are we connected with it?

A. Under the Workman’s Compensation Act of California, most employers are required to provide medical and hospital care as well as weekly compensation to employees injured while working. The shipyards contracted with private insurance companies to provide and administer these benefits to the employees. We in turn made arrangements with the insurance companies to provide the medical and hospital services for a certain fee.

The combined health plans proved to be a powerful medical and economic engine. In August of 1943, A.B. Ordway, Vice President of the Richmond Shipyards, sent a report to B.K. Ogden, Director of the Division of Insurance, United States Maritime Commission, in Washington, D.C. He observed:

The shipyard management further realized that the type of medical and hospital care necessary to secure and maintain the best morale and productive results for shipbuilding could not be made available from the possible income that could be derived from industrial cases only.

Therefore, early in 1941 a plan was devised for offering to the employees of the above yards a Medical Health Plan at a fixed price per week. The possible income that could be secured through an Industrial medical plan and a medical Health plan was of sufficient size to justify expenditures of large amounts of money for buildings and equipment and to better enable the holder of the medical contracts to secure the large staff of doctors and nurses needed to adequately provide the best medical and surgical attention possible.

…Medical costs on industrial cases are lower than would be possible were it not for the fact that one organization handles industrial and non-industrial cases, and the industrial costs are controlled through one contract method.

Kaiser Richmond shipyard first aid station, circa 1944

Kaiser Richmond shipyard first aid station, circa 1944

In terms of running a huge industrial network, the advantages of a healthy workforce were obvious and quantifiable. Henry J. Kaiser himself noted:

In 1943, the average male industrial worker lost 11.4 days and the average female industrial worker 13.3 days of work due to sickness and injury. By far the greater proportion of this loss – 80 percent in men and 90 percent in women – was believed to be due to common ailments. This means that in the U.S. today there is a loss of more than 600,000 man-days annually. This is 47 times the amount of time lost through strikes and lock-outs of all kinds during 1943.[iii]

Kaiser used the above argument – and his successful experience with running industrial medical care programs – as the basis for a bold proposal for a nationwide pre-paid medical plan as the war waned in 1945. Dr. Paul Cadman, in an addendum to the proposal, laid out the premise:

The Health Insurance Plan follows the general pattern of the Workman’s Compensation Law, a law which has been in effect for over thirty years and has been found to be practical and workable.

Alas, the proposal never went anywhere, but Henry J. Kaiser’s health plan continued to grow bigger and better.


Next: Postwar evolution of Kaiser Permanente’s worker health care

Short link to this story: http://bit.ly/QdEFCz


Special thanks to Dr. Doug Benner, Coordinator of Regional Occupational Medicine Services (1993 to 2011) and Connie Chiulli (Director of Operations, Occupational Health Service Line, Regional Occupational Health, TPMG) for help with this article.

[i] A slightly different percentage is described by Rickey Hendricks in A Model for National Health Care: “Since Garfield was losing money yet providing needed services and model facilities, Hatch proposed that Industrial Indemnity prepay Garfield 17.5 percent of premiums, or $1.50 per worker per month, to treat industrial injuries.”

[ii] “…In 1944, with the [shipbuilding] program in full swing, it was rare to find a yard of five thousand employees or more who could boast of more than 5 per cent of workers with previous experience in shipbuilding.” “Health and Safety in Contract Shipyards During the War,” by Philip Drinker, Ch.E., in Occupational Medicine, April, 1947.

[iii] “Proposal for a Nation-Wide Pre-Paid Medical Plan Based on Experience of the Permanente Foundation Hospitals” Henry J. Kaiser, March 3, 1945.

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Thieves abscond with bronze historical marker at Desert Center

posted on August 8, 2013

By Steve Gilford, Senior Consulting Historian

Southern California physicians to replace plaque dedicated in 1992 to commemorate Sidney Garfield’s Contractors General Hospital

Plaque placed in 1992 commemorating Sidney Garfield MD's desert hospital. Recently, thieves pried the 110-pound marker from the boulder presumably to turn the bronze into cash.

Plaque placed in 1992 commemorating Sidney Garfield MD’s desert hospital. Recently, thieves pried the 110-pound marker from the boulder, probably planning to turn the bronze into cash.

I’ve recently returned from Southern California where I assessed the damage vandals and thieves wreaked to the historical marker near the site of Dr. Sidney Garfield’s 1933-built Contractors General Hospital.

This location is significant because it’s where Kaiser Permanente’s pioneer physician first discovered how prepaid, preventive medicine could make health care more affordable.

The 110-pound bronze plaque, placed at the historical site 21 years ago, has been pried off its base and stolen, presumably for the value of the metal. This is another occurrence of the national trend of thieves dismantling historical markers to turn bronze to cash.

I traveled to the desert not only to evaluate the loss but also to arrange for a replacement plaque. My journey was successful: I found a safe location for a new plaque and an enthusiastic benefactor to pay the bill.

In 100-plus-degree heat that is usual for the area, I surveyed nearby Chiriaco Summit, an active way station for desert travelers, with Margit Chiriaco Rusche, the daughter of founders Joe and Ruth Chiriaco. We found an appropriate site for a new plaque in an island of green vegetation which many visitors pass.

Locating historic hospital site

For me, this mission was personal. Twenty-seven years ago, I uncovered the hospital site where, in 1933, Kaiser Permanente’s founding physician had started his prepaid health plan for workers on the Colorado River Aqueduct Project.

Google Map of the location of the Contractors General Hospital in 1933

Google Map shows the vicinity of where the Contractors General Hospital stood in 1933.

In 1986, Stanley Ragsdale, self-described “desert rat” and owner of Desert Center in Southern California, accompanied me on an expedition to find the long lost site of Garfield’s hospital, six miles west of the little town on Interstate 10.

As we approached the area, we could make out the foundation outlines, which were all that remained of the facility abandoned in the late 1930s.  As someone with experience in archeological digs, I headed for the nearby garbage pit, in which I found medical artifacts that positively identified the site.

With this information and other research, I prepared an application and supporting materials for the site’s designation as a historical landmark. The California State Historical Commission unanimously authorized an official plaque recognizing the importance of the tiny hospital to American medicine.

In a 1986 ceremony, Sally Garfield Blackman, Dr. Garfield’s elder sister, unveiled the bronze plaque attached to a boulder near the spot where the once bustling hospital had stood.

Southern California physicians sponsor replacement plaque

Over the past two decades, the dusty town of Desert Center, with its two-block long main street, has fallen on hard times. The restaurant, gas station, general store, and ice cream stand are all gone. With no one around the abandoned town, the plaque was easy pickings for thieves, and several weeks ago they struck.

Raymond Kay, MD, friend of Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong on the hospital site.

Raymond Kay, MD, friend of Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong on the hospital site.

I mentioned the loss to Paul Bernstein, MD, San Diego area medical director for the Southern California Permanente Medical Group.  Bernstein (Twitter: @sdthinkbig), personally interested in the history of Contractors General, is as chagrined as I am by the marker’s disappearance.

He approached the Southern California Permanente Medical Group, and they have agreed to replace the plaque as part of SCPMG’s 60th anniversary celebration in September. This year also marks the 80th anniversary of the hospital’s founding.

Chiriaco motorist stop fitting site for new historic marker

Joe and Ruth Chiriaco founded their first store the same year that Dr. Garfield opened Contractors General Hospital; they knew the hospital and Dr. Garfield well.

Ruth Chiriaco, a registered nurse, had worked in nearby Indio with Betty Runyen, Dr. Garfield’s first nurse. Having met the Chiriacos in my previous research, I was pretty sure the family would be amenable to putting the new plaque near their business that includes a store, restaurant and gas station.

This fall, Dr. Garfield’s favorite nephew and closest living relative, Dr. Robert Blackman, and Blackman’s two sons will participate in the dedication, as will nurse Betty Runyen’s three children. Betty’s daughter Susan, a nurse with Kaiser Permanente in Hawaii, has just finished a novel based on her mother’s life at Contractors General Hospital. 

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You don’t have to be a gym star to preserve your good health

posted on March 4, 2013
Kaiser Permanente Every Body Walk! campaign graphic: Anatomy of Walking

By Lincoln Cushing, Heritage writer

In January 2011, Kaiser Permanente launched the “Every Body Walk!” public awareness campaign.  Chairman and CEO George Halvorson kicked off the initiative in his weekly celebration letter to all employees and physicians on January 14, 2011:

“It is time to celebrate walking. There are very few things that we can do that have a more positive impact on our health and our lives than walking. . . Kaiser Permanente is on a new path, so to speak, to encourage everyone in America who can safely walk, to walk. The theme is — Every Body Walk!”

Walking a prescription for health

Bob Sallis, MD, family physician at Kaiser Permanente Fontana (Calif.) Medical Center and the national spokesperson for the campaign, described the goals for Every Body Walk:

“The aim of the campaign is to inform Americans about the tremendous health benefits of walking. Walking is an excellent form of exercise for everyone. For those with conditions like diabetes, asthma, heart disease and depression, a regular walking regimen has the added benefit of helping to manage these diseases.

Bob Sallis, MD, Kaiser Permanente’s national walking advocate, talks with U.S. Surgeon General Regina Benjamin MD, during a 2012 national walking movement conference.

“I’m a strong believer in the power of walking and that’s why I literally prescribe it to my patients as front-line medicine — often in place of medications.”

From a public health point of view, the campaign is important because it addresses the many people that don’t get what is commonly thought of as “regular exercise” – going to a gym, playing tennis, or riding a bicycle.

Every Body Walk! encourages a modest amount of activity, thus opening up a new path to healthy behavior for millions of people. The campaign provides news and resources on walking, health information, walking maps, help in finding walking groups, as well as a place to share stories about individual experiences with walking.

 

Research validates value of walking

Medical research shows that walking 30 minutes a day, five days a week, can prevent the onset of chronic diseases, or help manage them. The roots of this prescription can be found in a 1996 report by the U.S. Department of Health and Human Services, Physical activity and health: A report of the Surgeon General.[i]

The research supports the common-sense and empowering notion that some exercise is better than none, and any approach to encourage activity will have positive health benefits:

“Emphasizing the amount rather than the intensity of physical activity offers more options for people to incorporate physical activity into their daily lives. Thus, a moderate amount of activity can be obtained in a 30-minute brisk walk, 30 minutes of lawn mowing or raking leaves, a 15-minute run, or 45 minutes of playing volleyball, and these activities can be varied from day to day . . . Through a modest increase in daily activity, most Americans can improve their health and quality of life.”

Recent studies confirm concept

Subsequent medical research amplified the benefits. A 2002 study by the Centers for Disease Control and Prevention found that patients who ate a healthy diet and engaged in moderate physical activity for 30 minutes a day, five days a week, reduced their risk of getting Type 2 diabetes by 58 percent.[ii]

A 2010 prostate cancer study found: “A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for less than three hours a week may substantially improve prostate cancer-specific survival.”[iii]

Sidney Garfield, MD, Permanente founding physician, walking in Mojave Desert near the site of Contractors General Hospital, 1980

Recent research at Oregon State University’s College of Public Health and Human Sciences suggests the health benefits of small amounts of activity – even one- and two-minute increments that add up to 30 minutes per day – can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.

The study, which involved a broad demographic of more than 6,000 American adults, shows that an active lifestyle approach, as opposed to structured exercise, may be just as effective in improving health, including the prevention of metabolic syndrome, high blood pressure, and high cholesterol. Lead author of the study, Paul Loprinzi, explains:

“We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking.”[iv]

Garfield walks, jogs in desert

At Kaiser Permanente, innovation is usually framed in the context of deep previous experience. In the mid-1930s, founding physician Sidney R. Garfield, MD, was running a clinic in the Mojave Desert for the workers on the Colorado River Aqueduct project. Guess how the clinic staff stayed fit?

“When we were at the hospital (walking) is what the staff did all the time for keeping fit (and for) exercise, except we’d jog – yeah, we would run, but we’d wait until the sun went down, go out and jog and then would walk along. And about that time the rattlesnakes would come out, and then we’d really jog.”[v]

History is repeating itself, and we’re all the better for it.

 

See “Gift of Walking,” a short video featuring Kaiser Permanente Chairman and CEO George Halvorson.

Short URL for this story: http://bit.ly/WHcZbv


[i]U.S. Department of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, 1996. < http://www.cdc.gov/nccdphp/sgr/pdf/execsumm.pdf[ii]CDC Statement on Results of Diabetes Prevention Program
Reducing the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine has published a new article by Knowler WC, Barrett-Connor E, Fowler SE, et al entitled “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med 2002 Feb 7;346(6):393–403.
[iii] “Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study,” American Society of Clinical Oncology, November 9, 2010
[iv]“Association Between Biologic Outcomes and Objectively Measured Physical Activity Accumulated in [greater than or equal to] 10-Minute Bouts and [less than] 10-Minute Bouts,” Paul D. Loprinzi, PhD; Bradley J. Cardinal, PhD. American Journal of Health Promotion, Jan/Feb 2013. http://ajhpcontents.org/doi/pdf/10.4278/ajhp.110916-QUAN-348
 [v] Unedited transcript of Dan Scannell (Kaiser Permanente Audio-Visual Department) interview with Sidney R. Garfield, 2/27/1980. Filmed near the site of the original Contractors General Hospital (1933-1938) at Desert Center, California, between Palm Springs and the Colorado River. TPMG P1357

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Digging into Kaiser Permanente’s history

posted on January 16, 2013

By Steve Gilford, Senior Consulting Historian

Baxter bottle top, found at the site of former Contractors General Hospital. Photo by Steve Gilford, March 2006

Some time ago, I located the archaeological site of founding physician Sidney Garfield’s original Contractors General Hospital. Built by Garfield in 1933 in the Mojave Desert 175 miles east of Los Angeles, the hospital is long gone.

In the facility’s trash pit I came across numerous large broken bottles. Each was embossed with the words “Property of Don L. Baxter – Chicago, Illinois.” The bottles were from Dr. Baxter’s fledgling company, which he had founded in 1931.

A few years later, I managed to track down Garfield’s first nurse, Betty Runyen, who had worked at that hospital 60 years before. When I mentioned all the broken bottles in the trash pit she smiled with delight.

She explained that “back in the day” those bottles had contained the ingredients for Ringer’s solution.This was a very useful medication – a solution containing sodium, potassium and calcium salts in a definite proportion – often given intravenously to surgical patients, trauma victims and to workmen who had collapsed in the desert heat due to severe dehydration.

Innovative syringe remnants found

Luer-Lok patent drawing

In the pit, I also came across a Becton Luer-Lok syringe.  The first product of the Becton-Dickinson Company in 1897 had been an all-glass syringe invented by a French instrument maker named H. Wulfing Luer. It had been a great success, featuring a standardized tapered fitting that guaranteed a leak-free fluid connection between syringe and needle.

Five years later, Fairleigh S. Dickinson made an improvement to the syringe when he added a twist­-lock mechanism that held the hypodermic needle safely in place. It was a simple way to attach and to remove a needle from a syringe, minimizing the danger of the needle slipping off the tip while in use; it also reduced breakage of syringe tips.

The Becton-Dickinson Yale Luer-Lok Glass Syringe, as it was known, was a new development when Garfield opened Contractors General. At the time, it was better than the average syringe and cost more, but it would eventually become standard.

Despite his limited finances, he selected the more expensive, but safer, Luer-Lok. The fact that Garfield chose to spend the extra money for the better medical equipment is a glimpse into his medical priorities.

For more about Steve Gilford’s rediscovery of the Contractors General Hospital, go to the Permanente Journal.

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