Posts Tagged ‘HIV/AIDS’

Kaiser Permanente at the Olympic Games

posted on August 4, 2016

Lincoln Cushing
Heritage writer

 

 

Bob King wins high jump at Olympics, in The Capital Times (Wisconsin) 1928-07-30

Bob King wins high jump at Olympics, in The Capital Times (Wisconsin) 7/30/1928.

This year’s Thrive advertising campaign begins its launch on August 5 during opening ceremonies of the Rio 2016 Olympic Games. Kaiser Permanente first began airing what was then its ground-breaking new campaign during the 2004 Summer Olympics in Athens. Then, as now, it focused on total health, demonstrating Kaiser Permanente’s long-held mission to improve both the health and well being of members—to help people “thrive.”

Kaiser Permanente has also been involved in the Olympics up close and personal, through participation by members, physicians, and employees.

 

Robert King, MD, one of the six original Permanente Medical Group founders, won a gold medal for high jumping at the 1928 Olympics in Amsterdam.

Tom Waddell, MD, (1937-1987) was a decathlete in the 1968 Olympics in Mexico and a physician at San Francisco General Hospital’s emergency department. He founded the 1982 “Gay Olympics” (later named the

“Joe Rios’ 5’4” size didn’t handicap him at the U.S. Olympic trials in New York. “You can always compensate size with skill,” his teacher told him. Joe proved him correct.” KP Reporter, 8/1/1980

“Joe Rios’ 5’4” size didn’t handicap him at the U.S. Olympic trials in New York. “You can always compensate size with skill,” his teacher told him. Joe proved him correct.” KP Reporter, 8/1/1980

Gay Games after a challenge from the United States Olympic Committee). Dr. Waddell was diagnosed with AIDS in 1986, and his struggle to improve the treatment of HIV/AIDS patients at Kaiser Permanente was a continuation of his “never give up” spirit.

An article in the Kaiser Permanente Reporter featured this employee story:

Joe Rios, chief engineer at our Richmond (Calif.) Medical Center, finally realized his dream. “I made the team – the U.S. Olympic Fencing Team.” Although the United States didn’t compete in the 1980 Olympics, trials were conducted for selection of competition teams. Joe competed in two forms of fencing- foil and sabre – and won medals in both. Each event began with 75 participants. Six were finally chosen for the team. Comments Joe, “I fenced in an 11-hour match to win the silver medal in foil and a 15-hour match to win the bronze medal in sabre. It was absolutely the most fantastic experience. Everything seemed to fall into place for me.”

Shirley Craddick, RD, trains to carry the Olympic torch. Planning For Health 11/2/1984.

Shirley Craddick, RD, trains to carry the Olympic torch. Planning For Health 11/2/1984.

The United States had boycotted this Summer Olympic Games in Moscow as a protest of the Soviet invasion of Afghanistan.

In opening the 1984 Olympics in Los Angeles, Shirley Craddick, a Kaiser Permanente registered dietitian, carried the Olympic torch for one kilometer as a representative of the Oregon Dietetic Association. Craddick was active with the Health Service Research Center’s “Freedom From Fat” project.

The Olympic Games and Kaiser Permanente – carrying the flame for fitness and health.

 

Short link to this article: http://k-p.li/2alJM2m

 

 

 

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Blood supply key to world campaign to eradicate HIV/AIDS

posted on November 29, 2012

By Lincoln Cushing
Heritage writer

“They [Red Cross] make it so easy for you to donate blood,” comments Kaiser-Permanente’s Director of Special Marketing Programs, Tom Hussey. Photo from Factors, Pacific Northwest Regional Blood Services newsletter (American Red Cross) June/July 1984

World AIDS Day – set for December 1 every year – was established in 1988 by the World Health Organization to draw attention to the need for international medical and governmental cooperation in addressing this catastrophic disease.  

The WHO adopted one theme for the years 2011 to 2015: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One focus of “Getting to zero” has been a global effort to ensure a safe and ample supply of that renewable potion of life – human blood.

In its 67 years of operation, Kaiser Permanente has been an active partner in the ongoing quest to keep blood available and free of dangerous contaminants.

In 1948, three years after the Permanente Health Plan was opened to the public, the Permanente Hospital in Oakland started its own blood bank. It was the only private hospital in the San Francisco Bay Area to offer such a service to patients. The single requirement was that blood recipients had to arrange to replace the blood. Members could give blood ahead of time to ensure availability when they needed it.

KP gets out of blood bank business

By the mid-1960s, however, 80 percent of the blood used in KP’s Northern California hospitals came from community blood banks, costing $25 a pint. KP offered a Permanente Medical Group Blood Transfusion Insurance Program, which credited the donation of a single pint against unlimited blood needed by that member for two years, or one year if applied to a family.[i]

Graphic used on cover of the Permanente Medical Group Blood Program brochure, October 1967

The math worked out – Permanente Medical Group Executive Director Cecil Cutting, MD, noted: “. . . Participants are a relatively healthy lot of members whose transfusion requirements account for fewer than 3 percent of total Health Plan transfusions, while their contributions are running equivalent to 30 percent of the total blood used.”[ii]

In the past four decades, blood bank operators have been faced with the reality that the use of donated blood – its drawing, storing and administering – poses risks for transmission of disease, such as HIV/AIDS and Hepatitis B and C.  In 1971, blood banks began to test donated blood for Hepatitis B.

Keeping blood supply safe

In 1983, U.S. blood banking groups issued their first warnings about AIDS. This action was taken after researchers learned HIV/AIDS was a blood-borne disease that could be transmitted by blood transfusion, as well as by sexual contact and shared hypodermic needles.

This blood donation illustration appeared in the “AIDS update” published in the KP member publication “Planning for Health” in the Fall 1988 edition.

In 1985, immediately after the U.S. Food and Drug Administration licensed the first test to detect the antibody to HIV, Red Cross Blood Services regions began testing all newly donated blood for HIV. Since then, there have been an estimated 10,000 cases of HIV in the United States resulting from contaminated whole blood administered to patients between 1978 and 1985. (A heat treatment developed in 1985 renders blood plasma safe.)iii

In 1988, the federal Centers for Disease Control notified Kaiser Permanente that community blood banks in KP’s Bay Area service areas had not screened blood donations properly to prevent contamination in the supply.

Kaiser Permanente, not responsible for independent blood bank procedures, contacted Health Plan members who had received blood from local banks between 1978 and 1985. Affected members were told that the risk of transmission of HIV might be higher than the nationwide average due to the blood banks’ improper and inadequate blood screening.

KP encouraged these members to obtain free HIV screening tests. iv The 1985 cutoff date reflected the increased blood screening that virtually eliminated transfusion transmission.

KP has also aggressively reduced other HIV blood transmission risks, such as hospital staff needle sticks, but addressing member risk through contaminated blood was a major first step. The task of addressing the epidemic was huge, but KP took the challenge seriously.

By 2000, a KP Northern California spokesperson could safely affirm: “Our efforts make a difference. Kaiser Permanente is making profound efforts to stop the spread of AIDS.” v

 

Editor’s note: Heritage writer Lincoln Cushing is a regular blood donor and encourages all readers who are medically able to donate as well. This crucial renewable resource depends on volunteer donors. Blood agencies regularly schedule mobile units at large institutions. Please step up when you have the opportunity.



[i] Permanente Medical Group Blood Program brochure, 1967.

[ii]Newsletter from the Desk of the PMG (Permanente Medical Group) Executive Director (Cecil Cutting, MD), October, 1967.

iii “Prevention of AIDS transmission through screening of the blood supply,” Annual Review of Immunology. 1995; 13:201-27. Galel SA, Lifson JD, Engleman EG.

iv “AIDS Update,” Planning for Health, Fall 1988

California Wire, 11/20/2000

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Kaiser Permanente’s early struggle to stand up to AIDS

posted on December 2, 2011

This illustration of a Kaiser Permanente physician with an AIDS patient was originally published with a 1988 article about AIDS and medical ethics in in-house publication, Spectrum.

Lincoln Cushing
Heritage writer

 

How did Kaiser Permanente, one of the nation’s largest not-for-profit health plans, deal with the outbreak of a new and unpredictable disease? Depending on who was talking in the 1980s, that answer ranged from “not nearly well enough” to “better than any other provider.” And both were true.

The epidemic appears

AIDS was first reported in the summer of 1981. The next year, when the Kaiser Permanente San Francisco Medical Center began treating its first patients, diagnosis and treatment protocols were in their infancy. Doctors, nurses, administrators, and other caregivers struggled to know what to do.

Sometimes standard procedures worked fine, other times they were inadequate. One early conflict erupted in 1983 when two nurses at a Santa Clara, Calif., hospital (not a Kaiser Permanente facility) resigned over a dispute regarding caregiver safeguards in that facility’s first AIDS case. “I think most nurses would agree. . . There really isn’t anyone who wants to go in the room,” one nurse said.

However, the president of the Registered Nurses Professional Association concluded that “enough precautions are being taken” per the hospital’s AIDS guidelines. 1

At Kaiser Permanente  San Francisco, Infection Control nurse Barbara Lamberto described Kaiser Permanente’s response:

“We called a department head meeting immediately [and] we talked about our personnel policies and our posture about that kind of situation, and I think in the long run it made a difference because everybody knew [that] this is how we felt. We are a health care organization. We are here to care for patients.” 2

Michael Allerton, Operations and Policy Practice Leader for The Permanente Medical Group, describes the situation as he saw it: “Here was a disease that was invariably fatal, in a horrible way, and nobody knew where it came from, how it was transmitted. . . and in this incredible environment of fear and anxiety, our doctors walked in those rooms. Our nurses walked in those rooms. Our engineers went in to fix TVs. We had people who really rose to the occasion.” 3

The lack of solid data compounded treatment of “the mysterious disease” in unexpected ways. In a 1985 interview, Kaiser Permanente San Francisco RN Grace Rico-Peña explained the challenge in the early years:

“This is very different than any other illness we’ve needed to educate about. We’re trying to dispel myths and rumors. When news media reports stories about AIDS they have a certain bias — they want to make things seem a little more dramatic, a little more exciting, and so they highlight certain parts of the story and get everybody all charged up about it.

“There are a lot of people with crazy ideas about AIDS. I remember one story about a bus driver who didn’t want to take money when he was in the “gay areas,” people who don’t want to wait on people. That’s part of our getting sensitized and taking care of these patients. AIDS patients frequently become social lepers.” 4

She describes how Kaiser Permanente responded with reason and balance:

“Our philosophy in our educational approach, which has been dictated by our top level administration here in Epidemiology, has been to not let ourselves get carried off into emotion, or political controversies, but to educate very solidly along the lines of the information that’s known. We’ve done educational programming always on the facts. [We ask] “What are our patients’ needs, how are we going to meet those needs?”

Tom Waddell, MD, Olympic decathlete, SF physician, AIDS patient, and activist for better medical care for people with AIDS, 1987.

Patients get involved in care

And, as is true with all quality care, part of the solution came from the patients themselves. Tom Waddell, Olympic decathlete and a physician at San Francisco General Hospital’s emergency department, was diagnosed with AIDS in 1986.

Initially publicly critical of the treatment of AIDS patients at Kaiser Permanente  San Francisco, he fought for better care. “I made a lot of noise,” he said. Other patients did so as well. On June 8, 1988, the Kaiser Patient Advocacy Union (with the suitably explosive sounding acronym “K-PAU”) was formed, demanding a voice in a range of issues. This was a life-and-death issue, and emotions flared.

But, as Dr. Waddell later admitted, “Much to Kaiser’s credit they responded.  I think they may now have a model program for treating AIDS patients.” 5 It was clear that motivated, informed patients needed to be part of the solution.

An HIV Support Group Program was established in 1988 at Kaiser Permanente  San Francisco, and the next year a system-wide Kaiser Permanente  HIV Member Advisory Panel was formed. In 1998, Kaiser Permanente hired the top San Francisco HIV specialist, Dr. Stephen Follansbee.

Documentary highlights Kaiser Permanente’s central role

In the year 2000, Critical Condition, an independent three-hour documentary about the politics of managed care, observed this high-stakes match between institution and critics. One segment included footage of AIDS activists picketing Kaiser Permanente, angry that it moved slowly and would not prescribe medication other than standard and approved drugs. 6

Tensions were high and tempers flared, but the strategic choice of Kaiser as a target was revealing:

“We only picketed Kaiser — not because it was the worst but because you knew where Kaiser was.  It’s like the big kid on the block.  If you can bring that kid to his knees, the others are going to get in line also.” 7

Another protestor reflected on the choice: “Do I think those protests were effective?  Absolutely.  I think it slapped Kaiser in the face and I think Kaiser stood up to it and said, ‘Okay.  What can we do here?’ ”

A third activist agreed: “The fact is we still have to acknowledge that Kaiser is the only HMO that I know of that’s ever allowed the members to come in and be part of the process.” 8

The strength of many

The San Francisco Bay Area quickly became one of the national centers confronting the epidemic. By 1989 two cities (San Francisco and Oakland) accounted for 67% of the region’s cases.  But other Kaiser Permanente regions were affected as well and mounted their own responses.

In 1989 Kaiser Permanente Colorado created an AIDS-specific social services program to help patients manage their own care, led by Barry Glass.  Glass’ holistic model proved so effective that it was extended into other areas, including care of the elderly and those with catastrophic illness. Broader health care lessons were being learned.

Some answers were found through the strength of massed medical resources. In 1987 Kaiser Permanente established a multidisciplinary Interregional AIDS Task Force, expanding to an Interregional AIDS Committee the following year.

James Vohs, Kaiser Permanente health plan and hospital president and CEO in the 1980s, reflected on that process: “One of the best interregional committees that we established was in response to the AIDS epidemic. It was an excellent way to educate our other regions on the basis of the experience that we had in Northern California, especially because we had so many AIDS cases.

“Kaiser covered something like 2 percent of the population of the United States when I was there, but we had about 5 percent of the AIDS cases. . . Having the Interregional AIDS Committee was very, very helpful in providing a good knowledge base of what was working, what wasn’t working, and how to organize services. It was extremely successful.” 9

Kaiser Permanente continues to lead

Kaiser Permanente Educational Theater actors rehearse scene from 1989 Bay Area production of “Secrets,” a play about HIV/AIDS.

At the 30-year anniversary of the first diagnosis of the mysterious disease, Kaiser Permanente continues to be a leader in AIDS treatment and research, and in partnering with community-based efforts. Kaiser Permanente Southern California has provided grants totaling over $4 million to nonprofit organizations for a variety of services for people living with HIV and AIDS, including dental care, youth education and screening programs.

The nature of the epidemic has changed, but the work remains, and Kaiser Permanente has demonstrated its commitment to applying the full weight of its health care resources to finding solutions.

Learn more about Kaiser Permanente’s response to the AIDS epidemic at the Center for Total Health.


1 Spokane, Washington Spokesman-Review, June 12, 1983.

2 Transcript from Kaiser Permanente video interview, 3/1985; HIS07-508

3 Kaiser Permanente: 30 Years of HIV/AIDS with Coordinated Care, Compassion, and Courage, video produced by the Kaiser Permanente BSCPR Department winter 2011.
http://www.youtube.com/watch?v=LnXEseA4HwI

4 Transcript from Kaiser Permanente video interview, 3/1985; HIS07-509

5 Article in Spectrum, Summer 1987, p. 7.

Jay Lubbers, from film transcript, available at http://www.hedricksmith.com/site_criticalcondition/index.htm

7 Dave Mahon, from film transcript, ibid.

Mr. Sokolksi, from film transcript, ibid.

James Vohs interview, courtesy of Regional Oral History Office. The Bancroft Library. University of California, Berkeley. Berkeley, Calif., 94720-6000; http://bancroft.berkeley.edu/ROHO
http://content.cdlib.org/view?docId=hb8t1nb3kr&brand=calisphere“Ascending the Ranks of Management, Kaiser Permanente Medical Care Program, 1957-1992,” by Vohs, James A.; Malca Chall, editor,1999 (issued)

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Experts highlight progress in HIV/AIDS research and quality of care

posted on November 30, 2011

By Laura Thomas

Heritage correspondent

Greg Millett, White House advisor, speaks at KP diversity conference in San Francisco.

Kaiser Permanente’s 34th Annual National Diversity Conference, held recently in San Francisco, culminated in the presentation of the HIV/AIDS Diversity Awards, along with White House policy advisor Greg Millett’s battlefront assessment of the 30-year war against the disease in the U.S.

Millett noted the year-by-year drop since the 1990s of new HIV cases and a decrease in the public’s alarm over the disease. He contrasted that success with the continuing problem of delivering adequate care for the poor and minorities in urban areas where the prevalence of HIV is still high.

Bringing care to these victims is crucial, he said, because many studies show that beginning to treat an infected person in the early stages of HIV reduces the risk of transferring it to another by 90 percent or more.

“The road to treatment in the U.S. is fraught with difficulties,” he told the audience. “This is nothing new to any of us.” Millett, who is also a researcher at the Centers for Disease Control, lauded the Kaiser Permanente study published in 2009 that showed the risk of dying from AIDS didn’t differ between ethnic groups when there was equal access to care.

“You don’t see that nationally,” he said. “Kaiser Permanente is doing a very good job of suppressing HIV. This is exactly what we would like to see happen nationally.”

KP’s HIV leader shares Millett’s visions

Michael Horberg, MD

Millett’s words were well-received by Dr. Michael Horberg, Kaiser Permanente’s national director for HIV/AIDS, who announced the Diversity Award winners and was on stage with Millett and Diane Gage-Lofgren, senior vice president for KP Brand Strategy, Communications and Public Relations (BSCPR).

Appointed to Obama’s Presidential Advisory Council on HIV/AIDS (PACHA) in 2010, Horberg hopes to make Kaiser Permanente’s best practices a part of national policy. Practicing at Michael Reese and Northwestern Memorial hospitals in the Chicago area for 10 years before coming to California, he has spent most of his medical career in the fight against the disease.

He is one of those lucky people whose life both on and off the job is fueled by a strong sense of purpose. In the early 1980s, as the first patients infected by the HIV virus were being treated at Boston City Hospital where he was in his third year of medical school, he already knew he was gay, but it was still a little too early for him to declare himself.

“It was the fear of rejection, the fear of being ostracized, even in the medical community, of not being able to attract any patients,” he recalled.

AIDS outbreak spurs Horberg to action

Ironically, the onset of the AIDS crisis is what finally helped to liberate him. As patients with HIV symptoms, including some of his close friends, began coming to him in private practice, he realized stepping out of the closet would help them get the care they needed and allow him to be a more powerful advocate for specialized care.

The timing was good.

“There was no hiding any more. I was true to the world and it was true to me,” he wrote in California Medicine in 1997. “And it paid off in a number of ways. For one thing, because I was a gay doctor with a large gay and lesbian patient population, Northwestern Community Medical Group (affiliated with Northwestern Memorial Hospital) invited me to merge my practice with theirs.  And because I had a high patient satisfaction rating, managed care companies came courting as well.”

KP's Michael Horberg (fifth from right in front row) serves on Obama’s Presidential Advisory Council on HIV/AIDS (PACHA).

Dr. Horberg began specializing in HIV care in Chicago where he grew up. Early on, he knew he wanted to be a doctor. Both the science and the humanism involved appealed to him, and both values were part of his family heritage. His uncle was a physician and a great-aunt had attended medical school and practiced in the 19th century in Estonia and the Ukraine.

Being able to help his gay and lesbian brothers and sisters has fulfilled that early desire to meld technical skill with compassion. Especially early in the crisis “when there was a limit for what we could do for patients, really caring, really showing love was critical,” he said.

Research key to improving care

Both the science and the compassion have continued to motivate Dr. Horberg in his work: He was an early proponent of experimental drug trials and has devoted much of his research to improving the delivery of care as well as exploring the source of the disease.

Horberg was recruited by Kaiser Permanente for his work with HIV and was happy to leave the muggy hot summers of Chicago in 1996 for the Bay Area’s temperate climate. He worked briefly at South San Francisco before taking charge of the HIV/AIDS program at KP Santa Clara where he handled patients, began his work as a scientist in Kaiser Permanente’s Division of Research while studying for a master’s degree in research (MAS) at the University of California at San Francisco.

He has since worked on numerous studies using data from the records of 50,000 HIV patients who have been treated by Kaiser Permanente since 1981. His studies have focused on many aspects of caring for HIV patients, from the management of antiretroviral drug therapy and allied infections to issues of ensuring quality of care and equal access to care.

Dr. Horberg collaborated on the study that sought to determine whether equal access to care would result in a similar outcome for HIV patients of different races. The study – lauded by Millett in his remarks to the Diversity Conference – was the first to break out statistics for Hispanics and it found no disparity in the clinical outcomes between white, black and Hispanic KP patients, with Hispanics having a slightly lower mortality rate.

Leading the charge for best HIV/AIDS care

During his years in California, he was a tireless advocate for HIV patients in his roles as physician, researcher and leader of initiatives to improve and standardize care. Horberg chaired the central research committee for the Northern California region, and led the HIV Interregional Initiative.

Last year, working with the National Committee on Quality Assurance (NCQA) and other interested groups, the HIV Initiative developed 17 measures for quality HIV care – including patient retention, screening and prevention for infections, immunization, and initiation and monitoring of antiretroviral therapy – that are intended for nationwide implementation.

“We really have done a very good job,” he says of Kaiser Permanente.  “We can do better. We are not going to rest on our laurels. We know where there is room for improvement. . . We are willing to analyze our care. We are the first managed care organization to develop a set of care metrics. And from that we asked our other research questions that have led to policy changes. We have really compassionate care. We give a damn.”

Early this year, Dr. Horberg moved to Maryland to become executive director of research for the Mid-Atlantic States Permanente Medical Group. Dr. Horberg had to let go of seeing patients when he made his move to the east and that was hard to give up, but leading research, his other love, is also about people, he says. “The science we do at KP is the science of caring for patients and how to do that in the most effective way is really what we study.”

Fortunately, he left with his true love, husband Chip Brian Horberg, whom he married in 2008 while gay marriage was legal in California. The couple, whose birthdays are July 10 (Chip) and July 12 (Michael), were married July 11 under a traditional Jewish huppah on the rooftop of their condominium in San Francisco, surrounded by family and friends, including a large contingent of Kaiser Permanente colleagues.

This is the first of two articles about Kaiser Permanente’s response to the HIV/AIDS crisis. There’s more about KP’s history of taking care of HIV/AIDS patients at the Center for Total Health.

Next time: Kaiser Permanente’s early struggle to stand up to AIDS.

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