Posts Tagged ‘San Francisco Kaiser Permanente’

Breast cancer isn’t just a woman’s issue

posted on October 8, 2014

Lincoln Cushing
Heritage writer

Kaiser Permanente physician Monte Gregg Steadman (1921-2010) enjoyed a prestigious career as an outstanding head and neck surgeon and teacher. Throughout this conventional career, he also struggled against conformity, militarism, and prejudice in many ways, and made his mark as a committed humanitarian as well.

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“Breast cancer isn’t just a woman’s issue” poster, 2005

For a former military physician and athletic male who had played football at UCLA, perhaps being tackled by a potentially fatal disease revealed his bravery best. In 1966, Steadman was diagnosed with breast cancer and had a radical mastectomy, which he wryly noted “Ended his chance to be a world-class handball champion.”

This 2005 poster featuring Dr. Steadman was a stunning public education message about the disease few men think will affect them; that warning still rings true.

Confronting and overcoming obstacles

In 1954, when he was appointed chief of Head and Neck Surgery at the new Kaiser Permanente hospital on Geary Street in San Francisco, he was denied membership in the SF County Medical Society because he worked at KP. “It was felt at the time that we were a threat to private practice,” he later said.

In 1969, he met and mentored a young plastic surgery resident at Stanford Medical Center, Dr. Robert Pearl, now the executive director and CEO of The Permanente Medical Group. TPMG’s 8,000 physicians serve KP in all of Northern California. Steadman retired from Kaiser in 1982.

An item in the December, 1959 staff newsletter KP Reporter described another way in which he defied conventional norms:

Drs. Monte Steadman and John E. Hodgekiss came down from San Francisco to help us out in ENT clinic. Dr. Steadman’s method of transportation fascinated us to no end as he arrived on his dashing motorcycle equipped with crash helmet and suede jacket. Behind him rode his briefcase and necessary charts, neatly tied to the seat with nylon cord. Ah, how wonderful it is to be young!

Dr. Steadman was equally outspoken about social injustice. In 1962 his strong anti-war beliefs drew him and two other men to sail into an atomic test zone off Johnson Island in the Pacific Ocean in an attempt to stop the test and draw international attention to nuclear disarmament.

The following year a KP Reporter article described further his commitment to social change:

Dr. Monte Steadman at KP SF, KP Reporter May 1963.

Dr. Monte Steadman at KP SF, KP Reporter, 1963.

Dr. Monte Steadman, of ENT at Geary, appeared on TV station KQED recently. As a speaker on the program “Dissent,” he urged society to reject force and violence whose use we freely condemn in our enemies. He praised the Negroes of the South who, with their Northern supporters, are resisting injustice without retaliating in kind for the mindless violence done to them.

We salute the fearless physicians like Dr. Steadman who have contributed to the mission of Kaiser Permanente, which exists to “provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.”

Kaiser Permanente continues to be a leader in tackling breast cancer, especially early detection. In 2012 the National Committee for Quality Assurance reported that KP breast cancer screening rates for women were the best among health care providers in all the regions KP served.

 

Short link to this article: http://bit.ly/1scZ0Yt

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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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Kaiser Permanente’s early struggle to stand up to AIDS

posted on December 2, 2011

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

Lincoln Cushing
Heritage writer

 

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

The epidemic appears

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

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

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

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

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

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

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

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

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

She describes how Kaiser Permanente responded with reason and balance:

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

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

Patients get involved in care

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

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

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

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

Documentary highlights Kaiser Permanente’s central role

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

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

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

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

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

The strength of many

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

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

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

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

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

Kaiser Permanente continues to lead

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

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

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

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


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

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

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

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

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

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

7 Dave Mahon, from film transcript, ibid.

Mr. Sokolksi, from film transcript, ibid.

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

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