Posts Tagged ‘Kaiser Permanente Fontana’

Clarence Mayhew – early Kaiser Permanente architect

posted on May 31, 2016

Lincoln Cushing
Heritage writer

Part one of two parts – Walnut Creek, Dragerton, and Fontana

 

 “Hospital design is sort of a hobby of mine.”
—Sidney Garfield, MD, New York Times Magazine, April 28, 1974.

Sidney Garfield and architect Clarence Mahew, looking at drawing of planned Panorama City hospital, 1965 [circa]

Dr. Sidney Garfield and architect Clarence Mayhew looking at illustration of planned Panorama City hospital, circa 1965

Although Kaiser Permanente’s founding physician certainly had a passion for hospital design, and often served as a consultant, professionals were hired when it came to actually bringing these complex structures into being. One of the organization’s most significant architects was Clarence William Whitehead Mayhew (1906-1994).

Mayhew’s career began in 1922 as a draftsman at the San Francisco firm of Arthur Brown, Jr.. He traveled abroad to study at Paris’ Ecole des Beaux-Arts between 1922 and 1925, and returned to the Francisco Bay Area, where he graduated from the University of California at Berkeley School of Architecture in 1927.

He remained in the Bay Area began a long and distinguished career. Mayhew designed homes, including two in scenic Big Sur and Los Angeles for Lucille and David Packard (co-founder of the multinational information technology company Hewlett-Packard). Among his institutional commissions were the Aurelia Henry Reinhardt Alumnae House at Mills College (Oakland, Calif.), the Alumni House at U.C. Berkeley, and a racetrack in Lima, Peru.

But it was his design of early Permanente Foundation hospitals that is the foundation of his legacy.

Planning for Health newsletter  1952-10

Sketch of future Walnut Creek Medical Center, Planning for Health newsletter October, 1952

Mayhew’s first Permanente hospital was the 76-bed Walnut Creek Medical Center, which opened in April, 1953, one year after the flagship Kaiser Permanente Los Angeles hospital. Dr. Garfield was listed as “functional designer and medical consultant.” It, and the subsequent Kaiser Permanente Fontana Hospital, were part of a “small city” hospital movement; the larger and more urban Kaiser Permanente hospitals in San Francisco and Los Angeles were called “dream hospitals.”

Walnut Creek, along with Los Angeles and San Francisco (opened August 1953), were considered marvels of hospital design. Kaiser Permanente’s member newsletter Planning for Health of October 1952 gushed about its charms:

"Today's Most Talked About Hospital..." article on Kaiser Walnut Creek hospital, Architectural Forum, 1954-07. [Also source tiff files saved separately] [TPMG P1288]

“Today’s Most Talked About Hospital…” detail from article on Kaiser Walnut Creek Medical Center, Architectural Forum, July, 1954.

Many unusual innovations have been incorporated to make the hospital outstanding in the service it will render. The usual central corridor has been converted into a private corridor for nurse, doctor and employees, with a nurse’s station located for approximately each eight beds. This keeps the public away from the service area and bring the nurse, supplies and equipment in close proximity to the patient for more efficient care. Visitors reach the rooms via an outer corridor. Each patient enjoys a private or semiprivate room enclosed on one side with glass, affording the patient a pleasant view of landscaped grounds and trees.

Another progressive feature is the maternity wing. Here the central nursery has been eliminated and replaced with an individual nursery behind the bed-wall. At any time the mother, or visitors, can view the baby through a glass window beside the bed while the baby is actually attended by the nurse. Whenever the mother wants her baby beside her, she need only pull out the bassinet and her baby is there.

Even more impressively, the hospital was featured in an eight-page article in the July 1954 issue of Architectural Forum. It was titled “Today’s Most Talked-About Hospital…for four good reasons,” which it articulated:

1: Its architecture is part of the cure
2: Its corridors are actually long workrooms
3: Its bedrooms are designed for patient self-help, and
4: Its economics make it self-supporting at low rates.

Although many of those functional features were Dr. Garfield’s ideas, the aesthetics of the design were credited to Mayhew: “Note the easygoing grace with which Architect Mayhew has imbued a necessarily machinelike plan.”

Immediately on the heels of Walnut Creek were two smaller facilities built in 1954, one at a remote World War II Kaiser Steel coal mining location in Dragerton, Utah, and the other as a civic expansion of the hospital in the city of Fontana, Calif., where Henry J, Kaiser’s wartime steel mill was located.

Detail from blueprint for alterations and additions to Dragerton, Utah hospital, lot bounded by Center Street, Third Street, and Whitmore Drive. Original hospital built 1952. 1953-02-25. [TPMG P2640]

Detail, 1953 alterations and additions to Dragerton, Utah hospital, (Center Street, Third Street, and Whitmore Drive.)

The War Production Board had built a hospital at Dragerton (now called East Carbon City), which was later purchased by a physician who soon afterwards was charged with medical and fiscal mismanagement. United States Steel asked Henry J. Kaiser to take over the hospital in early 1952. Miners were desperate for proper care, and the team of Permanente physicians – which included shipyard doctor Wallace “Wally” Cook – was swamped. Mayhew designed a simple hospital, for which Dr. Garfield was listed as “consultant.”

Although a Permanente health plan was never established in the region, the hospital remained as Utah Permanente Hospital until 1966. However, this commitment to serving working people would eventually re-emerge as a plea for expansion from stakeholders in Colorado, which Kaiser Permanente began to do in 1969.

Architectural drawing, Fontana Kaiser Foundation Hospital, 9961 Sierra Ave., completed 1954. Clarence Mayhew, architect. Plans 1953 [circa]. [TPMG P1479]

Architectural drawing, Fontana Kaiser Foundation Hospital, 9961 Sierra Ave., completed 1954. Clarence Mayhew, architect.

In Fontana, a wartime hospital existed on the steel mill site, but once the Permanente Health Plan was opened to the public after the war it made more sense to locate a hospital in town. At first Dr. Garfield considered simply expanding the hospital at the steel plant, but in late 1953 Kaiser Steel Corporation Vice-president and General Manager Jack L. Ashby wrote to Dr. Garfield and told him:

I am advised that last month alone some 9,000 to 10,000 people visited the existing clinic now at the steel plant. The overcrowded condition is constantly a problem… In our opinion, not to build the clinic in the City of Fontana would be like building a beautiful automobile without an engine.

The San Bernardino County Sun published an article August 19, 1954, announcing a three-day open house:

The Kaiser Foundation’s newest “hospital of the future,” bringing to the Fontana area the last word in comfort and efficiency for patients and the hospital staff, will be introduced to the public next week.

The new medical facilities, initially containing 42 beds, are located on a 15-acre site at 9961 Sierra Ave., corner of Marygold Ave. They will complement the existing 88-bed Foundation hospital at the nearby steel mill of Kaiser Steel Corp., which donated $300,000 to help finance the new structure. The hospital, in the center of the expanding Fontana-Bloomington-Rialto-Etiwanda area of 60,000 population, is a community hospital open to the general public and to all qualified physicians and their patients, as well as Kaiser Foundation Health Plan members.

The one-story, “T” shaped building, of steel construction and utilizing vast amounts of glass, is the second of the Foundation’s concept of the ideal “small city” hospital.

Three hospitals in two years – that’s a pretty remarkable pace. But Mayhew was just getting started.

 

Next: More California hospitals 1955-1973: Harbor City, Panorama City, and San Rafael.

 

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

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Fontana’s Sinister Garden

posted on December 11, 2013

by Lincoln Cushing, Heritage writer

Sinister Garden1

Dr. Guy Hartman, pediatrician, and Franklin Boeckman, hospital administrator, take a look at the expanded Sinister Garden at the Kaiser Permanente Fontana Medical Center, 1976.

In 1974 physicians at Kaiser Permanente Fontana (Calif.) Medical Center planted a most unusual garden at the center’s entrance. Behind a fence and locked gate they displayed 17 common poisonous plants found in homes and gardens, and called the collection the Sinister Garden – complete with a warning skull.

Pediatrician Guy Hartman, MD, (1922-2008) was concerned about the high number of local cases – as many as 300 in 1973 – that resulted from ingesting poisonous vegetation. “Children who are 4 years of age are our most frequent patients,” he told reporters. “This is the age of curiosity for these youngsters who are learning about their world by touching, feeling, and tasting just about everything.”

Dr. Hartman became interested in poisonous plants as a Boy Scout master in Southern California. “While working on a Scout project, we discovered that many common ornamental house and garden plants contain enough poison that, if accidentally eaten, could kill an entire family.” [i]

His garden was actively used for teaching. All plants were labeled and keyed to an exhibit sign explaining what the plants were named, which parts were poisonous, and what symptoms would occur if the plants were eaten. Busloads of children were brought to the garden to hear his warnings about castor beans, oleander, and wild mushrooms, to name a few.  In 1976 the positive response led to the garden more than doubling in size, to 49 plants.

Around that time the pediatrics department produced a short video to broadcast the message, using a hand puppet named Amigo to charm the children. They also published a seven-page booklet, Welcome to the Sinister Garden.

In 1986 Kaiser Permanente’s Rockwood Clinic in Gresham, Oregon, installed its own garden, also as a response to local children’s poisonings. And in 1988, the physician-in-charge Thomas Hartman, MD, (no relation) planted a sinister garden at the old Bellflower (now Downey) service area at the Kaiser Permanente Imperial Medical Offices.

The garden in Fontana continues to be maintained and modernized, with landscape architecture students from nearby Cal Poly Pomona using it for design projects.

 

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


[i] “Enlarged Sinister Garden Flourishes,” Kaiser Permanente Insight (Southern California), Fall 1976

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Southern California pediatrician’s career parallels KP’s quest for best

posted on April 18, 2012

By Ginny McPartland
Heritage writer

Last in a series

Sam Sapin, MD, Southern California Permanente Medical Group quality pioneer

The story of Kaiser Permanente in Southern California could not be told better than through the life and career of Sam Sapin, a pediatric cardiologist who joined the medical group in Los Angeles in 1955. Sapin, a New York City transplant with a slight accent reminiscent of his roots, could have had a lucrative career taking care of wealthy patients in his native city. He had a thriving practice on Park Avenue before choosing to migrate to California.

He was lured to Los Angeles after hearing from friends about an innovative, albeit fledgling, group of doctors with a philosophy quite different from his fee-for-service colleagues in New York. Rendering proper and compassionate care to patients without having to consider their ability to pay sounded good to Sapin. So good, in fact, that after one brief visit to the West Coast, he and his wife, Jean, with their two small children, picked up and moved.

In the course of six decades associated with KP, Sapin has seen unimaginable changes, played many roles and helped to nurture the health plan’s phenomenal growth in membership, reputation, and influence in Southern California and in all its regions.

He’s had his hand in establishing and expanding programs in physician and patient education and research; he’s been influential in the creation and refining of quality assessment and improvement systems; and he’s been a trailblazer in KP efforts to ensure appropriate use of medical technology.

LA Center for Medical Education honors Sapin

Sapin received an Excellence in Medical Education Award in 2011 from the Thomas F. Godfrey Center for Medical Education. He was honored for his lifetime achievements, especially in promoting physician education.1  In presenting the award, retired director of the center and fellow pediatrician KP Rudy Brody said: “Over the years no one has done more for Kaiser Permanente to advance medical education, research and quality than Sam.

“He was co-founder in 1955 and a long-standing member of the Southern California Permanente Medical Group’s (SCPMG) Pediatric Symposium Committee (which celebrated its 50th symposium in 2008). Most importantly, Sam was a member of the Center for Medical Education’s Advisory Committee (1999 to present) that guided the center through its initial years.”

These accomplishments are really just frosting on the cake for Sapin whose main career focus has been to take care of newborns and older children with heart problems. His decades-long efforts in this realm have entailed finding groundbreaking ways to repair congenital problems so his often tiny patients could live healthier and sometimes completely normal lives.

In 1981, Sapin was the KP Southern California medical group's director of Research and Education.

As KP physicians have always been encouraged to do, Sapin quickly associated himself with academia and conducted and published research throughout his career, as recently as 2005.

“Shortly after I joined the group I applied for a teaching appointment at Children’s Hospital, just across the street, but I was never accepted, nor rejected, because I was one of those ‘Kaiser’ doctors,” Sapin said recently. “I then drove across town to UCLA, where I was welcomed, became an assistant professor of pediatrics in the Division of Cardiology, and eventually, a clinical professor.

Setting up pediatric cardiac ‘cath’ lab

“I was able to take our pediatric patients to UCLA, perform cardiac catheterizations, and have their cardiac surgery done there. In 1957, Pete Mahrer, Mt. Sinai trained (as Sapin was), joined our group.The two of us set up a small cath (cardiac catheterization) lab at Sunset (KP Los Angeles Medical Center). The equipment was kept in a closet and rolled out into an X-ray room when available.

“We put on our red glasses half-hour before the procedure, to be able to see the fluoroscope in the dark. Pete helped me with the pediatric cases, and I helped him with the adults,” he said. In 1960, a diagnostic cardiac catheterization laboratory for pediatric and adult patients was opened at Panorama City, and Sapin served as director until 1982.

Sapin took on administrative duties when he became the chief of pediatrics at Panorama City in 1959. But he didn’t give up his practice, a decision he never regretted. “Fortunately, for me, I was able to practice until I was fully retired in 2000.”

As chief of pediatrics, Sapin founded the first Kaiser Permanente nurse practitioner program in 1964 and at one point oversaw the training of nurse practitioners. He held the chief position until 1972 when SCPMG Medical Director T. Hart Baker appointed him regional director of the Department of Education and Research, a department created to manage the growing education and research programs funded by the Community Services Fund.

In accepting his lifetime achievement award last year, Sapin recalled: “Seeing patients was very gratifying. On the other hand, my administrative career could sometimes be frustrating. Physicians, who’ve been trained to be problem-solvers and independent operators, can be resistant to change.

“Let me read to you, from a brief memo, which Dr. T. Hart Baker, our medical director at the time, sent out to doctors in May 1972:

“ ‘Dr. Sam Sapin has been appointed director of Research and Education. . . The location of his office and his telephone number will be forwarded to you as soon as a suitable location is found.’

“What I’d like to read to you now is the comment of some anonymous person – presumably a physician – who sent the memo back to me with the following suggestion scribbled on the back of it, in red ink, about a suitable location for my office, it read: ‘On Edgemont, behind garage at 1226 apartment house – go thru back yard, but beware of German Shepherd dog. (Go) up to second story – above chicken coops – and past the old EKG labs.

“Turn left, then right, knock twice and say Marshal. If a short fellow scratching his cheeks answers, turn back, you’re in Fontana! P.S. Dress at this office is casual – jeans and old shirt – since only orange crates and dirty Zolotone boxes are available for desks. Boots are a must, until the exterminators are through. Bring your own Xerox machine, since our last one fell through the loose floorboard. Also, a cheerleader’s megaphone will come in handy for long distance calls.”

Growth of research and education spawns new department

In 1982, Sapin was appointed SCPMG's associate medical director of Clinical Services.

In 1982, newly appointed SCPMG Medical Director Frank Murray founded another new department – the Department of Clinical Services – which subsumed Sapin’s responsibilities concerning research, education and quality. Murray appointed Sapin associate medical director of Clinical Services, which soon included divisions of research, staff training and medical manpower, quality of care, quality of service and appropriate use of technology.

In 1983, Sapin beefed up KP Southern California’s preventive medicine program by requiring each medical center to offer a core health education curriculum addressing chronic conditions and healthy lifestyle issues. Also as Clinical Services leader, Sapin formalized the Inter-Area Chiefs of Service Groups and required chiefs in all specialties to convene four to six times a year. “I thought this structure was essential to assure the delivery of a comparable quality of care throughout the region.”

By 1990, Sapin had served on the SCPMG board of directors for 16 years, as an elected representative from 1957 to 1966 and as a regional associate medical director from 1982 to 1990. He had won the respect of his physician colleagues and the adoration of his patients. In his last years before retirement from the medical group administration, Sapin had several invitations to size up his career and the changes he’d seen. One such opportunity was to speak before the annual meeting of the American Group Practice Association in Minneapolis in 1989.

What makes a successful prepaid group practice?

Rather than speaking just from his perspective, Sapin surveyed his SCPMG colleagues and presented the results in his talk titled “Managed Care – What Works in Groups.”

The survey identified six KP success factors: 1) integrated care design with doctors making medical decisions and KP owning its own hospitals; 2) people with a social purpose and ethics, commitment to high quality and peer review; 3) innovation, long-term planning, nonprofit financing plan, comprehensive care and affordable rates.

Sapin’s list continues: 4) ability to control costs due to ownership of facilities, purchasing power and physician extenders (nurse practitioners, etc.); 5) support from labor, business, academia and government; 6) reputation as a strong organization that is always there to provide care for significant illness. 3

Sapin, a tireless KP defender and passionate believer, summed it all up for his audience: “The right people with a good idea at the right time.”

In 1992 when health care reform was hugely topical and Sapin was retired and consulting for Clinical Services, KP quality leader Sharon Conrow asked him to draft what he thought Kaiser Permanente’s reform position should be. Sapin didn’t hesitate.

“I said, one, I think it should be a single-payer system . . . eliminating the fee-for-service idea. That it would be essentially the model that we have now, but with (ways to address) some of the things we had problems with. For example, when it comes to new technology, what should we invest in?” Sapin recounted recently.

“Now (2012), my recommendation for reform is to duplicate the Kaiser Permanente model. That’s what I’ve been saying. The more I’ve been looking and thinking about this, and all these intrinsic, built-in things that make us have to provide better care based on all the evidence, and so on, (the best structure for effective reform) is the model that we’ve built.”

KP sticks to original HMO model

Kaiser Permanente is the one and only health maintenance organization (HMO), the only managed care organization that fits the original and the current HMO definition, Sapin says. As conceived in 1971 by Paul M. Ellwood, Jr., famed health policy expert, an HMO consists of a multi-specialty group practice whose doctors contract with a nonprofit health plan to take care of patients on a prepaid basis.

Ellwood, who has influenced national health policy over the decades, is frustrated by the lack of progress on the health reform front. He said he originally intended HMOs to be nonprofit entities and to include structure to ensure accountability for quality of care as well as to contain costs, the main objective in the early 1970s as well as today.

“What went wrong?” Ellwood asks rhetorically in his 2011 oral history. His answer: “Political expediency in the initial plan designed to promote HMO growth led to the inclusion of three mistakes: for-profit plans, independent practice associations, and the failure to include outcome accountability.”

Ellwood’s sad assessment gives credence to Sapin’s argument that KP stands out as the model. Ellwood says of Kaiser Permanente and its pioneering physician Sidney Garfield: “Sid Garfield’s plan is 80 years old but it is still the gold standard.” 4

 

1 The Center for Medical Education was founded at the KP Los Angeles Medical Center in October 1999. The center offers continuing education, residency and fellowship programs and rotations for residents and fellows from nearby medical schools. Its advisory committee draws members from the community as well as SCPMG.

2 Sapin earned his MD from the New York University College of Medicine and completed a rotating internship at Mt. Sinai Hospital and his residency in internal medicine at the U.S. Veterans’ Hospital, both New York institutions. He took his internship in pediatrics at Bellevue Hospital in New York and his residency in pediatric cardiology at Mt. Sinai Hospital in New York City.

3 “Managed Care – What works in groups 1989 – A case study of successful HMOs,” Samuel O. Sapin, MD, presented at the Annual Meeting of the American Group Practice Association, Minneapolis, Sept. 15, 1989

4 “Paul M. Ellwood, Jr., MD, In First Person: An Oral History,” American Hospital Association, Center for Hospital and Healthcare Administration History and Health Research & Educational Trust, 2011

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