Posts Tagged ‘kaiser permanente’

Weekend home front festival celebrates Bay Area history

posted on October 11, 2012

By Ginny McPartland
Heritage writer

The USS Potomac, President Roosevelt’s “Floating White House” will be open for tours at the Richmond home front festival Saturday, October 13. Wikimedia Commons photo.

This Saturday, October 13, Kaiser Permanente will celebrate its beginnings as the workers’ medical care plan in the World War II Kaiser West Coast Shipyards. We’ll gather with thousands of Bay Area residents, many living in Richmond, to reminisce about the days when Richmond hosted Henry J. Kaiser’s monumental shipbuilding operation.

The small waterfront city was transformed during the war by the arrival of thousands of people from around the country who came to work in the shipyards.  Transplanted workers from the South, the Mid-West and the Northeast brought their faith, their lifestyles, and their music and art to the Bay Area. Their contributions changed the demographics and cultural landscape remarkably.

The sixth annual Richmond Home Front Festival by the Bay showcases the rich culture of Bay Area life that is largely the legacy of World War II. The festival takes place at several sites on and near the former Kaiser Shipyards. The main events will be in the Craneway Pavilion, the former Ford Assembly Plant and wartime tank and jeep depot at the south end of Harbour Way (1414 South Harbour Way).

New Rosie park visitors center open

Sherman Tanks for World War II were assembled at this plant in Richmond, California. The home front festival this Saturday (October 13) will be in the restored plant, which is now called the Craneway Pavilion. Photo courtesy of the Richmond Public Library.

New this year is the amazing and beautiful National Park Service Visitors Education Center, which has historical exhibits and films that tell the story of Richmond and the home front. The center, operated by the Rosie the Riveter national park staff, is the renovated and remodeled brick oil house where the fuel to power the nearby vehicle assembly plant was stored. Tours of the center are free.

Also new this year is a chance to take a free tour of the USS Potomac, the rescued and restored presidential yacht of wartime President Franklin Delano Roosevelt (FDR).  The yacht, model AG-25, served as the U.S. Coast Guard Electra until 1936 when Roosevelt claimed it as his “Floating White House.” The yacht is permanently docked at Jack London Square in Oakland, California. Festival-goers can take a free 1940s shuttle bus ride from the Craneway to the dock of the former Shipyard 3, which is off Canal Boulevard, to see the Potomac.

The SS Red Oak Victory, operated by the Richmond Museum of History and also docked at Shipyard 3, will be open for tours. The Red Oak, one of the ships built in Kaiser’s Richmond Shipyards, has been restored by the museum and is often the site of film showings and other events. World War II memorabilia and books are available for purchase in the museum gift shop.

USO dance Friday night

This welder worked in the Kaiser Shipyards in World War II. Her photo is part of the new KP exhibit of shipyard photos to be dedicated next Tuesday, October 16, at Macdonald Avenue and Eighth Street in downtown Richmond. Photo courtesy of the Richmond Public Library.

The night before the festival, Friday, October 12, Lena Horne will be honored in a 1940s USO dance featuring Junius Courtney’s Big Band. The dance will be from 7 to 10 p.m. in the Craneway Pavilion, 1414 South Harbour Way, Richmond. Admission is $20 per person in advance, $25 at the door. Advance tickets available until 5 p.m. Thursday.

Other festival events include: Duck (Amphibious Truck) Tours of Marina Bay to view the historic shipyards, the YMCA Home Front 5K & 10K Fun Run beginning at 9 a.m., kids rides, music, a karaoke stage, and lots of food and beverages to purchase.  The festival begins at 11 a.m. and closes at 5 p.m.

* * * *

KP will celebrate Richmond again at 4 p.m. on Tuesday, Oct. 16, when we dedicate our addition to Macdonald Avenue art and cultural displays. KP Richmond Medical Center has created an outdoor public art display that features shipyard workers of World War II and honors today’s Richmond citizens. The art installation is on Macdonald Avenue at Eighth Street.

 

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Brisk daily walks keep retired KP CEO Jim Vohs in the pink

posted on September 21, 2012

By Ginny McPartland
Heritage writer

Jim Vohs created this outdoor portrait of his red-headed grandsons in the autumn red leaves in his front yard. This framed portrait hangs in his home.

I had the pleasure one day this summer to take an early morning brisk walk with Jim Vohs, retired Kaiser Foundation Health Plan and Hospitals CEO. Formerly a marathon runner of some note, Vohs enjoys the physical benefits of walking, as well as the time it affords him for reflection. He subscribes to KP CEO George Halvorson’s belief in the power of walking. “Every Body Walk!” is the mantra of Halvorson’s current campaign to get people moving.

I had heard through the grapevine that Vohs, who retired in 1991 and is in his 80s, was an avid walker. So I called to see if I could talk to him about his daily walking routine. He invited me to walk with him at 7 in the morning a few days later. On the phone, I asked: “What if I can’t keep up with you?” He said: “I can adjust to your pace.”  OK! I was up to it.

I met him outside his Piedmont home at the appointed hour. The charming gentleman came out of the gate wearing beige casual pants, white walking shoes, a stylish sweatshirt – and a nice, welcoming smile. My first time to meet him was smooth and relaxed. We began to walk the gentle hills around his neighborhood at a clip talking as we went. He shared with me his thoughts on retirement, his time as leader at Kaiser Permanente, and his views on exercise.

This cartoon appeared in Harper’s in December 1978. Fun-loving friends added “J.V.” to the male jogger’s shirt and presented their version to Vohs. Cartoon and prayer by famed writer of “The Right Stuff (1983)” and “Electric Kool-Aid Acid Test (1968)” Tom Wolfe.

He confided that he used to look down his nose at walkers, considering them “wimps” who weren’t serious about their fitness. He later showed me a cartoon from Harper’s magazine featuring a runner with the initials “J.V.” on his chest who recited Tom Wolfe’s “The Joggers’ Prayer”:

“Almighty God, as we sail with pure aerobic grace and striped orthotic feet past the blind portals of our fellow citizens, past their chuck roast lives and their necrotic cardiovascular systems . . . past their inability to achieve the White Moment (jogger’s high) or slipping through The Wall . . . help us . . . to be big about it.”

Today, however, Vohs has changed his mind and believes walking can be the best kind of exercise, indeed for everyone. “What are the benefits of walking for you? I ask him. “Everything that George (Halvorson) says in his missive on walking,” he replies, referring to Halvorson’s weekly letters to KP colleagues.

The number of benefits of walking 30 minutes a day is astounding. They include: lowering the risks of diabetes, stroke, hypertension, breast cancer and its recurrence, colon cancer, prostate cancer, hip fracture and gallstones. Such a regimen can also boost high density cholesterol, lowering the risk of heart attacks and stroke.  Walking helps people to lose weight and makes them feel better psychologically. The list goes on and on.

After our 30-minute walk, we returned to the Vohs home, and he invited me in for breakfast and to meet his wife, Eileen. The fare consisted of decaffeinated coffee, bananas, blackberries, yogurt and muesli. Basically, very healthy, it goes without saying.

The display case for Vohs’ KP service pins was also made of Koa wood by his Hawaiian friend. Koa wood, found only in Hawaii, is prized for many uses, including fine furniture and guitars.

Jim Vohs was the CEO of Kaiser Health Plan and Hospitals from 1975 to 1991. He is credited with many accomplishments at the helm of KP, including initiating an active Board of Directors Quality of Care Committee, expanding the Health Plan into new geographical regions, supporting a rigorous Affirmative Action policy, and defending the core values in times of change. The annual Vohs Award for Quality was established in his name when he retired in 1991.

In reflecting on his KP career, Vohs says he wishes he would have thought of the health plan’s current focus on healthy lifestyles as exemplified by the Thrive advertising campaign, started in 2004. He was  opposed to advertising when it was first suggested in the 1980s because he did not want the not-for-profit Kaiser Permanente viewed as just another commercial organization and says he only agreed to it if the people featured in commercials were actual KP members or staff.

Keeping KP from becoming a commercial enterprise was a no-brainer for him. “We started out as a nonprofit organization providing care that people could afford. I fought against us becoming a profit-making business. That’s not who we were (are).”

Mail Room Clerk Travis Bailey and KP President Jim Vohs show off the March of Dimes TeamWalk trophy — a bronzed shoe worn by baseball star Willie McCovey — from 1985. KP Reporter cover photo by Jaime Benavides, July 1985.

While KP CEO, Vohs was heavily involved with local communities and charitable organizations and urged KP staff across the regions to participate in public events.  In 1985 and 1986, he served as Alameda County chairperson for the March of Dimes’ TeamWalk and marshaled 900 KP walkers in 1985 and 1,000 in 1986.

With Vohs in the lead, the KP team raised $35,000 in 1985 and $60,000 in 1986. Vohs is quick to note that the March of Dimes walk – 32 kilometers for more energetic participants – wasn’t a promotion of walking. “That was different. We were walking to raise money, not for fitness.”

The KP walking team attracted staffers from all over Northern California. As the top team, KP won the traveling trophy, which was a bronzed shoe originally worn by baseball star Willie McCovey. “Once again we proved we’re number one.” Vohs said at the time.

Of his athletic pursuits, Vohs is most proud of his success as a marathon runner. He competed in the Avenue of the Giants 26-mile marathon, which only accepts 1,000 qualified runners, and two full-length Oakland Marathons when he was in his 50s. He stopped running a few years ago when he developed plantar fasciitis, a condition affecting his feet. He continues to play golf, walks the course and carries his own bag.

This clock of Koa wood was made for Vohs by a friend and Hawaii Permanente Medical Group physician. He treasures it and keeps it on display in his study.

After retirement, Vohs maintained a KP office for about five years and continued his participation on a number of boards, including the Federal Reserve Bank in San Francisco, the Oakland Coliseum, Holy Names College and the Oakland Port Commissioners. “My wife (Janice) said I failed retirement,” he offered, half joking. “She said it was like I was still working because I went into the office every day.”At a certain point, he vacated the office to spend more time at home.

Vohs has four daughters, among them a couple of runners who have entered the Bay to Breakers with him over the years.  He also has nine grandchildren. Grandpa Vohs snapped a beautiful photo of two of his grandsons playing in the autumn leaves in a season that has long passed. The boys’ thick red hair blends with the leaf baskets’ contents to create an impressively artful photograph. Vohs has a large framed print of the scene hanging in his family room.

In his study, Vohs displays two special mementos from his KP days – a hand-crafted clock and a display case for his service pins, both made of Koa wood by a Hawaii Medical Group physician and friend. The case shows all his pins from his Kaiser Permanente career under glass. The last one marks his 40 years with the company.

 

Vohs and his boating friends have a running joke about this papier mache-covered shoe and the memory of a mishap when their boat was swamped.

Another prized object is a tennis shoe preserved with papier mache to remind him of a water excursion with friends that ended with a swamped boat. He and his fellow boaters have a running joke that involves sneaking the shoe back into each other’s possession.

Sadly, Vohs lost his wife of almost 50 years to cancer about 10 years ago. He remarried recently after renewing his acquaintance with Eileen Galloway, a college friend, at a UC Berkeley alumni reunion. Eileen sometimes walks with Jim, but mostly she likes to walk later in the day and a bit slower.

“I want to enjoy myself and appreciate my surroundings,” she said. “And I don’t want to get out of bed at dawn.”

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1990s spawn research and refinement of KP addiction care

posted on August 30, 2012

By Laura Thomas
Heritage correspondent

Old stereotypes don’t accurately represent people who have trouble controlling alcohol consumption. Fotosearch photo

Second in a series
Northern California KP found itself scrambling in the early 1990s to enhance its substance abuse treatment program to meet new government mandates and employer group expectations. But a dedicated and innovative team of psychiatrists and psychologists soon caught up with the trend to treat addicts with the latest methods.

Mimicking the KP Southern California chemical dependency program established in the 1970s gave the Northern California programs upgrade a jumpstart.  Since then, The Permanente Medical Group (TPMG) has conducted studies and pilot programs to improve care and “mainstream” alcoholics and addicts into the primary care program for early intervention.

Charles Moore, MD, now chief of addiction medicine at KP Sacramento, and Lyman Boynton, MD, who had begun the alcoholism program in KP San Francisco, headed south in the early 1990s for consultations with Don Gragg, MD, and Tony Radcliffe, MD, at Fontana Medical Center and at the outpatient chemical dependency program at the Los Angeles Medical Center.

“We literally stole their design. We made copies of all the written documents they used for patient care in their facilities and used it as a template to design our programs,” Moore said.  Psychiatrist David Pating, MD, Moore, and psychologist Steve Allen, PhD, who cheerfully refer to themselves as “dinosaurs,” were all involved in setting up Northern California’s programs in the early 1990s.

Exxon Valdez spill prompts new regulations

The Exxon Valdez whose captain was asleep below the deck ran aground shortly after leaving the Port of Valdez near Alaska in 1989. This picture was taken three days later just before a storm. The captain had reportedly been drinking alcohol and asked the third mate to pilot the tanker. Photo courtesy of Wikipedia

All health plans were compelled to offer these services after the Exxon Valdez oil spill disaster propelled Congress to pass the Omnibus Transportation Employee Testing Act of 1991.

With the mandate to test employees and get serious about treating employees’ drug and alcohol problems, major employers threatened to “carve out” (go elsewhere for) the behavioral health portion of their employees’ health insurance coverage if Kaiser Permanente didn’t offer more extensive treatment.

“It was a confluence of pressures that brought about a concerted effort to build an integrated care system for treating addiction,” remembers Pating, chief of addiction medicine today at Kaiser Permanente San Francisco.

They hired new staff and got busy trying out new ideas. “There was a certain frenetic excitement that we had,” Pating recalled. “We would redesign the program and curriculum until we could get it to be really the best.”

Pilot programs began at KP San Francisco and Sacramento, and then expanded to Vallejo, Santa Clara and Oakland; in 2006, departments were established at Hayward, Santa Rosa, Fresno, Walnut Creek and Modesto.

What emerged in the ensuing years was a more comprehensive curriculum of individual and group work led by trained counselors that focused on helping addicts confront their illness and work on recovery over an extended period. 

Success for intensive day treatment

Treatment might begin with 40 hours a week of intense day treatment, followed by weeks of group therapy, tapering off over one to three years.  Patients requiring detoxification were managed by primary care physicians or sent to contract facilities.

Outpatient group therapy is a key element of the updated KP chemical dependency programs. Fotosearch photo

“We argued our model would be more effective than a 28-day or 30-day (inpatient) program,” said psychologist Steve Allen, who helped set up the program in KP Vallejo, “because with (28-day treatment) there is a high relapse problem.” The response (to intense day treatment) was so positive, he remembered, that employers who had carved out their behavioral health coverage returned to Kaiser Permanente, and “employee assistance programs were advising (companies) that did not have Kaiser Permanente to sign up.”

In addition, fewer chemically dependent patients showed up in the emergency room (ER). “We managed detox as an outpatient (service) better than we thought, and ER responded positively,” Pating said.

Chemical Dependence Recovery Program (CDRP) staffers moved on to work with the psychiatry department to coordinate care for patients with the dual diagnosis of depression and addiction. They also put into place Northern California KP’s innovative Early Start program for pregnant women with drug or alcohol problems, which began in 2003.

Today, 42 KP prenatal clinics in Northern California have a team of specialists who do initial screening and then follow women throughout their pregnancy with a program to counsel and support them in reducing their use. Based on continuing evaluation of the results in baby birth weight and other factors, with the help of the Division of Research (DOR), the program has been expanded to the Hawaii Region and part of Southern California since 2006.

Ambitious research to validate treatment methods

In the intervening years, the “dinosaur” pioneers also began a partnership with TPMG’s Division of Research to study the quality of substance abuse care and possible costs savings realized by providing this type of treatment.

In the October 2000 issue of Health Services Research, TPMG researchers, led by Connie Weisner, doctor of public health, published a study of outcomes for patients who began treatment in KP’s Sacramento alcohol and drug treatment program from 1994 to 1996.

The study, “The Outcome and Cost of Alcohol and Drug Treatment in an HMO: Day Hospital Versus Traditional Outpatient Regimens,” compared the success and costs of an intensive six-hours-a-day program to a two-to-eight-hours-per-week program.1

KP programs offer hope for recovering addicts. Fotosearch illustration

In 2001, Weisner, Moore and others studied the benefits of integrating primary care with substance abuse services at KP Sacramento. They found that substance abuse patients who were mainstreamed were more likely to be abstinent at six months. They continued to track those patients for another nine years and found those who continued to get primary care were less likely to be hospitalized or use the emergency room. 2

It’s taken a lot of research, numerous pilot programs and persistence on the part of Pating and his colleagues, but Kaiser Permanente is moving forward along with the nation in mainstreaming substance abuse treatment.

The research team recently obtained a $2.5 million National Institutes of Health grant for primary care medical teams to screen for substance abuse, offer brief interventions, and study the results.

Health care reform’s impact on addiction care

Full integration will require overcoming the reluctance of primary care doctors to take on increased workloads and to acquire new skills associated with treating addiction, Pating said. But he predicts that in the next five to 10 years there will be major changes in this arena, pushed by mandates in the 2010 Affordable Care Act that require parity between the treatment of substance abuse and other chronic medical conditions.

Pating et al. recently compiled an analysis of the future of substance abuse programs in the new climate created by the health care reform act. The report, published in Psychiatric Clinics of North America in June 2012, reviews current systems and examines the expansion of addiction treatment to include new methods and settings. The report also discusses changing technology, new financing/payment mechanisms and expanded information management processes.

In the journal report, Pating notes that about 23.5 million American adults have a substance abuse disorder, but only 10.4 % receive the addiction treatment they need. He adds that integrating these patients into the primary care setting may be the only hope for some who won’t seek addiction treatment due to societal stigma.3

 

1 “The Outcome and Cost of Alcohol and Drug Treatment in an HMO: Day Hospital Treatment Versus Traditional Outpatient Regimens,” Kaiser Permanente Division of Research staffers Constance Weisner, doctor of public health; Jennifer Mertens, MA; Sujaya Parthasarathy, PhD; Charles Moore, MD, MBA; Enid M. Hunkeler, MA; Teh-wei Hu, PhD, UC Berkeley; and Joe V. Selby, MD, former DOR director, October 2000, Health Services Research.

2 “Integrating Primary Medical Care With Addiction Treatment: A Randomized Controlled Trial,” DOR researchers Constance Weisner, doctor of public health; Jennifer Mertens, MA; Sujaya Parthasarathy, PhD; Charles Moore, MD, MBA; and Yun Lu, MPH, 2001 Journal of the American Medical Association (JAMA).

3 “New Systems of Care for Substance Use Disorders. Treatment, Finance, and Technology under Health Care Reform,” David R. Pating, MD, Kaiser Permanente Division of Research; Michael M. Miller, MD, University of Wisconsin; Eric Goplerud, PhD, MA, University of Chicago; Judith Martin, MD, BAART Turk Street Clinic, San Francisco, CA; and Douglas M. Ziedonis, MD, University of Massachusetts; Psychiatric Clinics of North America, June 2012.

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Twentieth century stigma retards treatment for addiction

posted on August 27, 2012

By Laura Thomas
Heritage correspondent

First in a series
Despite Kaiser Permanente’s early emphasis on preventive health care, pervasive 20th century American attitudes about alcohol and drug abuse curbed Health Plan leaders’ willingness to tackle addiction as a bona fide treatable illness.

“Very few physicians or even psychiatrists are willing to treat the chronic alcoholic, just as few lawyers go into the specialty of bankruptcy law,”
Paul Gliebe, MD, of the University of California medical school, told Kaiser Permanente physicians in 1953. “The chronic alcoholic is in most instances looked upon as a bankrupt personality.”

The American Medical Association (AMA) was also reluctant to empathize with alcoholics, stopping short of declaring alcoholism a disease in 1956, while encouraging hospitals to admit patients suffering from the symptoms.1

“Since the earliest era, (Kaiser) Permanente (KP) physicians had resisted the idea of comprehensive care for alcoholism, self-inflicted wounds, or other self-induced illness,” the late KP San Francisco pediatrician John Smillie, MD, wrote in his 1991 book, Can Physicians Manage the Quality and Costs of Health Care?

This resistance existed despite some early voices in Kaiser Permanente who pointed out what the Permanente organization accepts today – that social and behavioral imbalances lead to disease and the symptoms include addiction and depression, now being recognized as diseases in themselves.

KP psychiatrist Kahn warns addicts need early care

One early KP psychiatrist, Bernard Kahn, MD, sounded an alarm at a Permanente Medical Group planning meeting in Monterey in 1960. From that vantage point, Kahn described the modern, ever-present pressures of managing technology, work and leisure:

“Our national consumption of tranquilizers and alcohol prove we are a nervous nation. Let’s face it: the internist, the surgeon, the general practitioner, our Drop-In (Clinic) physicians are treating this kind of illness – the intangible, aggravating, emotional upsets, day in and day out – regardless of what the Health Plan contract reads.”

Kahn asserted that the Health Plan needed to extend its preventive care to include alcoholics because they would surely develop chronic disease without treatment for their addiction. “(In this area) we’re already too late, and we are covering end-stage disease (caused by alcoholism).”

Dr. Kahn, a retired Navy psychiatrist, was helping to craft a cost-effective and practical psychiatric program, along with The Permanente Medical Group (TPMG) pioneer Morris Collen, MD, in the 1950s. Collen was concerned that traditional psychiatric appointments were too long at 50 minutes and would add unduly to Health Plan costs. He wanted Kahn to develop a program based on a 30-minute appointment. Unfortunately, Kahn died of a heart attack before he could accomplish the task, Dr. Collen said in his 1986 oral history.

KP institutes psychiatry program in late 1950s

In the late 1950s, Kahn and psychologist Nicholas Cummings had been successful in establishing a KP psychiatry program. But treatment for alcoholism and other addictions was kept at arm’s length until it was pushed by the federal government for its employees in 1969, physician leader Raymond Kay, MD, wrote in his 1979 book on the history of the KP Southern California medical group.2

The AMA also took its time to define alcoholism as a disease. It waited until 1967 to declare it a “disease that merits the serious concern of all members of the health professions.” By then, President Lyndon Johnson had publicly called for more study and treatment for alcoholism, and health insurance plans had begun to respond.1

Richard Merrick, MD, then a young internist at KP’s Harbor City Medical Center in Southern California, said he was approached by the department chief in early 1971. “They needed at least one physician from each area to start an alcoholism program.

“There were 12 or 15 doctors in the department at the time and he came to me last because he had been turned down by everyone. There was zero interest at that time in having anything to do with ‘those people’. That was the common mentality at the time.”

Saying ‘no’ to alcohol excess

There was little understanding of the functional alcoholic or socialite imbibing wine, he said, only of the “stinking drunk. There was hardly any concept of addictions being diseases. They were defects of character. It was a matter of choice. These people were ‘bad’ so how could you treat that?” he said.

Dr. Merrick hired a recovering alcoholic to help him organize a one-night-a-week outpatient clinic, which lasted for three-and-a-half years. But if a patient was going through withdrawal symptoms, he or she could not be admitted easily.

“They had to have a seizure to get admitted. That’s how crazy it was for a while,” he remembered. “Once in a while I would sneak somebody in, and I would take all kinds of heat from the Health Plan because they would tell me it wasn’t a covered benefit.”

But industry and the government were determined to extend addiction treatment to as many American workers and their families as possible. Recognizing the need, KP regions began instituting coverage in the late 1970s, usually offering outpatient treatment services through the psychiatry department with a copayment and yearly cap on the number of counseling appointments or group meetings a member could use.

By the early 1980s, alcoholics were no longer falling “through the cracks at Kaiser (Permanente),” according to Andrus Skuja, MD, then chief of the alcohol and drug abuse program in South San Francisco. His comments in an interview in the KP Reporter employee newsletter in December 1982 reflected Merrick’s early experience in Southern California:

The U.S. Post Office issued this commemorative stamp in 1981. Illustration: Catwalk/Shutterstock.

During the 1980s as the nation recognized cocaine as a new addiction problem, KP saw the need to treat many other drug addictions. It was a little tough at first. Many alcohol counselors were not comfortable with “heroin addicts or pill users, and they didn’t seem to realize that the dynamics were all the same. Addiction is addiction,” Merrick recalled. “In the San Fernando Valley, one clinic treated alcoholics and another treated addicts other than alcoholics . . . that lasted for a while.”

Kaiser Permanente resisted the initial trend of sending people to 30-day inpatient treatment programs even though many large employers and well-off unions, such as the longshoremen, were pushing it.  KP established inpatient detoxification programs at KP Fontana for Kaiser Steel Mill employees in 1978 and in Carson just south of Los Angeles in 1988.

Thirty days was the gold standard based on the Minnesota model of alcoholism treatment that health insurers recognized and were willing to pay for. It got a large push when Betty Ford, wife of President Gerald Ford, spoke of her alcoholism in 1978 and later lent her name to the Betty Ford Center for alcoholics and drug addicts.1

Merrick, who was never convinced of the need for the month-long inpatient stay, noted: “We never kept them in for 30 days . . . As it has shaken out, I was right.

“It was just common sense. If you are a functioning alcoholic and not going through detox, why on earth do you need to be in for 30 days when you can do equivalent work on an outpatient basis over a longer period of time, because treatment for alcoholism or any drug is a lifelong thing . . . There is nothing magical about the 30 days.”

This inpatient treatment model died off everywhere in the early 1990s and was replaced by less expensive residential treatment as an alternative for patients with special needs.

Next time: 1990s spawn research and refinement of addiction care

1 Slaying the Dragon: The History of Addiction Treatment and Recovery in America, William L. White, Chestnut Health Systems/Lighthouse Institute, 1998

2 Historical Review of the Southern California Permanente Medical Group, Raymond M. Kay, MD, 1978, publisher: the Southern California Permanente Medical Group.

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KP Northern California marks half a century of stellar research

posted on August 14, 2012

By Lincoln Cushing
Heritage writer

Ellsworth Dougherty, MD, one of KP’s earliest researchers, studied the worm that eventually led to the mapping of the human genome. This photo is from a research trip he took to Antarctica circa 1959. KP Heritage Resources Archive photo

Kaiser Permanente (KP) has a well-deserved public reputation for providing top quality health care, but less known is the health plan’s long and illustrious record for conducting high-caliber medical research. KP is widely considered the leading non-university-based health research organization in the United States, with KP Northern California’s Division of Research amassing more than $100 million in 2011 to conduct research.

This research has a direct effect on health care in this country, influencing the way physicians care for patients and refining broader policies that support medical services. KP researchers, generally partnered with academic institutions, successfully compete for federal research grants, and develop lines of research whose results translate to improved patient outcomes at the local, state and national levels.

Centers for Disease Control and Prevention (CDC) Research Director Jeffrey Harris, MD, put it this way: “If you look at who the leaders in research are and who the folks are that have been doing research… to improve care, it’s a very short list.  And Kaiser Permanente is clearly at the top of that list.” [i]

This year, The Permanente Medical Group (TPMG), oldest of the eight KP regional medical groups, celebrates the 50th anniversary of the founding of its Division of Research (DOR). 

In the past five decades, KP researchers have conducted thousands of studies and helped to solve many medical mysteries – from the best way to cure pneumonia in the World War II shipyards, to making discoveries leading to the mapping of the human genome, to learning the most effective use of drugs to prevent heart attacks.

Gary Friedman, MD, led the Division of Research from 1991 to 1998. This image originally appeared in the KP Reporter, 1987.

The DOR (under its original name, Medical Methods Research, or MMR) was established September 21, 1961, by the Northern California medical group’s Executive Committee. Morris F. Collen, MD, one of the Health Plan’s founding members and a pioneer in the emerging discipline of medical informatics, led the group, which occupied offices in the old KP headquarters at 1924 Broadway in Oakland.

Ten years earlier, Dr. Collen had met with Lester Breslow, MD, then a public health officer in San Jose who had recently completed a trial of “multiphasic screening.” This battery of thorough and efficient examinations was a practical solution to the problem of providing care to large populations despite the post-war shortage of physicians.

This approach was put to the test when labor leader Harry Bridges insisted that all members of the International Longshore and Warehousemens Union (ILWU) be given annual check-up exams as part of a negotiated care package with the Permanente Health Plan. Importantly, this exam approach provided a critical evidence base to empirically determine what screening methods are and are not clinically beneficial for patients.

Morris Collen, MD, was the first director of the Northern California research department, established in 1961. KP Heritage Resources Archive photo

In 1962, KP Northern California received its first grant from the U.S. Public Health Service to develop, automate, and evaluate the multiphasic exam. Within three years, the Health Plan’s Oakland and San Francisco clinics began offering automated multiphasic health testing (AMHT) to all members. In 1968 Dr. Collen dismissed some of the resistance to this use of technology:

“Many physicians are concerned that the computer is depersonalizing medical care,” he said. “Just the opposite is true. Because of the computer, the physician will have more individualized information about his patient—more complete and more accurate than he could possibly have gathered before.”[ii]

Antecedents to Permanente medical research

Even before the Health Plan went public in 1945, Henry J. Kaiser articulated research as one of its goals at the August 21, 1942, dedication of the Permanente Foundation Hospital in Oakland.  As KP historian Tom Debley observed:

Illustration for article on medical research, Kaiser Foundation Medical Care Program Annual Report 1968

“From prepaid dues it collected, the Permanente Foundation paid for the medical care of Health Plan members and accumulated funds for such charitable purposes as medical research and the extension of medical services to larger population. . .The idea that research would be a tool to bring advances in medicine to the plan’s dues-paying members thus was embedded in the medical care program from the outset.”[iii]

In 1943, founding physician Sidney R. Garfield received $25,000 from the Permanente Foundation to study new methods of curing syphilis[iv] and he launched the Permanente Foundation Department of Medical Research under the leadership of Franz R. Goetzl, PhD, MD. He also started the research journal Permanente Foundation Medical Bulletin, edited by Dr. Collen from 1943–1953.

The Department began to receive national recognition for outstanding work in the study of peptic ulcers, human appetite, and pain. By 1949 the name was changed to The Permanente Foundation Institute of Medical Research to clarify that the research was not only a department within the hospital.

 

Ernest Saward. MD, medical director of KP Northwest from 1945 to 1970, launched the region’s research center in 1964. KP Heritage Resources Archive photo

In late 1958, research involving basic medical sciences was shifted to the Kaiser Foundation Research Institute (KFRI), established by Kaiser Foundation Hospitals to coordinate long-term basic research projects supported by grants from sources other than the Kaiser Foundation Medical Care Program.[v] At first this just covered Northern California’s MMR and the Northwest research center (established in 1964.)

Today, all Kaiser Permanente regions – Hawaii, Georgia, Ohio, Colorado, Northwest, Northern and Southern California, and Mid-Atlantic States, conduct research under the auspices of the KFRI.

By 1961 KFRI’s domain included more than 50 long-range clinical research studies exploring such medical problems as cardiovascular and renal diseases, adenovirus infections, cancer, diabetes mellitus, and psychosomatic medicine. More than 70 staff physicians and residents conducted these investigations, often in collaboration with laboratories at nearby medical and scientific institutions.

Clifford H. Keene, MD, chief executive officer of Kaiser Foundation Hospitals and Health Plan, was named director of KFRI.[vi] A wing of Kaiser Foundation Hospital in Richmond was remodeled to bring together several disparate research projects under the KFRI umbrella.

Laboratory of Comparative Biology Annex, 1301 Cutting Blvd., Richmond, CA, October 1961. KP Heritage Resources Archive photo

These included a Laboratory of Comparative Biology (under Ellsworth C. Dougherty, PhD, MD) studying the basic physiology of microorganisms; a Laboratory of Medical Entomology (under Ben F. Feingold, MD) investigating the role of insects in causing human allergies; a Laboratory of Human Functions; a study of the Epidemiology of Human Cancer; and a Child Development Study and Blood Grouping project that investigated congenital abnormalities and childhood diseases.

KP Northern California research evolves

During the late 1960s Edmund Van Brunt, MD, a project director for MMR, piloted the San Francisco Medical Data System, a computer-based patient medical record system with a database that supported both patient care and health care delivery  research. By 1973, Health Plan members in San Francisco had a computerized “lifetime” medical record, and pivotal work was conducted to begin to understand the safety of prescription drugs.

But by the early 1970s researchers were forced into a different avenue of research when the Nixon Administration abruptly canceled the department’s funding. The loss of $500,000 per year led to shutdown of the hospital computer system in San Francisco, but the application of computers and databases in medicine and health research continued, supporting new investigators and new areas of research.In 1979 Dr. Van Brunt succeeded Dr. Collen as the second director of the research department (MMR), and in 1986 he changed the name to the current Division of Research (DOR) to more accurately reflect the expanded mission and scope of clinical and other types of research that were being conducted there. Recently he described his vision of the program:

Mary Belle Allen, a basic scientist, conducted her studies in the Richmond KP laboratory along with Ellsworth Dougherty, MD. This photo is from the KP Reporter, 1959

“[We] conducted high quality health services and biomedical research, epidemiologic and vital statistical analysis of the whole variety of medical care processes. . . of different collections of people drawn . . . from the Health Plan membership and by different collections of people . . . males, females, different ethnic groups, young and old.”

Van Brunt continued: “. . . The mission is to use these resources to conduct the kinds of health services research that we feel are important not just to the organization but important in a larger sense.”[vii] Dr. Van Brunt expanded DOR’s research agenda by adding a department of Technology Assessment headed by Director Emeritus Collen.

In 1985 KP Northern California opened its first research clinic to support the heart disease research study CARDIA (Coronary Artery Risk Development in Young Adults). Within a year it was looking at a group of 5,115 black and white men and women aged 18-30 years in four centers – Birmingham, Chicago, Minneapolis and Oakland. Also in 1985, MMR began the Vaccine Study Center as a way of responding to numerous requests to use KP’s large population for vaccine efficacy studies.

The center currently operates 31 sites in Northern California and collaborates with KP’s Northwest, Hawaii, and Colorado regions and participates in several Centers for Disease Control and Prevention and National Institutes of Health studies.

Studies to better understand HIV/AIDS impact

During the AIDS crisis in the 1980s, DOR proved its worth in analyzing the impact of the disease. KP Northern California was second only to San Francisco County’s public health services in the number of people with AIDS it treated in the initial years of the crisis.  

Consequently, KP researchers knew how many patients were actively seeking treatment, but they didn’t know how many of its members were infected yet untreated.  Anonymous analysis of blood samples taken during routine checkups of 10,000 Kaiser Permanente patients in late 1989 told DOR researchers that 1 in 500 of its members was infected with HIV/AIDS.[viii]

Gary Friedman, MD, succeeded Dr. Van Brunt as director in 1991. During Dr. Friedman’s seven-year tenure, the DOR conducted important research on the etiology, prevention and early detection of cancers; on prevention and treatment of cardiovascular disease and diabetes; on the determinants of health care utilization; and on population approaches to chronic diseases.

Early research on the effects of socioeconomic status, race and ethnicity on health care and outcomes laid the foundation for the DOR’s ongoing involvement in health disparities research.

In 1994, KP Northern California became a founding member of the Health Maintenance Organization Research Network (HMORN), ushering in an era of large-scale collaborations seeking to integrate research and practice for the improvement of health and health care in diverse populations.

Long chain of clinician-researcher leaders

Joe Selby, MD, MPH, took the helm in 1998, and former research investigator Tracy Lieu, MD, MPH, was appointed director in 2012, continuing DOR’s unbroken line of leadership by clinician-researchers. 

Currently, 58 researchers and over 500 research staff continue DOR’s work in health care delivery research, outcomes research, clinical trials, epidemiology, genetics/pharmacogenetics (how individuals react to drugs), effectiveness and safety research, sociology, qualitative research (conducting patient interviews to better understand study data), and quality measurement and improvement.[ix]

Kaiser Permanente’s massive member database and consistent medical record keeping, maintain medical informatics as the cornerstone of KP research in fields such as cardiovascular disease, cancer, metabolic disorders, dementia, autism, infectious diseases, osteoporosis, maternal and child health, chemical dependency and mental health. Dr. Friedman, Division of Research scientist emeritus, touts KP data as offering “the best epidemiologic workshop in the world.”

KP Northern California research also leads or co-leads several national research collaboratives sponsored with federal funds involving multiple KP and non-KP organizations, including the Cardiovascular Research Network (CVRN), Cancer Research Network (CRN), Vaccine Study Datalink (VSD), Developing Evidence to Inform Decisions about Effectiveness (DEcIDE), Accelerating Change and Transformation in Organizations and Networks II (ACTION II), among others.

Overall, DOR has a remarkable history filled with contributions to the health of KP members and the broader community. DOR is committed to expanding its impact through better understanding of the underpinnings of risk factors and diseases, determining methods for effectively preventing and detecting these conditions, delineating the natural history of diseases, identifying ways to improve outcomes and the overall delivery and organization of health care.

 

Thanks to Alan Go, MD; Maureen Mcinaney; and Marlene Rozofsky Rogers at DOR for their contributions in the preparation of this article.

For an introduction to DOR research scientists and their work, please visit:
www.dor.kaiser.org 

For more information, including all of the published work of DOR authors, please visit The Morris F. Collen, MD Research Library, 2000 Broadway, Oakland, CA.

Also see “Something in the Genes: Kaiser Permanente’s Continuing Commitment to Research,” by Robert Aquinas McNally, Permanente Journal, Fall 2001
<http://xnet.kp.org/permanentejournal/Fall01/genes.html>

 short permalink to this article: http://bit.ly/RM39iE

 


[i] “Perspectives – Research,” [videotape] [Oakland (CA):] Kaiser Permanente MultiMedia Communications; 1998, quoted in “Research in Kaiser Permanente: A Historical Commitment and A Future Imperative,” Robert Pearl, MD, Permanente Journal, Fall 2001.

[ii]Kaiser Foundation Medical Care Program Annual Report 1968.

[iii] The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, by Tom Debley, The Permanente Press, 2009.

[iv] Correspondence November 1, 1943 from E. E. Trefethen, Jr., Trustee of the Permanente Foundation, to Dr. Garfield; letter is an appendix to the Cecil C. Cutting Regional Oral History Office interview 1985 by Malca Chall, <http://www.oac.cdlib.org/view?docId=hb8p3006n8&brand=oac4&doc.view=entire_text>

[v]Kaiser Foundation Medical Care Program Annual Report 1961.

[vi]KP Reporter, September 1959.

[vii] Interview June 13, 2012 by Bryan Nadeau, Senior Producer Northern California Multimedia.

[viii]AIDS research among Kaiser’s quiet studies,”Carolyn Newbergh, Oakland Tribune, 10/8/1991.  The published medical research finding is: Hiatt RA, Capell FJ, Ascher MS.; Seroprevalence of HIV-type 1 in a northern California health plan population: an unlinked survey.; Am J Public Health. 1992 Apr;82(4):564-7.; PubMed PMID: 1546773; PubMed Central PMCID: PMC1694106.

[ix] http://www.hmoresearchnetwork.org/members.htm#dor

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Millie Cutting: physician’s wife makes her own mark

posted on July 27, 2012

By Ginny McPartland
Heritage writer

Millie Cutting in the early years of Permanente Medicine. Kaiser Permanente Heritage Archives photo

Millie Cutting was the wife of Kaiser Permanente’s pioneering chief surgeon Cecil Cutting, but her influence on the fledgling medical program during World War II contradicts any cliché prescribing the role of a doctor’s spouse. She was a vibrant, energetic force in her own right, a good woman behind a good man, but much, much more.

The Cuttings met in Northern California at Stanford University in the early 1930s. He was training to become a physician; she was a registered nurse with a degree from Stanford. They met on the tennis courts and married in 1935.

During her husband’s nonpaid internship, Millie Cutting worked two jobs – for a pediatrician during the day and an ophthalmologist in the evenings – to pay the bills. He was making $300 a month as a resident when Sidney Garfield, MD, contacted him about joining the medical care program for Henry Kaiser’s workers on the Grand Coulee Dam in Washington State.

Millie was at first reluctant to leave San Francisco to relocate in the desert. But when Cecil convinced her that he would have more opportunity as a surgeon with Garfield than in San Francisco, she was game.  “Oh, she was willing to go along; she had a lot of spirit and enthusiasm,” Cecil Cutting said in his oral history.

“I think with a little reluctance, perhaps of the unknown,” he told interviewer Malca Chall of UC Berkeley’s Regional Oral History Office in 1985. “We didn’t have any money. She had worked during my residency as a nurse, to keep us in food.”  Sidney Garfield was able to match the $300 Cutting was earning at Stanford to get him to Coulee.

A rough start at Grand Coulee

Unfortunately for Millie, things at Coulee didn’t start out too well. John Smillie, MD, writes: “Cecil and Millie Cutting resided in the company hotel. They were flat broke. The young couple had exhausted their resources getting to Washington. Neither of them thought of asking for an advance.”1

“My wife couldn’t take the heat very well,” Cutting told Smillie. “She would lay on the bed with a wet sheet over her; and we didn’t have enough money to eat, really. She would go to the cafeteria and see how far she could stretch a few pennies to eat. Of course, I ate well at the hospital and had air conditioning and everything.

Cecil Cutting, a surgeon, and Millie Cutting, a registered nurse, both graduates of Stanford University, married in 1935. Kaiser Permanente Heritage Resources Archives photo

“She finally learned to come over and sit in the waiting room on the very hottest days. Since then, Dr. Garfield laughed at us and said, ‘Why didn’t you ask me for money?’ We didn’t know enough to do that!”

“At the end of the first discomforting month, Cutting received his first paycheck for $350,” Smillie writes. “He and Millie moved into a remodeled schoolhouse, the largest home in the community, and it soon became the social center for the physicians and the Kaiser executives.”

Millie gets her groove back

During the rest of their time at Coulee, Millie not only got her energy back but she exhibited her strength as a staff nurse and as a community volunteer. Probably her most significant contribution was the development of a well-baby clinic in a community church. As a volunteer, she organized the clinic and went door to door soliciting funds for its operation. She had no qualms about knocking on the portals of the town’s brothels.

“The madams were very friendly,” Cecil Cutting told Smillie. “The community church provided the space, and the houses of ill repute the money – a very compatible community.”

Garfield’s right hand ‘man’ at wartime shipyards

Millie and Cecil Cutting with Kaiser Permanente physician co-founder Sidney Garfield (right) at Oakland Kaiser Foundation Hospital, 1943. Kaiser Permanente Heritage Resources Archives photo

The Grand Coulee Dam was completed in 1940, and the medical staff and their families scattered. The Cuttings settled briefly in Seattle where Dr. Cutting set up a surgery practice. But it wasn’t very long before World War II broke out and Dr. Garfield was called upon again to assembe the medical troops.

Cecil Cutting was the first physician to arrive in Richmond, California, where Henry Kaiser set up four wartime shipyards. Millie Cutting volunteered to work side by side with Sidney Garfield to get the medical care program up and running and to take charge of any job that needed to be done.

She recruited, interviewed and hired nurses, receptionists, clerks, and even an occasional doctor, to staff the health care program that was set up in a hurry in 1942. She smoothed the way for newcomers and helped them find homes in the impossible wartime housing market.

Thoroughly adaptable Millie drove a supply truck between the Oakland and Richmond hospitals and the first aid stations and served as the purchasing agent for a time. As she had done at Grand Coulee, Millie set up a well-baby clinic for shipyard workers’ families, and she opened her home in Oakland as a social center for the medical care staff.

Perturbing postwar perceptions

After the war, Millie and Bobbie Collen, wife of Morris Collen, MD, started a Permanente wives group in 1949. The association created a support system against an often hostile medical establishment that shunned prepaid group practice of medicine as “socialist.” The physicians were not allowed in the local medical society, and the women felt socially ostracized.

“They organized themselves as the Permanente Wives Association, which had a nickname, ‘Garfield’s Girls,’ ” Smillie wrote. “They had dances, parties, picnics and social outings several times a year that were really a lot of fun. The auxiliary. . .became famous for its rummage sales.”

Millie and Cecil Cutting with daughter Sydney and son Christopher, circa 1948 in Orinda, California. Kaiser Permanente Heritage Resources Archives photo.

The Cuttings became good friends with Sidney Garfield, and in fact, he spent periods of time living with them in their Orinda home in the 1940s and 1950s. Cecil Cutting credits Garfield with the couple’s decision in 1948 to adopt their two children, Sydney and Christopher. “He talked us into it,” Cutting said.

Garfield often went to them for advice about business matters, as well. “I think he talked over a lot of things with Dr. Cutting and Millie,” said Smillie in his oral history. “He had a great deal of confidence in their judgment. If they told him he was wrong, he was able to accept it.”

The Cuttings were the friends Garfield chose to share the happy moment of burning the mortgage papers once the renovated Fabiola Hospital (the first Kaiser Foundation Hospital in Oakland) note was paid off.  The private celebration took place in the Cuttings’ home with just Garfield and Millie and Cecil present.

Dr. Cutting worked his way up to become the executive director of The Permanente Medical Group in 1957 and retired in 1976 after 35 years as a major figure in the organization. Millie Cutting continued to volunteer at the Oakland Kaiser Foundation Hospital all of her life. She had to quit in 1985 when she became too ill to leave her house. She died that year at the age of 73. Cecil Cutting received a flood of condolence notes from all the people whose lives Millie had touched.

One woman wrote: “When life seemed just too much, Millie’s unforgettable laughter would ring in my mind’s ear, and the will to tackle life again would be there like a gift from her. She didn’t just give. She was a gift.”

1 John Smillie, MD, Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group, McGraw-Hill Companies, New York, 1991

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The “Positive Lounge” at the 2012 International AIDS Conference

posted on July 24, 2012

By Bryan Culp
Heritage director

Kaiser Permanente, not a newcomer to the 30-year struggle to alleviate the suffering of AIDS patients, is the sponsor of The Lounge for People Living with HIV/AIDS at the XIX International AIDS Conference in Washington, DC. The “Positive Lounge,” a quiet corner of rest and support, provides refuge from the hurly burly of the momentous event.

This week 25,000 clinicians, researchers, activists and journalists from the world over convene for a week chock-full of lectures and symposia on the epidemiology of the disease, research for a cure, and progress on halting the rate of infection. Not a few of the delegates and attendees live with HIV/AIDS, and we anticipate 12,000 or more visits to the “Positive Lounge.”

One observer has described the biennial congress, first held in 1985, as a “cacophonous, confusing, crowded, interesting and exhausting” event for all involved, especially for those attending who are living with HIV. Each conference has a way of “calling up feelings of despair, surprise and solidarity.” Midst all of this the Lounge offers intervals of rest for those who need it.

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

According to UNAIDS, the United Nations agency that tracks HIV/AIDS, of the 34 million people worldwide who live with HIV, 8 million partake in the growing armament of anti-retroviral therapies, and one million of these live in the United States. The medications taken in a combination of three or more, the “drug cocktail,” may induce fever, nausea, and fatigue. Daily regimens require strict adherence and involve the downing of several pills with or without meals and/or other medications. The drugs can rob one of appetite even while diets high in protein and carbs are needed to combat weight loss and fatigue.

The case could be made that the Lounge, as part of the Conference, mimics the range of treatments for AIDS itself. There is an intensity to a conference, a rapid paced relentless sea of schedules and presentations. The Lounge, on the other hand, offers an opportunity to reflect, to absorb, and to recalibrate. Good medical care requires an understanding of pacing, of tempo, and of balance. Too many drugs too fast can cause harm – and everybody responds a little differently, as does one’s own body over time.

During the early years of the epidemic there was so little known about the disease and of treatment options that mistakes were made. But with analysis, reflection, and the direct participation of patients and caregivers, solutions were found. Kaiser Permanente researchers contributed to the body of knowledge needed to improve HIV/AIDS care.

When two nurses at a non-KP facility were so fearful that they refused to enter a patient’s room, Kaiser Permanente reacted. San Francisco Medical Center Infection Control nurse Barbara Lamberto remembers: “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.”

The epidemic is far from over and more solutions remain to be found. Kaiser Permanente is proud to help be part of that process.

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KP Heritage writer uncovers uncle’s stint as shipyard reporter

posted on July 13, 2012

By Lincoln Cushing
Heritage writer

KP Heritage writer Lincoln Cushing's Uncle Bob was a reporter for the Richmond wartime shipyard publication Fore 'n' Aft.

Serendipity is the secret bonus of academic research. You can be prowling through documents, methodically and tediously looking for a particular item, when something unexpected comes along and gobsmacks you.  I had just such a moment yesterday, as I was looking for photos of women on the various sports teams that served as recreational diversion during the hard work of shipbuilding during World War II.

My go-to source was Fore ‘n’ Aft, a sprightly weekly magazine published for the 93,000 workers in the four Richmond (California) Kaiser Shipyards where the Kaiser Permanente health plan was born. But in the course of learning about baseball teams with occupation-themed names like the “Yard Three Burners” and the “Grave Steamfitters,” I saw a captioned photo of my maternal uncle, Robert Heizer.

I knew that Robert, a distinguished U.C. Berkeley anthropologist who died in 1979, had worked in the Richmond yards during the war. It was family lore that he had replaced his security badge photo with that of a gorilla, just for kicks, and never got caught. I had even learned from one of my cousins that Robert had been a steamfitter. But no one knew much more than that.

The photo in the October 29, 1943, article has the uncomfortable but period-authentic caption “Bob Heizer is trying to decide whether to squash Mr. Jap or push him into oblivion.” A curious caricature of an Asiatic enemy (Hideki Tojo?) peeks out of a pipe, and my somber uncle is contemplating the absurd tableau.  

The accompanying short article extols his academic status and professional accomplishments, and goes on to describe his shipyard role as steamfitter leaderman (subforeman) and spare time reporter for Fore ‘n’ Aft.

There you have it, the circles close in. My uncle was also writing for a Kaiser publication, ten years before I was born. The world of information may be hurtling along at breakneck speed, but much of the human record remains outside the grasp of search engines and data mining.

Manual research still reveals unknown nuggets, and writers still put those pieces together into a compelling narrative.  The vast human organism that was the Kaiser shipyards lives on as the vast human organism called Kaiser Permanente, striving to thrive and make the world a better place.

Here is the article from Fore ‘n’ Aft about my uncle, Bob Heizer.

“It’s a pipe to Bob!”

Whether it’s hooking up a steam line, digging for prehistoric relics, or writing a story for Fore ‘n’ Aft, it’s all a pipe to Bob Heizer. And by the way, if you have a spot o’ news and don’t know just how to tell it, look for Bob in his little cubbyhole headquarters hidden under the starboard side of Way Four; he’s a spare-time official Fore ‘n’ Aft reporter.

Bob has lived variously in Denver, Washington, D.C., and among the jackrabbits and sagebrush of Nevada. Graduated from U. of Cal. and also took a Ph.D. in his favorite study, archaeology. Spent two summers with a Smithsonian expedition digging long-buried Eskimo bones from their graves in the Aleutian Islands, and two more summers at Drake’s Bay in Marin Co. digging up remains of a Spanish ship wrecked there in 1595.

Bob is a steamfitter leaderman in Yard Two, which does not mean that he takes two pieces of steam and fits them together, but he does spend most of the time bumping his head and skinning his knees in the double-bottoms. Says he likes his job mainly because he doesn’t think the Japs are pleased to have him doing it.

Hard hats off to you, Uncle Bob.

 

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Kaiser Permanente: Seeds Planted Amid Rancorous 1930s Health Care Debate

posted on June 30, 2012

This blog was originally posted on August 7, 2009

By Ginny McPartland
Heritage writer

Ig Falk, 20th Century public health hero few people know

Isidore “Ig” Falk was a 20th Century hero, but most Americans have never heard of him. Falk was a major figure in the 1930s to 1980s discussion of how health care should be organized in America. He was the head of research for the Senate Committee for the Costs of Medical Care (CCMC), whose voluminous report was published in 1932.

Falk, educated at Yale with a PhD in Public Health, was largely responsible for writing the committee’s recommendations that called for prepaid group practice and integrated health care in America. The committee said that fee-for-service health care should continue to exist, but that in some fashion, quality health care should be made accessible to everyone, rich, poor, and in-between. The committee majority figured that prevention of illness, like public education, was good for the country, as well as for the common man.

Garfield—A grass roots approach

As Ig Falk pursued these ideals on a national scale, another of my heroes—Sidney R. Garfield—was busy putting these ideas into practice on a grass roots level. Born in humble circumstances, Garfield attended medical school at his parents’ insistence and was out to make a living in California during the Great Depression.

For all the right reasons, Falk spent a good chunk of his life advocating for the principles embodied in the committee recommendations. Alas, due to political circumstances, i.e., charges that he was pushing socialized medicine, and a lack of public understanding and support, Falk didn’t succeed in achieving prepaid, coordinated medical care for all Americans. (He’s still a hero in my book.)

Tom Debley's biography of Sidney Garfield, MD, Kaiser Permanente founding physician

Sidney Garfield took care of industrial workers in the California desert on a fee-for-service basis. He soon realized he couldn’t make it if he waited for the patients to come to him. So he made a deal with the workers’ insurance company to pay him in advance for the workers health care. Voila! Prepaid health care that was affordable and sustainable.

Garfield’s troubles begin

With the help of industrialist Henry J. Kaiser, Garfield enhanced and refined his methods of health care delivery and brought them to the World War II home front, and in 1945 introduced his brand of care to the public. That’s when his troubles really began.

Like Falk, Garfield had to fight. He had to fight to keep himself out of jail and in the business of taking care of people. Not only did they call him a socialist or communist, his opponents said he was violating medical ethics, and he was brought up on charges for running a group practice. Anyone who tried to join Garfield’s medical group was scorned by their peers and warned against ruining their careers by being associated with this renegade doctor.

Fortunately, Garfield did not fail. Amid all the obstacles, Garfield kept it together and with the support of organized labor and physicians in academic medicine, today his legacy lives on in Kaiser Permanente. He’s the fellow who pushed his colleagues to get into computers in the early 1960s. He’s the one who pushed the idea that if you screened patients for signs of early chronic illness, you could slow down or stop the advance of disease.

A great model of health care

Garfield is my hero because he persisted in his mission to keep his modest plan alive. He won myriad battles and left us Kaiser Permanente as one of the U.S. models of health care that works. I’m personally glad because I’m one of the lucky ones who have good, no great, health care.

One period of my life when I wasn’t a member of Kaiser Permanente, I sought a mammogram, a vital preventive screening for women. I picked a radiologist out of a network book and I had the exam. Up to a year later, I was still receiving past due notices that my insurance had not paid the claim.

In contrast, in the past two months, I’ve received several letters and phone calls from Kaiser Permanente reminding me that it’s time for a mammogram. When I went in for the exam at a convenient evening hour, my copayment was waived. Somehow I get the feeling that someone is watching over me. Wow!

Health care reform still a discussion

As I’m sure you know, the people in Washington today are wrangling over health care reform again (read, still). Right now the quest for change seems to be stymied by political special interests. Reminiscent of Falk’s time and renewed conversations in the 1940s and the 1990s, transformative change remains elusive. Perhaps a 1997 discussion of Falk’s challenges by Alan Derickson, PhD, in the American Journal of Public Health can help us reach a solution to benefit all Americans:

“If a chorus of demands from many sources were to drown out overheated ideological claims, public discussion might shift to a fuller consideration of human need and the capability of an affluent society to meet it.”

To learn more about Sidney R. Garfield, MD, you can read: Dr. Sidney R. Garfield: the Visionary Who Turned Sick Care into Health Care. The newly released book illuminates for the first time the details of Garfield’s professional and personal struggles and triumphs.

 

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KP early physician leader views health care future from 1966 vantage

posted on June 25, 2012

By Ginny McPartland
Heritage writer

Cecil Cutting, MD, led The Permanente Medical Group from 1957 until 1976. Kaiser Permanente archives photo

As we wonder and worry about the fate of health care in America, it’s interesting to look back at how Kaiser Permanente physician leaders saw the future just after the 20-year-old health plan got a firm foothold in the 1960s.

Cecil Cutting, MD, executive director of The Permanente Medical Group, told of his worst fears in a talk to a group of hospital administration graduate students at the University of Chicago on Nov. 17, 1966.

“Looking ahead, there seems little doubt but that our present ‘derangement’ of providing medical care is totally inadequate to absorb the onrush of the technological revolution that is now upon us, even if the rising personnel costs can be absorbed,” Cutting lamented.

“The tempo of the hospital has changed from a relatively easy-going, low cost charity institution to a competitive, high cost one, with third parties paying the costs and becoming ever more critical of hospital management,” Cutting said.

A 1935 Stanford Medical School alumnus, Cutting joined Sidney Garfield when he established a medical care program at the Grand Coulee Dam job site in the late 1930s. During the war, Cutting also took a leading role in Garfield’s Kaiser wartime shipyard program in Richmond, California.

1960s changes threatened traditional medical care delivery

Cutting was talking about the mid-1960s climate that included newly enacted government-paid Medicare-Medicaid programs for the elderly and poor, a flood of new medical technology, health care professionals’ demands for higher pay and a proliferation of union and company health plans for workers.

With the blessing of KP founding physician Sidney Garfield, Cutting laid out the problem: “Today we have many individual, unrelated, competitive hospitals seldom organized among themselves as a team, for the most part with unorganized staffs of physicians, serving an unknown population – a population unknown both in numbers and in health requirements.

“The consequences of continuing along our present path of complete disorganization are staggering and make the need to change methods of organizing medical care inevitable,” he told the group.

Kaiser Foundation Hospital in Oakland, circa 1966. Kaiser Permanente archives photo

Cutting warned that high technology was too expensive for an individual institution to purchase on its own. He said a system should be established in which medical facilities are designated as one of three types: a community preventive health center; a service hospital for routine care, such as trauma, appendectomy, hysterectomy, maternity, hernias, cancer surgery, pediatrics and psychiatry; and a “super-specialty” hospital.

‘Super-specialty’ hospital to optimize high technology use

The highly specialized treatment facility envisioned by Cutting (perhaps the precursor of a center of excellence) would be designed for handling neurological cases, open-heart surgery, megavoltage radiotherapy – the types of cases that required the most sophisticated equipment.

Here, specialists would take care of a sufficient number of patients referred from other facilities to optimize utilization of the equipment and highly skilled staff.

As it happened, Kaiser Permanente was in the process of developing such a system by this time, and Cutting could report its success to his audience. “In Northern California area the Kaiser Permanente program is working along these lines, though it is by no means a finished demonstration,” Cutting said.

“The (Kaiser Permanente) group practice-prepayment arrangement is, in itself, a step toward improving organization of medical care and undoubtedly makes accomplishment of further organization considerably easier to attain.”

Health assessment staff greet a longshoreman ready for his battery of tests, 1961. Kaiser Permanente archives photo

Health center concept proposed

The health center concept, which Cutting called “predictive and preventive medicine,” had already been developed and was in operation in KP Northern California.  “Forty thousand patients a year are being given an extensive health questionnaire (to complete), updated each year, and an automated battery of some 20 test measurements plus 18 laboratory procedures amounting to almost 1,000 different characteristics on each patient,” Cutting continued.

With this information, all recorded in a computer data base, KP physicians compiled knowledge of each patient’s changes from year to year. This information helped physicians to predict illness and to advise patients and their families about how to prevent chronic illnesses such as diabetes, heart disease and cancer.

Annual physicals usually include eye exams, as well as other preventive screenings. Kaiser Permanente archives photo.

Data compiled about whole populations, i.e. KP members, also helped researchers answer such questions as: Can treatment of asymptomatic patients with a slight increase in blood sugar prevent diabetes altogether or merely postpone the disease? With data from a questionnaire about a patient’s psychological state, researchers compared the effectiveness of psychiatric services versus medical office visits for reducing total visits for emotionally disturbed patients.

Too many specialists spoil the broth

Cutting complained to his audience that medical schools were turning out too many specialists, a trend that threatened basic medical care. “It would appear that the rush for super-specialization may be leaving behind an ever widening gap in well rounded, competent medical judgment.

“Though the individual episode of care may be superb, it certainly does little for the orderly development of efficient, economical medical care as a whole.”

In what must have surprised many, Cutting suggested that medical education should develop a new type of medical doctor: the preventive, predictive specialist. “Following the natural development of disease of entire families over long periods, alerted to early changes through the screening program, he becomes a health specialist.”

Today, both primary care and preventive medicine are specialties recognized by the American Board of Specialties.

A pilot Health Education Center opened in Oakland in 1967. Sidney Garfield, MD, champion of Total Health, stands next to the transparent woman, one of the center's displays.

Kaiser Permanente has advanced Garfield and Cutting’s ideas about preventive care and health appraisals in a variety of ways over the decades. KP physicians promoted healthy eating and exercise for the workers in the World War II Kaiser Shipyards, and they began offering preventive testing in the 1950s for members of the longshoremen union and other groups.

KP’s ‘Total Health’ concept emerges

In the 1970s, health education centers were established to teach patients how to stay well; Garfield’s Total Health Research Project launched in the 1980s led to the opening of special centers where  healthy patients received their routine care.

Centers for preventive medicine functioned within KP for many years, largely giving way to periodic screenings for particular diseases such as breast and colon cancer, heart disease, hypertension and diabetes. Healthy Living programs, an expansion of member health education, have flourished in the past decade offering many classes in good nutrition, exercise, smoking cessation and stress reduction.

Cutting ended his talk with a few wishes for the future: community institutes to teach people to preserve their good health, easily shared electronic medical records, and above all, cooperation among health organizations to provide a broad spectrum of care – from the preventive to the most complicated.

“When (all) care, whether in super-specialty hospitals, service hospitals, extended care, office or home, is correlated . . . I will begin to see hope,” he said.

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