Posts Tagged ‘ILWU’

Kaiser Permanente’s History of Nondiscrimination

posted on July 24, 2015

Lincoln Cushing
Heritage writer

Final essay in a series on Kaiser Permanente’s 70th anniversary

Lobby at Richmond Field Hospital, circa 1943

Lobby at Richmond Field Hospital, circa 1943

One of Kaiser Permanente’s key features is that it is an “Integrated health care system” – meaning it seamlessly provides care and coverage together and provides a wide range of services under one roof, whether in a Kaiser Permanente medical office or hospi­tal or at a contracted facility. But in 1945 “integrated” also held another important meaning when the health plan was opened to the public – it reflected a deep commitment to being one of the first health care providers in the United States to have racially integrated hospitals and waiting rooms, as well as an ethnically diverse workforce, including physicians and allied health professionals.

During World War II, compliance with federal law (such as the Fair Employment Practice Committee) as well as decent best practices meant that employees were treated without institutional discrimination. An estimated 20,000 African Americans, along with many Chinese Americans, Native Americans, and Hispanic Americans, worked in the Kaiser shipyards. Kaiser Industries took great pride in this ethnic and racial diversity, featuring stories in the shipyard newsletters. A caption for a photo of an elegantly attired African-American female shipyard worker launching the Liberty ship S. Hall Young boasted: “How’s this, Adolf? It’s Richmond’s answer to your efforts to split America into warring racial groups.”

Industrial health care covered all workers, and the affordable supplemental health plan that Sidney Garfield, M.D. created for workers and their families in the Kaiser shipyards were equally open. In a time when the Civil Rights movement was just coalescing, racism in America was pervasive. Access to health care was no exception, yet the Permanente Foundation Hospitals took the high road.

Journalist Nick Bourne wrote about the Permanente Health Plan in the San Francisco News on October 7, 1943. He noted:

Illness knows no color line here. Red-helmeted men, women welders, Negroes lined up for a checkup by the busy young doctors. In one double room was Miss Katherine Rossi, shipyard loan office employee, here from Duluth, Minn., for six months; ill six months from skin trouble. A Negro woman was in the adjoining bed. “So help me!” declared Miss Rossi. “I’ve been in hospitals before, but never one like this. It’s sure swell. I don’t know what I would have done.”

The International Longshore and Warehouse Union newspaper The Dispatcher favorably remarked in 1945:

“The hospital’s facilities are open to all groups with no segregation of patients because of creed or color.”

Nurse attending shipyard worker, Oakland hospital, circa 1943

Nurse attending shipyard worker, Oakland hospital, circa 1943

In 1946, the year after the Health Plan was opened to the public, several local policemen visited the Oakland hospital with an eye to join. Permanente medical economist Avram Yedidia recalled the event:

“. . . The police chief said to me, ‘You know, when we walked through, I saw that you had some Negroes and whites in the same room. I don’t think we like that.’ “As I can recall, I responded, ‘Do you know this plan started that way, with blacks and whites in the shipyards, and that’s the way it goes. They worked together, and they were sick together.’ ” I told the police chief: ‘Those who don’t like it shouldn’t join the plan.’ ”

Diversity and inclusion continues to be a guiding principle at Kaiser Permanente. In 2013 Diversity Inc. magazine ranked Kaiser Permanente third in their “Top 50” national corporations, noting a workforce that at all levels reflects high percentages of women, Blacks, Latinos and Asians and has a diverse board of directors. This year Kaiser Permanente moved up to #2. Ronald Copeland, MD, Kaiser Permanente’s chief diversity and inclusion officer, recently affirmed the organization’s progress and challenge:

We must robustly, and in a systematic way, embrace multiculturalism and differences of our workforce and our member population to make sure that everybody’s meaningful needs are met in a personalized way…That is a journey we have been on for nearly 70 years and much progress has been made, but we still have a ways to go in order to become truly inclusive.

It’s about understanding and owning your own talents and vulnerabilities, and being comfortable and humble enough to share with and learn from others. It is about seeing and respecting the value in other people who are different than you and expecting them to do the same in return.

Over the past 70 years Kaiser Permanente’s commitment to nondiscrimination has moved well beyond race and ethnicity, to include gender, generation, sexual orientation, physical, and cognitive abilities in the pursuit of equality without exception. And, as a testament to the acceptance and support for such practices, 10 million people have chosen to “join the plan.”

Happy 70th anniversary, Kaiser Permanente.

 

Short link to this story: http://k-p.li/1MpkWJE

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Kaiser Permanente’s Early Support from Labor

posted on July 21, 2015

Lincoln Cushing
Heritage writer

 

Second in a series on Kaiser Permanente’s 70th anniversary

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Nurses Guild Local 699 (CIO), signing first Permanente Foundation hospital nurses contract. Labor Herald, August 23, 1946.

From providing health care to workers and their families at Grand Coulee Dam to the massive medical program in the World War II shipyards, Henry J. Kaiser believed that cooperating with labor was more productive than fighting it. This institutional philosophy had profound positive implications on the nascent public postwar health plan. As the war was drawing to a victorious close – Victory in Europe had been announced on May 8, 1945 – Henry J. Kaiser’s health plan began to prepare for a peacetime economy by expanding beyond its own employees. The plan would be opened to the public by late July.

Given Henry J. Kaiser’s support for labor, it was not surprising that labor unions would be among the early member groups. Bay Area workers – Oakland city employees, union typographers, street car drivers and carpenters – embraced the Permanente Health Plan and its emphasis on preventive medicine.

On June 7, 1945, the Stewards and Executive Council of the International Longshoremen and Warehousemen Union’s Oakland unit voted unanimously to make coverage in Permanente a part of its future negotiations with employers. The executive council also requested that employers pay for the plan’s premiums.

Founding physician Sidney Garfield, MD., reflected on that support:

So [the postwar health plan] gathered momentum… [In 1949] the longshoremens’ union came to us and said, “We would like you to take over all our members.” They had about thirty thousand here and the [San Francisco] Bay area. They said, “We won’t give them to you unless you do it up in Portland, Seattle, Los Angeles and San Diego. We want to give you the whole thing.”

Then Joe DeSilva of the Retail Clerks’ union called up and wanted to see me. He came up here and said, “I want you to set up a health plan for our workers in Los Angeles.” I guess he had about thirty thousand workers plus families of I don’t know how many. I told him that we would need facilities because we couldn’t depend on using other hospitals because some day they would boycott us probably. So he said, “I’ll pay you several months dues in advance if that will help you build a hospital.”[i]

Years later, Kaiser Permanente CEO David Lawrence would express that relationship succinctly:

“If not for organized labor’s active marketing support immediately following World War II, it is unlikely that Kaiser Permanente would exist today.”[ii]

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Permanente physician examines longshoreman in San Francisco, 1951.

But labor did not just mean health plan members, labor employees were also a key part of delivering health care. A year after opening up to the public, the Permanente Health Plan signed its first nurses contract – which also was likely the first such labor agreement in California.

On July 26, 1946 the Nurses Guild Local 699, affiliated with the Congress of Industrial Organizations, announced that they approved a contract covering wages and working conditions with Permanente Hospital of Oakland and Richmond (as well as medical staff at Kaiser Steel in Fontana). Lora Lee Swan, nurse consultant for the Guild, declared:

This is the first Alameda county hospital in which nurses have been allowed their democratic rights to a free election in choosing their bargaining agent. The precedent set here is truly a great victory for working nurses everywhere. [iii]

In 1997, after years of labor turmoil within Kaiser Permanente and competitive pressures within the health care industry, Kaiser Permanente and the Coalition of Kaiser Permanente Unions formed their groundbreaking Labor Management Partnership. Today, the partnership covers more than 100,000 union-represented employees in 28 local unions as well as 14,000 managers and 17,000 physicians in California, Washington, Oregon, Colorado, Georgia, Hawaii, Virginia, Maryland and Washington, D.C.

 

 

[i] “Sidney R. Garfield in First Person: An Oral History,” interview by Lewis E. Weeks, 8/22/1984.

[ii] KP CEO David Lawrence, “Tentative national partnership announced between AFL-CIO and Kaiser Permanente,” Newswire (KPNW) May 2, 1997

[iii] “CIO nurses approve pact at Permanente,” People’s World, August, 1946

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

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Dr. Eugene Hickman – First black Kaiser Permanente physician in Northern California

posted on April 27, 2015

Lincoln Cushing
Heritage writer

Who was Kaiser Permanente’s first black physician? Given our enduring commitment to member and care provider diversity, such a question is important. Medical practice after World War II was still overwhelmingly white. It was also private – physicians hung up a shingle and arranged for privileges with local hospitals. Group practices, as run by the Permanente Foundation Health Plan, were rare. Once each group grew beyond the original medical partners, new physicians were hired to be part of a team. Physicians hired physicians.

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Dr. Hickman conducting training session at KP Oakland Medical Center, circa 1970, photo courtesy John Hickman

In 1954, the racially diverse International Longshore and Warehouse Union (more commonly known by its initials, ILWU) expressed a desire for the Southern California Permanente Medical Group to hire black physicians. Although the physician leaders didn’t like being told whom to hire, they wanted to serve the medical needs of their large union membership. They hired radiologist Raleigh C. Bledsoe, MD (1919-1996), who had already achieved a distinguished career in the U.S. Army while completing his medical education and training. Even within the relatively progressive setting of the SCPMG, Bledsoe’s acceptance as a partner was controversial. But he was brought in, and stayed more than 30 years. In 1965 he transferred to the newly opened West Los Angeles Medical Center and served as chief of Radiology until his retirement in 1986, becoming the longest serving chief in Kaiser Permanente’s history at the time.

Five years later, in 1959, the Northern California Permanente Medical Group would hire its first black physician, Dr. Eugene Hickman.

Eugene A. Hickman was born in 1921 in Alton, Ill. He served as a trumpeter in the U.S. Navy band stationed in Hampton Institute, Virginia, and graduated from Nashville’s Meharry Medical School (the second oldest medical school for African Americans in the nation) in 1949, specializing in radiology. Looking for opportunity, he moved west to California. There he practiced in Los Angeles, first briefly in a traditional partnership, then with the Los Angeles City Health Department, Mt. Sinai Clinic (now Cedars-Sinai Medical Center), and the Veterans Administration hospital.

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Dr. Hickman at Mt. Sinai Clinic in Los Angeles, circa 1955; photo courtesy John Hickman

Dr. Hickman wrote an unpublished memoir of his life that describes his experience of choosing to move to Northern California and work for the Kaiser Permanente Hospital in Oakland:

I was hired by Dr. James Davis at the Veterans’ Hospital on Sawtelle, near UCLA. I became the chief of Radiology at the branch for the mentally impaired. This hospital had an excellent staff. Again I was treated with cordiality and respect. Seldom was the work really interesting, so I spent a lot of time reading.

It occurred to me that I would lose the skills I had acquired and that this would be a dead end. My wife Eunice encouraged me to move on and asked me if I didn’t think I was worth more than I was being paid. I had a major problem. Hospital radiology departments were, and still are, staffed by a group of radiologists, invariably white. It would not have been a good decision, from a financial point of view, for them to hire me.

I found a copy of the annual Journal of the American Medical Association in which was listed medical facilities throughout the U.S. and names of persons to contact when searching for employment. So again I wrote a few letters.

One was to Dr. Irving Lomhoff, who was then the chief radiologist at Kaiser Hospital, Oakland, Calif. I had seen a Life magazine article about the showcase Kaiser Hospital, Walnut Creek, Calif. Otherwise I knew absolutely nothing about the Kaiser Permanente system. Dr. Lomhoff responded to my inquiry and suggested I come to Oakland for an interview. I was still living in Los Angeles. I had received so many rejections, I found it difficult to take Lomhoff’s invitation seriously. Eunice very strongly suggested I forget the past and go for it. I needed that push.

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[l to r] Dr. Hickman; Dr. Irving Lomhoff and his wife; Eunice Hickman, relaxing at Lake Tahoe circa 1960; photo courtesy John Hickman

I arrived [by train] in Oakland on a Monday morning, midsummer 1959 at about 8:00 a.m… [and] called Dr. Lomhoff. Of course he told me to take a bus up Broadway and get off at MacArthur. I did just that, then started walking because I didn’t see anything resembling the hospital I had envisioned. I entered the MacArthur- Broadway Bldg. and called Lomhoff again. He told me he was a big stout red haired Jew and would stand on the front porch to greet me on my arrival.

Well, he was across the street and came out and stood on the porch of a building that I had not recognized as a hospital. In fact, I believe if I had seen a picture of this hospital beforehand, I probably would not have made the trip. Lomhoff greeted me very cordially and took me for coffee and pastry. Then we went to his office for a fairly long interview.

At that time there was not, nor had there been, a black physician on the hospital staff, but this was not to be a factor in the interview or its outcome. He gave me a tour of the facility and introduced me to many of the staff members. He warned me that I would probably encounter difficulty finding a place to live. How correct he was…

 

Dr. Eugene Hickman, TPMG directory of physicians, 1980

Dr. Eugene Hickman, TPMG directory of physicians, 1980

Dr. Hickman’s reception by fellow Kaiser Permanente physicians was not without struggle. He described experiencing hostility and condescension from some doctors, and even ugly rumors that members might leave the plan due to his hiring. But Dr. Lomhoff stood by him and things settled down. Dr. Hickman had a long career at Kaiser Permanente, becoming president of the hospital staff and later chief of the department of radiology. He ended his 30-year tenure  in 1989.

 

Dr. Hickman also experienced discrimination of a different type, one entirely unrelated to his skin color:

Before I started working at Kaiser Permanente, I didn’t know anything about the organization, nor about the attitude of the local medical society vis-a-vis Kaiser, but I soon found out. I had been a member of the L.A. County Medical Association for several years. I wanted to transfer my membership to the Alameda Contra Costa Medical Association. I was informed that I would have to be interviewed by one or several members of the ACCMA. At the interview at an office on “Pill Hill” I was strongly advised against affiliating with Kaiser. I was assured Kaiser Permanente was a front for socialized medicine, if not in fact a communist cabal. ACCMA was not accepting physicians allied with the Kaiser organization. I was not enlightened as to the basis for this charge.

Because of the history of racial discrimination/segregation in this country there were also medical associations for black doctors, the one in Oakland named Sinkler-Miller in honor of two outstanding black physicians. [The Sinkler Miller Medical Association was formed in 1969 by physicians located in Alameda and Contra Costa Counties] This group accepted me for membership, but insisted on characterizing me as some sort of traitor to the black physician community. I didn’t let that be a problem for me.

Years later, ACCMA changed its policy and in fact had a member of Kaiser-Permanente as president. There were members of ACCMA who were not in accord with the Association policy regarding Kaiser and with whom we had good relationships, educationally and socially.

 

Dr. Hickman passed away in 2013 after a short illness, survived by his wife of 64 years and two sons. We honor his courage and persistence in helping Kaiser Permanente provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.

 

Thanks to those who helped with this story, including retired Kaiser Permanente physicians who remembered Dr. Hickman. A special thanks to Dr. Hickman’s son John, for generously sharing his father’s legacy.

 

Short link to this story: http://k-p.li/1QC88RD

 

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The Roots of Southern California Kaiser Permanente

posted on October 7, 2013
Cover of Southern California Planning for Health featuring Los Angeles hospital - Fall 1957
Cover of Southern California Planning for Health featuring expansion of operating room facilities at the new Los Angeles hospital – Fall 1957

By Lincoln Cushing, Heritage writer

The Kaiser Foundation Health Plan’s first beachhead in Southern California was a modest hospital for workers at the Fontana Steel Mill.

The plant was built by Henry J. Kaiser in 1942 as the first West Coast source of the rolled steel plates needed to build Liberty and Victory ships for World War II.

After the war the Health Plan in Fontana went public, and with the strong support of labor unions like the Retail Clerks International Union and the International Longshoremen and Warehousemen Union it began to grow throughout the region.

The first facility outside of Fontana was established in Harbor City in 1950 when the entire West Coast ILWU signed up for the plan.

The next year the Retail Clerks International Union signed on and facilities were founded in Los Angeles, at an inauspicious clinic on La Cienega Boulevard; the state-of-the-art Permanente Foundation Hospital on Sunset Boulevard would not be built until 1953.

On January 1 of that year 13 physicians signed the Southern California Permanente Medical Group’s first Partnership Agreement with  Raymond Kay, MD, as Medical Director.

Special thanks to Cathy Romero, Communications Production Specialist, Pasadena, for providing the Heritage Resources archive with scans of the Southern California Planning for Health newsletters.

Short link to this story: http://ow.ly/pADVN

Article in Southern California Planning for Health on Retail Clerks Union group members, Winter 1952-1953
Article in Southern California Planning for Health on Retail Clerks Union group members, Winter 1952-1953

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Labor unions offer early support for nascent Permanente Health Plan

posted on July 16, 2013
"Kaiser launches 747th - and last- wartime ship," article in the Oakland Tribune, August 13, 1945. Expanding the shipyard workers' health care plan to the public would be the birth of the Kaiser Permanente program.
“Kaiser launches 747th – and last- wartime ship,” article in the Oakland Tribune, August 13, 1945. Expanding the shipyard workers’ health care plan to the public sparked the birth of the Kaiser Permanente program.

by Lincoln Cushing, Heritage writer

As World War II neared an end, the Permanente Health Plan was looking at a dramatic shift in its member base. Wartime shipyard closures loomed, and the future of the plan during peacetime would hinge on attracting new members in the community.

Given Henry J. Kaiser’s support for labor, it was not surprising that labor unions were among the early member groups. Bay Area workers – Oakland city employees, union typographers, street car drivers and carpenters – embraced the Permanente Health Plan and its emphasis on preventive medicine.

One of the first and largest unions to endorse the plan was The International Longshoremen and Warehousemen Union.

On June 7, 1945, the Stewards and Executive Council of the ILWU’s Oakland unit voted unanimously to make coverage in the health insurance plan of the Permanente Foundation a part of its future negotiations with employers.  The executive council also requested that employers pay for the plan’s premiums.

We want our Permanente!

An article in the ILWU’s The Dispatcher explained:

“. . . Permanente operates on three principles: prepayment . . . group practice of medicine (the hospital has 84 doctors on its staff, many of them specialists . . . and adequate facilities.)”

Related to adequate facilities, the article noted that a group practice health plan like Permanente could afford the latest medical equipment, which individual, fee-for-service physicians did not have.

Preventive care takes center stage

“The most important provision of the plan . . . is that the first two visits to the hospital are included in the insurance.”

“A spokesman for (Permanente) explained that the hospital was interested in really affording the worker medical security. If the patient had to pay for the first two visits, he would be deterred from using the plan until an ailment became necessarily serious.”

“The hospital’s facilities are open to all groups with no segregation of patients because of creed or color,” the article reported.

Within five years, by 1950, ILWU president Harry Bridges had brought all 6,000 union members working up and down the West Coast into the Permanente Health Plan.

The union’s agreement with Permanente leader Sidney Garfield, MD, included opening a medical facility in San Pedro near Long Beach. Up to that point, the health plan had only one Southern California hospital, which provided care for the workers at the Kaiser Steel Plant in Fontana.

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Healthy lifestyles: tough to achieve, worth the effort

posted on May 31, 2013

By Ginny McPartland, Heritage writer

Kaiser Permanente’s Northwest Region initiated its Freedom from Fat program in 1989. Exercise was an integral part of the healthy living program. This photo of Donna Dean, a Health Plan member, William Cooper, associate regional manager of the Northwest Region, and Chris Overton, health education staff member, appeared on the cover of the Spring 1989 Spectrum, a magazine for Kaiser Permanente employees.

Kaiser Permanente founding physician Sidney Garfield caught on early that changing people’s habits would have positive results for their health. Urging his patients to avoid accidents by following safety guidelines and eating right to avoid health problems was a no-brainer for Garfield. Everyone would be happier and healthier, and the need for costly medical care could be minimized.

Voila! Prepaid care with an emphasis on prevention. Garfield adopted this theme in 1933, and Kaiser Permanente leaders have held this as a predominant tenet ever since.

Garfield’s interest in nutrition and exercise programs for shipyard workers in the 1940s, multiphasic examinations (annual physicals) in the 1950s, data processing of patient records in the 1960s, health education centers in the 1970s and the Total Health Project in the 1980s all fed into the push to promote healthy lifestyles and prevent illness.

Newsletters in the World War II Kaiser shipyards constantly reminded workers to eat three square meals a day and avoid too much fat and sugar. “Are you starving?” one article asked. “You can be starved without being hungry. . . Are you aware: 24 million man-hours per month (nationally) are lost through minor illnesses preventable by better nutrition?”

‘Are You Starving’ article in the Oct. 6, 1944, issue of the Kaiser Richmond Shipyard newsletter Fore ‘N Aft. The message: Eat healthy food and stay fit.

The Kaiser child care centers served healthy meals, and parents could buy nutritious family dinners to take home when they collected their offspring at the end of the day. Shipyard management sponsored intramural sports teams to help workers blow off steam and stay fit.

Screening workers for unhealthy habits

In 1950 Dr. Garfield responded to labor leader Harry Bridges’ request for a preventive care screening program for the members of his longshoremen’s and warehousemen’s union. The examinations, union-mandated for all workers, highlighted lifestyle problems and educated the men on how to avoid heart disease and other chronic illness.

In the 1960s, the first computer technology recorded the examination results so physicians could track their patients’ progress electronically and identify trends that could aid in the care and treatment of other patients, even in subsequent decades.

The 1970s saw the debut of the health education centers in which patients could seek disease prevention information and partake in groundbreaking programs to help them maintain healthy lifestyles and a healthy weight. (This was the beginning of Kaiser Permanente’s Healthy Living centers that offer a myriad of programs designed to preserve good physical and mental health and help patients manage chronic conditions.)

Health appraisal gains momentum

Health appraisal programs were established in a number of Kaiser Permanente locations, and healthy members were encouraged to visit the clinic when they were well, not just when illness struck. They filled out questionnaires and discussed their health status with practitioners who tracked their lifestyles and gave advice on staying well.

The transparent woman was a prominent exhibit in the first Oakland Health Education Center. Instructors could light up various parts of the body and describe the functions for visitors to the center. This photo appeared on the cover of the Kaiser Permanente’s 1967 annual report.

In the 1980s, Dr. Garfield conducted the Total Health research project in which he expanded the health assessment theme and had new well members diverted to a Total Health Center in which the emphasis was on promoting healthy lifestyles.

In the 1990s, Kaiser Permanente researchers participated in studies to test the success of a dietary regimen meant to reduce blood pressure and help prevent heart attacks and strokes. The Dietary Approaches to Stop Hypertension approach called for a healthy diet rich in fruits, vegetables, whole grains, low-fat dairy, fish, poultry and nuts.

The participants who followed DASH experienced a significant reduction in 24-hour blood pressure. The others, who continued to eat red meat, sweets and sugary soda, saw no improvement in blood pressure. Following the study, the DASH approach became the basis of Kaiser Permanente’s teaching about the prevention of hypertension and related conditions.

Also in the 1990s, Kaiser Permanente physician Vincent Felitti discovered while running a health appraisal clinic in the San Diego area that some patients needed help overcoming childhood trauma before they could change unhealthy behavior. Felitti conducted the Adverse Childhood Experience study and urged the consideration of psychological as well as physical issues in assessing a patient’s ability to adopt a healthy lifestyle.

Thriving in the 21st century

Kaiser Permanente offers a wide variety of healthy living classes at its facilities in all regions. Here, students enjoy an exercise class in Oakland, Calif.

In 2004 Kaiser Permanente launched its Thrive advertising campaign, which spotlighted the health plan’s continuing emphasis on healthy living to help patients stay well. In the 20-Teens, the organization gave birth to other behavior change modalities, including online healthy lifestyle programs, Healthy Eating and Active Living community programs and free classes open to the public.

In 2012, Kaiser Permanente launched “Every Body Walk!” a campaign to get literally everyone up on their feet to take the first small steps that can lead to success in achieving a healthy lifestyle.

Today, patients who choose to alter their habits to achieve better health can get help in Kaiser Permanente’s Healthy Living classes, by enrolling in online Healthy Lifestyle programs, and by accessing the bonanza of health information on kaiserpermanente.org.

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Kaiser Permanente’s long history of “culturally competent care”

posted on August 28, 2012

Kaiser Permanente Heritage Resources has started a regular column in the labor-management partnership publication Hank about the rich labor history of the organization.

The Summer 2012 issue includes a story about how Bay Area longshore workers participated in a groundbreaking medical program—the Multiphasic Screening Examination, the first comprehensive health assessment conducted in cooperation with a union, way back in 1951. One aspect of this relationship was understanding that good medical care requires knowing about a patient’s living and working conditions. Even after a remarkable record of offering health care for workers in the shipyards during World War II, further physician education was called for.

Recognizing traditional medical services were not well attuned to the health needs of working people, the ILWU newsletter The Dispatch noted “Local 10 is going to put five Permanente doctors through a course of indoctrination on the waterfront, so that they will learn first-hand the conditions under which longshoremen work and will be better able to interpret the tests.”

Read the whole story at http://www.lmpartnership.org/stories-videos/longshore-start-total-health

short permanent URL for this item – bit.ly/RVK5RY

 

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Permanente embraces its partnership with labor

posted on December 31, 2010

By Laura Thomas

Henry J. Kaiser and Sidney R. Garfield, MD, survey the site for the Walnut Creek Medical Center, completed in 1953

Throughout its history, Kaiser Permanente has relied on the “can-do spirit” of its dedicated workers and on the support of organized labor to keep the prepaid health plan strong.

Coming out of World War II, the medical plan had proven its viability in caring for a large shipyard workforce, but with the end of shipbuilding contracts, Henry Kaiser and Permanente founder and medical director Dr. Sidney Garfield had a big problem. Where were the large numbers of new members going to come from?

Kaiser, a friend of labor, attracted workers’ unions whose leaders understood the power of prepaid health care and wanted it for the welfare of their workers. Bay Area workers – from Oakland city employees, who were the first to sign up, to union typographers, street car drivers and carpenters – embraced the Permanente Health Plan with its emphasis on preventive medicine.

In 1950, Harry Bridges brought the 6,000-member International Longshoremen and Warehousemen Union (ILWU) into Kaiser Permanente, bringing the total West Coast membership, including Los Angeles, to almost 160,000.  In 1951, the Retail Clerks union added 30,000 to the membership rolls in Los Angeles.

Opposition tries to squelch KP

Despite this success, Kaiser and Garfield often faced rear guard actions from private practice doctors who felt threatened by group practice medicine. In 1953 when KP opened a new hospital in Walnut Creek and sought the health plan contract with workers in the U.S. Steel plant in Pittsburg, California, all hell broke loose in that small town along the Carquinez Strait.

A family visits the new KP Walnut Creek facility completed in 1953

Before Kaiser Permanente came along, the steelworkers union had both a national hospitalization plan and a local supplementary health plan with local private practice doctors. The workers were not satisfied with the current health plan and were complaining that providers charged too much and were lackadaisical about responding to emergencies and requests for house calls.

For their part, the Pittsburg area doctors argued that inflation required rates to rise and disputed the idea that service to members was lax.

Kaiser Permanente already provided care to steelworkers at the South San Francisco Bethlehem Steel plant and was prepared to expand services to the Pittsburg area. The beginning of KP’s negotiations with the Steelworkers Local 1440 in Pittsburg raised the hackles of the 41 private practice doctors already established in the area.

These doctors, all members of the East Contra Costa branch of the Alameda-Contra Costa Medical Association, quickly devised a new and better plan to offer the union, including 24-hour emergency service and a cap on fees.

Offer steelworkers couldn’t refuse

Joseph Garbarino, in his 1960 study of the Pittsburg conflict for the University of California, reported that the union bargainers welcomed Kaiser Permanente because of its offer to provide comprehensive care for a specific price for a specified period of time. This arrangement was attractive to the local union whose leadership had never before been able to negotiate such a favorable deal with their private practice providers.

The first Pittsburg clinic was in an old motel

The Pittsburg area doctors were furious and immediately mounted a campaign to discredit the Kaiser Permanente agreement.  The doctors appealed to the steelworkers to reject the decision of their insurance committee and place the KP plan and the private doctors’ revised offer side by side for a vote of the full membership.

Fred Pellegrin, a Kaiser Permanente physician in the new Walnut Creek facility, remembers a rally where the local doctors “begged us not to go to Pittsburg … People stood up, yelling at us, called us Communists. It was a real shouting match.”

Using full-page newspaper ads, handbills and direct mail, the fee-for-service doctors bombarded the community with arguments supporting their plan and implied that the national Steelworker union officials were investigating the local’s decision.

The union answered the doctors’ charges in its newsletter and then agreed to a Sept. 3 (1953) election. Both sides agreed to a break in hostilities for the month of August. The agreement called for the doctors to stop their campaign and for the union leaders to remain neutral on the election.

The truce ended just days before the election when the union distributed voting packets with both health plan proposals, and included a leaflet encouraging members to favor the Kaiser Permanente plan. Enraged private practice doctors took to the battlements again, issuing a more detailed plan explanation and blasting the union in a full-page newspaper ad.

The doctors hired a truck with a loud speaker that cruised through workers’ neighborhoods broadcasting their opposition to Kaiser Permanente. They enlisted supporters, including Pittsburg doctors’ wives, to distribute literature in the steel company parking lot. Plan B was to drop leaflets from the air if solicitors were barred from the plant. According to news reports, tensions rose and the sheriff’s department was called, but no clashes occurred.

Victory of KP health plan

The Pittsburg medical establishment’s effort failed as steelworkers voted 2,182 to 440 to retain the Kaiser Permanente plan. For KP, this was a victory, but more struggles related to organized labor were yet to come.

Financial troubles in the 1980s and 1990s resulted in labor issues that threatened to stunt the health plan’s progress. Happily, those years of turmoil spawned Kaiser Permanente’s landmark Labor Management Partnership (LMP), which forged a cooperative relationship between KP’s 26 unions and the health plan leadership. The partnership fosters a respectful collaboration to improve health care for members and to create a positive work environment.

Kaiser Permanente unions had a big role in bringing about that partnership. In the midst of hostile bargaining in 1995, union leaders realized the labor disputes could damage the future of the health plan. Kathy Schmidt, a member of the bargaining team from Oregon, recalled, “We realized: here is the most unionized system in the country. Why don’t we try to help them? We learned more about trying to have a Partnership.”

Then-Kaiser Permanente CEO David Lawrence reached back across the abyss and agreed. “What I remember thinking about at that meeting was: We’ve got nothing to lose by being forthcoming about what I believed needed to happen …about the kind of collaboration that I think is required to deliver modern medical care in all of its complexity,” he told Harvard University researchers in 2002.

Today, scholars at both Harvard’s School of Government and Stanford University’s School of Business are following the progress of the LMP and consider it a prime example of labor and management cooperation. Its continued success will contribute to the realization of KP’s goal of being the model for health care delivery in the United States.

Read more about the Labor Management Partnership.

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Permanente traditions advance with total health assessment campaign

posted on December 29, 2010

By Ginny McPartland 

Longshoremen line up for their health assessment or "physical" in 1961

I recently took an online total health assessment (THA) through the healthy lifestyles program on Kaiser Permanente’s members Web site, kp.org. This was my second time (in three years) so I knew the drill: answer quite a few questions about my health and lifestyle habits and find out where I stand health-wise. I did it for me, but I had another motive. By taking the assessment, I earned $50 for charity.

When I first heard Kaiser Permanente was offering its employees a $50-to-charity incentive to take the THA, I wasn’t that impressed. I didn’t think the donation would convince people to participate in KP’s initiative to build a healthier workforce. I also didn’t think $50 would go that far. I have to admit I was WRONG!

By mid-December, more than 22,000 (14.5%) KP employees nationwide had taken the THA and by that small action collectively raised an impressive $1.1 million. Now that will go a long way. How far? For starters, each $50 could buy 700 pounds of fruits and vegetables or 77 dozen eggs for the hungry. Or it could provide 10 pediatric flu shots for needy kids. Multiply those items by 22,000 donors and you get the picture. 

The money raised by the 2010 THA incentive program will go to community healthy eating initiatives and to support health care for disadvantaged people and families, especially the homeless, the disabled and those living with HIV/AIDS.  The KP region whose employees raise the most money will receive an extra $50,000 for charities in their communities. The winner will be announced in January; the money will be awarded in March.* 

1951 brochure announcing Longshoremen assessment program. Image courtesy of the ILWU.

I think it says something about the KP culture that so many employees were motivated to raise money for others less fortunate than themselves. If they hadn’t felt compelled to take the assessment for their own sake, they were motivated to help others. Of course, Kaiser Permanente has given millions to good causes over the years through its Community Benefit programs.†

Total health assessment by any other name

Given our history as a preventive care organization, it shouldn’t come as a big surprise that Kaiser Permanente has been a champion of the total health assessment for over 60 years. In 1950, such an assessment was called the “multiphasic examination,” and it was initiated when labor leader Harry Bridges of the International Longshore and Warehouse Union (ILWU) demanded it for all members of the union. 

The ILWU members lined up at the waterfront for preventive clinics that included blood and urine screening tests, chest X-ray, electrocardiogram, and other tests to search for chronic disease. Each member also completed a health questionnaire similar to today’s THA. The recording and archiving of test results became the impetus for Kaiser Permanente to acquire its first computers in 1960. 

These records, still accessible today, have supported long-term health research related to heart disease and other chronic diseases. One such study, “Characteristics of Longshoremen Related to Fatal Coronary Heart Disease and Stroke” by Paffenbarger et al., was published in the “American Journal of Public Health,” in 1971. 

Robert Feldman, MD, and Sidney Garfield, MD, confer on the health assessment program launched in the late 1960s.

In the late 1960s, Permanente founding physician Sidney Garfield launched a program called “The Total Health Care Project” to expand the multiphasic programs in Oakland and San Francisco. Garfield and Robert Feldman, MD, hired and trained KP’s first nurse practitioners to run the program that included the use of computerized lab machines that yielded results while the patient was still at the clinic. Their goal was to collect baseline health data that could be used to identify health risks and to prevent disease. 

Today’s iteration of the multiphasic exam is a system of chronic disease screening programs designed to detect symptoms early and identify risk factors. The total health assessment questionnaire challenges participants to scrutinize their lifestyles and work with their doctors to figure ways to head off diseases such as diabetes, heart disease and cancer. 

For me, the THA results are a reminder of what I need to do to stay healthy. I’m also hoping I can improve my sleep by following through with the online insomnia program. But most of all, I feel glad that my co-workers saw fit to get involved for themselves and to raise money to improve the health of others less fortunate. 

*Benefit-eligible Kaiser Permanente employees and physicians may earn the $50 charitable donation by taking the THA by Dec. 31.  Go to the Healthy Workforce site to participate. 

†Click here for more information about Kaiser Permanente’s Community Benefit Program

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Kaiser Permanente’s LA Harbor Area Blossoms after Humble 1950 Start

posted on June 21, 2010

By Ginny McPartland 

Kaiser Permanente’s post-World War II public health plan was but an embryo in 1950 when famed labor leader Harry Bridges asked Dr. Sidney Garfield to provide medical care for West Coast longshoremen. The International Longshore and Warehouse Union (ILWU) had just adopted a health and welfare plan for its members, and Permanente’s prepaid health coverage fit Bridges’ vision. 

The health plan, then called Permanente, already had services in the San Francisco Bay area, so covering the six or seven thousand Northern California dock workers was no problem. But Permanente’s only presence in Southern California was at the Fontana Steel Plant, 70 miles inland from the Los Angeles harbor area where the roughly 3,000 longshoremen lived. 

Kennebec medical clinic in the 1950s

Garfield didn’t have to ponder Bridges’ offer for long. The struggling health plan needed members – desperately. After saying “yes!” to Bridges, Garfield flew into action. He hired a physician to run the longshoremen clinic, found a suitable building in the Port of Los Angeles town of San Pedro and opened for business in about two weeks. 

Today, Kaiser Permanente’s South Bay service area, boasts about 190,000 members, a 255-bed medical center, and medical offices in Long Beach, Torrance, Harbor City, Lomita, Carson, and Gardena. The KP South Bay community is celebrating its 60 years of history on Wednesday, June 23, in Harbor City. 

It’s been a rough ride 

The Harbor area health plan’s six decades of existence can be characterized as a roller coaster ride with its ups, downs, and unexpected turns. The years have brought growth, at times unmanageable, stopgap solutions to facility needs, the San Pedro murder of a popular doctor, and a fire that disrupted operations for a year – not all roses and sunshine. 

The early medical group, led by Ira “Buck” Wallin, MD, worked out of a small clinic in San Pedro and had to fight for legitimacy and for staff privileges at any of the area hospitals. They were blackballed by the local medical community for practicing what was called “socialized medicine” when the “Red Scare” was the order of the day. This contention was typical of the anti-group-practice atmosphere anywhere Permanente Medicine established itself. 

In the beginning, and for many years, the doctors made house calls and took turns sleeping overnight in a blood draw room in the clinic. They were at the beck and call of the longshoremen and their families. Over the first five years, the ILWU became steadily more impatient with the health plan for delaying construction of a sorely needed Harbor area medical center.

Early Parkview clinic in Harbor City

 Meanwhile, the group had expanded to Long Beach – first to an old house and then to the old posh Kennebec Hotel across from the Pike, a popular amusement park in Long Beach. The health plan also opened a Los Angeles clinic and then a hospital on Sunset Boulevard. From 1953 when the Sunset Hospital opened until the Harbor City hospital was built in 1957, patients were shuttled to Los Angeles for hospital care.

After a tussle with the ILWU that threatened the loss of the group, Sidney Garfield and Buck Wallin got the funding to build the Harbor City medical center. The first medical office building, called Parkview, was opened adjacent to the hospital in 1958.

South Bay no stranger to innovation

The South Bay/Harbor City movers and shakers contributed more than their share of innovative ideas over the years. Some examples:

  • In 1964, Harry Shragg, who later became area medical director, was the first in Southern California Kaiser Permanente to perform outpatient surgery, a practice that would become prevalent for its economy and medical soundness.
  • In 1964-65, Buck Wallin and Chief of Medicine William Fawell pursued the idea of discharging patients sooner and providing follow-up medical care in their homes. When Medicare came along in 1965, suddenly (home health care) became one of the ‘in’ things to do.
  • In the early 1970s, Harry Shragg, Internist Jay Belsky, and Medical Group Administrator Ed Bunting worked together to develop a new exam room layout that would leave more room for the patient and the examination table. “It was such a big success that it was adopted and became standard for all of Southern California, Bunting said.

The good, the bad and the ugly

  • In 1967, Dr. Shragg saw the opportunity to help disadvantaged Harbor City people through a local program funded by the federal Office of Economic Opportunity. Kaiser Permanente used its community service funds to provide medical care for 100 participant families.
  • In 1960, Leon Quattlebaum, a well-liked and respected 36-year-old Harbor City OB-GYN, was killed in San Pedro by a local tough who, unprovoked, punched “Q” in the jaw, knocking him to the cement floor and fracturing his skull. The prosecutor at the murder trial said the only reason for the killing was the murderer’s “malignancy of heart.”
  • In November of 1973, a night fire of unknown origin collapsed the three-story Parkview engineering tower and threatened to destroy Harbor City’s medical records and appointments data. The medical offices and appointment center were up and running again in about a week, said MGA Ed Bunting. But it took about a year to rebuild the burned out section at the center and make the complex whole again.

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