Posts Tagged ‘sidney r. garfield’

Henry J. Kaiser in Modern Healthcare’s Health Care Hall of Fame

posted on February 7, 2011
By Bryan Culp

Director of Heritage Resources

Henry J. Kaiser, inducted into Health Care Hall of Fame

Henry J. Kaiser (1882-1967), the co-founder of Kaiser Permanente and a titan of industry during the first half of the 20th Century, has been inducted into Modern Healthcare’s Health Care Hall of Fame for 2011.

Along with Sidney R. Garfield, MD (1906-1984), Kaiser was a champion for a new kind of health care system in a period when prepaid, group practice was not accepted by the American medical establishment. “He is greatly restless and restlessly great, one of America’s last real Horatio Algers,” the Oakland Tribune and Parade magazine said of him in 1958.

“I am very pleased to hear that my grandfather, Henry J. Kaiser, has been selected as one of Modern Healthcare’s 2011 Hall of Fame inductees,” said Kim J. Kaiser of the Kaiser Foundation Health Plan and Hospitals Board of Directors.

“Henry Kaiser created many successful businesses during his life, but he was most proud of Kaiser Permanente. It is fitting that he join 1988 Hall of Fame inductee, Sidney R. Garfield, MD, since it was the partnership between an entrepreneur and business leader, and a dedicated and innovative physician which created the Kaiser Permanente prepaid, integrated health care model. Henry Kaiser and Sid Garfield would be pleased to see how their partnership continues today.”

Henry Kaiser in good company in Hall of Fame

Modern Healthcare and the American College of Healthcare Executives created the Health Care Hall of Fame to honor men and women who have made outstanding contributions to the health care industry. Prior to this year’s inductees, 87 health care visionaries and innovators had been inducted.

Among those 87 are Sidney Garfield, MD, who was inducted in the hall of fame’s inaugural class in 1988. Other honorees include American Red Cross founder Clara Barton (1993), chairman of Johnson & Johnson Robert Wood Johnson (1990), former U. S. surgeon general C. Everett Koop (1997), and Massachusetts Senator Edward “Ted” Kennedy (2010).

At age 75 when Henry Kaiser’s industrial empire was at its zenith, the builder of some of the 20th century’s iconic bridges, dams, ships, airplanes, and automobiles said, “Of all the things that I’ve done, I expect only to be remembered for my hospitals.  They’re filling the people’s greatest need – good health.”

Health plan has roots in Great Depression

With Sidney Garfield, Kaiser forged Kaiser Permanente out of the challenge to provide Americans quality medical care during the Great Depression and World War II, when most people could not afford to go to a doctor.

The health care program that today bears his name emerged in all but name in the late 1930s when Kaiser was establishing his reputation as the builder of the great dams of the American West – Hoover, Bonneville, and Grand Coulee. In 1938 he partnered with Garfield to provide health care for his workers at the remote Grand Coulee site in Mason City, Washington.

Garfield had earlier successfully experimented with prepayment in a five-year industrial medical care program in the deserts of southern California.  Prepayment took the form of a modest, affordable, payroll deduction that spread the cost of care for the injured and ill over a large number of healthy people, and it ensured a stable income by which a medical care operation could meet expenses.

Workers’ health paramount to Kaiser

Garfield’s ideas resonated with Kaiser who viewed the experimentation as needed in those economically challenging times to find ways for people of modest means to obtain health care. Garfield remembered their first meeting – what he thought was to be a routine job site inspection – this way:

“To my surprise, he seemed more interested in the welfare of his workers, in the medical care program that we were developing for them, than he was in the progress of his job…. He spent the whole day going through our facilities, discussing our plans and questioning me on all the details of the operation … how we had developed the plan and what the principles were, and how and why it worked….”

“By the end of the day I felt like I had been vacuumed and completely drained of all information I knew about medical care.  When we had gone about as far as we could go … he said, ‘Young man I think you have a plan that should be made available to everybody in the country.’”

“From that time on we were bound together by this common belief and interest in developing our health plan,” Garfield said.

Core principles of health plan

The two health care pioneers founded Kaiser Permanente on the principle of prepayment that spread the cost of care over a large number of healthy people, and provided stable revenue for medical care, clinical research and education to enhance the quality of care. 

Prepayment triggered best practices in the prevention of injury and illness, to the betterment of workers’ lives and to the improvement of health care finances.  With the cost barriers removed, the ill presented earlier for treatment establishing a true practice in preventive care, the early detection of disease, and the emergence of lifestyle medicine to maintain health and enhance the quality of life. 

Multispecialty group medical practice maximized physicians’ abilities to care for patients through doctor-to-doctor consultation, through the training and mentoring of young physicians, and through the inherent quality controls built into the group. 

Facilities under one roof brought the doctors’ offices, laboratories, pharmacies and hospital all within proximity, reduced costs through economy of scale, and most effectively utilized the time of both physicians and patients. 

This is Henry Kaiser’s ninth inclusion in lists of hall-of-fame honorees, including the U.S. Labor Hall of Fame in Washington, D.C., where he was honored in 1990, and the California Hall of Fame in 2009.

Henry J. Kaiser was known in every American household for his renown as a builder and as the “patriot in pinstripes” that revolutionized shipbuilding during World War II.  Click on the video to see his appearance on the TV classic, “What’s My Line?” in September 1957.

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Destination Bedside

posted on September 7, 2010

by Bryan Culp

Few care givers are more deserving of mention this week than the acute care nurse.

As anyone who has spent time in a modern hospital can tell you, the nurse is the linchpin of care delivery in a complex, sometimes frenzied and chaotic environment. Ask any hospital nurse what he needs in a typical shift and he likely will ask for more time bedside with patients. Nursing is a caring profession in desperate need of time for one-to-one communication between the nurse and the patient.

At Kaiser Permanente’s Sidney R. Garfield Health Care Innovation Center, a design lab that models and tests care delivery innovations, I recently learned of a study underway to increase the time that the care nurse has with the patient. I’ll say more about “Destination Bedside” in a moment.

To free the nurse for time with the patient is not a new problem in care delivery. Over fifty years ago San Francisco architect Clarence Mayhew and Kaiser Permanente’s founding physician, Sidney R. Garfield, earned industry accolades for a hospital design that took-on this problem. “Efficiency Centers on the Corridor” published in The Modern Hospital, March 1954, covered the layout and design of the new Kaiser Foundation Hospital in Walnut Creek, California. What was the problem asked the writer in The Modern Hospital with the conventional designs of the era? “Simply stated . . . the patient’s charts, medicines . . . equipment and utilities which the nurse uses in her work are too far removed from the patient.

The dedicated central work corridor at the Walnut Creek hospital, 1954.

The design solution was a new work corridor for the exclusive use of the care providers in the Walnut Creek hospital. “The [dedicated] central corridor becomes work space, and the nurses’ station, utility equipment, drugs, x-rays . . . linens, charts and so on for each patient can be kept in this work space just behind the patient’s room.” It was estimated the dedicated corridor would save six out of every seven steps a nurse takes in a conventional design and would offer immediate proximities to the patient. Nurses themselves have validated the design saying that the corridor enhanced patient privacy and one-to-one communication between nurse and patient.

Time marches on. The advance of medical knowledge, patient information systems, and biomedical and robotic devices have added layers of complexity to an already complex environment.

A few years ago a 36-hospital, nation-wide, time and motion study of nurse activities in acute care hospital settings was funded by the Robert Wood Johnson Foundation and the Gordon & Betty Moore Foundation. Ascension Health of St. Louis, Missouri, Kaiser Foundation Hospitals, Duke University Health System, New York-Presbyterian (the University Hospital of Columbia and Cornell universities), Vanderbilt University, Inova Health System, Carolinas Health System, and Intermountain Health, participated in the study.  Findings were reported in The Permanente Journal.

What emerged from the time and motion study was a picture of the hospital nurse “who is constantly moving from patient room to room, nurse station to supply closet and back to room, spending a minority of time on [direct] patient care . . . and a greater amount of time on documentation, the coordination of care [services], medication administration, and movement around the unit.”

In a typical 10-hour shift, the authors found that less than one fifth of nurse time was given to direct patient care. Thirty-five percent of nurse time was given to care documentation, 21 percent of time to care coordination, 17 percent of time in medication administration, and 7 percent of time was given to patient assessment and vital signs. Only 19 percent of the time in a 10-hour shift was devoted to patient bedside activities.

Which brings me back around to the study I heard about at the Garfield Center. “Destination Bedside” design engineers are seeking solutions that minimize chaotic disruptions to nurse care and others that enable the nurse to spend less time charting, arranging for care services, or hunting for equipment, and more time in direct patient care activities. The integrated suite of process changes, some hi tech and some not, include among other things, an efficient transfer of patient information at bedside during nurse shift changes. They include a medication administration program that reduces interruptions to improve patient safety. They employ wireless hand held devices that free the nurse from the nurse station to move bedside with care documentation. They also improve upon the deployment of equipment and supplies.

Pilot implementations are in progress at Kaiser Foundation hospitals with nurse time in patient rooms up 19.6 percent at two pilot locations.

This week we acknowledge the complexity that confronts the hospital care nurse and commend Kaiser Permanente for it’s commitment to free-up time for the nurse to do what nurses feel called to do: care for their patients.

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‘Aloha’ Symbolizes Kaiser Permanente’s Entry into Post-war America

posted on July 27, 2010

By Tom Debley

Front and back covers of launch program for the S.S. Burbank Victory, July 28, 1945 (Courtesy of the National Park Service, Rosie the Riveter/WWII Home Front National Historical Park, Launching Program, RORI 3169)

Director of Heritage Resources

The world was changing dramatically 65 years ago this week. The war in Europe was over, and Japan would surrender within a few weeks. In Richmond, Calif., the last Victory ship built in the Kaiser Shipyards was readied for launch on July 28. Above the ship, the S.S. Burbank, the word ‘Aloha’ in giant letters was suspended between two cranes.

An orchestra played Hawaiian music, guests wore leis made from fragrant pikake blossoms, and Henry J. Kaiser’s wife, Bess, cracked the traditional flower-wreathed bottle of champagne across the bow.

“In launching the last of the Victory ships, we are not registering a finality,” said Kaiser, “but beginning the second phase in the achievements of our industrial family.”

Looking on were Kaiser’s two adult sons, Edgar and Henry Jr.

It was said 10,000 people were on hand, including shipbuilders who had worked on the very first Victory ship.  They sang “Aloha” to Mr. and Mrs. Kaiser and, as the S.S. Burbank slid down the way into San Francisco Bay, flowers tossed from the deck showered the crowd.

The symbolism of the “Aloha” theme has only grown over time. The Hawaiian word is used to say both goodbye and hello. America was saying farewell to World War II, and greeting the post-war world. Henry Kaiser was leaving shipbuilding and embarking on new ventures—including opening the Permanente Health Plan, later renamed Kaiser, to the public. And he was advocating for national reforms that would make health insurance available to all Americans.

Indeed, days before the launch of the S.S. Burbank, Kaiser announced he had drafted a legislative proposal that he presented to several U.S. Senators to create a national program of voluntary prepaid medical care.

“…The greatest service that can be done for the American people,” said the preamble to Kaiser’s 1945 proposal, “is to provide a nationwide prepaid health plan that will guard these people against the tragedy of unpredictable and disastrous hospital and medical bills, and that will, in consequence, emphasize preventive instead of curative medicine, thereby improving the state of the nation’s health.”

These events also were coupled with opening the Permanente Health Plan and Hospitals to the public under the leadership of physician co-founder Sidney R. Garfield. Thus, this week became the springboard for the 65 years—to date—of continually defining the future of health care with the growth and leadership of Kaiser Permanente . (See: Opening a Prepaid Health Plan to the Public 65 Years Ago this Month.)

This would be Kaiser’s ultimate legacy.

The Kaiser family at the launch of the last Kaiser Victory Ship, July 28, 1945.

As the preeminent California historian, Kevin Starr, has noted, “After all the things he did—the great dams he had built, the great waterways, the unprecedented work in the shipyards—Kaiser knew that this was the thing that would last.”

Or, as Kaiser, himself, said on several occasions in the last years of his life in Hawaii, “Of all the things I’ve done, I expect only to be remembered for…filling the people’s greatest need—good health.”

National health care legislation failed in 1945 and many times thereafter, but Kaiser, Dr. Garfield and their successors have persisted in advocating for heath care for all ever since and saw President Obama sign the Affordable Care Act last March 23. That came exactly 65 years and 20 days after the official date of Henry J. Kaiser’s original “Proposal for a Nationwide Prepaid Medical Plan Based on Experience of the Permanente Foundation Hospitals,” which had been prepared in consultation with Dr. Garfield.

Today, Kaiser and Garfield are honored for their contributions on the Home Front of World War II at the Rose the Riveter/World War II Home Front National Historical Park for making prepaid medical care “a legacy of the WWII Home Front.”

(Special thanks to Veronica Rodriguez, Museum Curator at the Rosie the Riveter/World War II Home Front National Historical Park, for locating and sharing use of the program images for the launch of the S.S. Burbank Victory, July 28, 1945.)

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Replacing ‘Sick Care’ with ‘Health Care:’ Dr. Sidney Garfield’s Ideas in the National Reform Dialogue

posted on April 5, 2010

By Tom Debley, Director, Heritage Resources

It was fascinating to me to research and write a book about the life of Kaiser Permanente’s founding physician, Sidney R. Garfield, but it has become even more so to observe how visionary he was in his time as discussion continues in the wake of President Obama’s signature on health care reform.

Dr. Sidney R. Garfield, a surgeon, co-founded prevention-focused Kaiser Permanente with industrialist Henry J. Kaiser.

A month ago, I wrote a blog about Harvard Business School Professor Clayton Christensen, who argued in the pages of Business Week that health care needs business models like Kaiser Permanente—health care systems in which doctors and insurers are on the same side of the ledger as the patient. I observed that this was an idea Dr. Garfield put forward as the model for Kaiser Permanente in a speech in Portland, Oregon 65 years ago Sunday (April 4).

This Monday (April 5), I was struck by a quote in an article by Robert Pear in the New York Times.

“We don’t have a health care system in America,” said Senator Tom Harkin, the Iowa Democrat who chairs the Senate health committee. “We have a sick care system. If you get sick, you get care. But precious little is spent to keep people healthy in the first place.”

First Lady Eleanor Roosevelt, visiting World War II Home Front patient, asked Dr. Sidney R. Garfield to tell her about prevention-focused medical care.

Harkin’s statement is an interesting juxtaposition with an event exactly 67 years earlier—April 5, 1943—when First Lady Eleanor Roosevelt visited a World War II Kaiser Industries shipyard worker, a woman with a seriously injured left leg, as shipyard manager Edgar F. Kaiser looked on in Vancouver, Washington.

Whatever Mrs. Roosevelt heard about Dr. Garfield’s focus on injury and illness prevention efforts as he built the largest civilian medical care program on the Home Front of World War II, she was immediately intrigued. Returning to the White House, she dictated a note to Dr. Garfield, “I am interested in getting medical care, both preventive and curative, at the least cost to the people. What is your program on the preventive side?”

“Your expression of interest in preventive medicine is rather closely allied with our thoughts for medical care,” Dr. Garfield responded in a letter detailing his ideas.

What Dr. Garfield did on the Home Front is, of course, one of the historical stories told at the Rosie the Riveter / World War II Home Front National Historical Park in Richmond, Calif.

Dr. Garfield spent his whole professional life on these ideas. It was not easy, but his vision was central to the evolution of Kaiser Permanente as—in Dr. Garfield’s words—a “total health” system of care.

In the first 15 years of toil after World War II, Dr. Garfield’s big frustration was how challenging it was to move from a “sick plan” to a “health plan,” but he never gave up. His big breakthrough came 50 years ago next month, and I will write about that story in a blog in May.

In the meantime, if you are interested in learning more about Dr. Garfield, my book, “The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” is available from the publisher, The Permanente Press, as well as from Amazon.com in both book form and on Kindle.

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Reviewer Suggests Taking Garfield’s Biography to the Next Level

posted on January 18, 2010

By Ginny McPartland

Tom Debley’s biography of Sidney R. Garfield, released last year, sheds light on Garfield’s role as the founder and guiding force of the Kaiser Permanente Medical Care program. Debley brings Garfield out of the shadow of Henry J. Kaiser and fleshes out his fuzzy historical image with great detail.

“Everyone knows the Kaiser name, and specifically Henry J Kaiser,” writes professor and medical researcher Leon Speroff, MD, who reviewed “Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care Into Health Care” for the current issue (Winter 2009) of the Oregon Historical Quarterly.

But, Speroff wonders: How many people know Sidney R. Garfield, MD, who established and expanded the principle of prepaid, group practice with an emphasis on keeping people well?

Debley’s book is novel-like, telling Garfield’s story in a conversational and often humorous way. That’s one way to make his life’s work known. But the work of objectively analyzing Garfield’s contribution to contemporary health care is not yet finished, Speroff wrote.

“The story of Sidney Garfield in this book is compelling, but the book, although well written and a pleasure to read, is more like a Festschrift (book of tribute). One is impressed with the uniform praise (almost fawning) of Garfield and wonders whether an objective, more scholarly work would provide criticisms and character flaws that would lend an even greater dimension to this important man.

“Garfield deserves a full historical biography that would give greater credibility and understanding to the evolution of Kaiser Permanente and its contributions to American medicine,” Speroff wrote.

Author Debley, director of Heritage Resources for Kaiser Permanente, agrees with Speroff. In the book preface, Debley wrote: “This is not… a definitive biography. That awaits the work of some future scholar and medical historian.”

Debley said he appreciated Speroff’s kind words and is hoping someone will pick up where he left off with a full scholarly historical biography of Dr. Garfield. “We debated about this book and decided it was important to bring Dr. Garfield to a wide audience,” Debley said. “I’m hoping an academic or PhD candidate out there will take up the challenge.

“And given the nature of my work in a corporate history program, I feel most strongly that the definitive biography be by an independent researcher to whom our private archive would be fully open,” Debley said.

Speroff also identifies Debley’s book as a resource to inform the current health care reform debate: “Garfield died in his sleep at age 76, on December 29, 1984. He left a history that contains lessons for the present.

“As America struggles to provide effective and efficient health care in the 21st century, many of the concepts and plans being articulated can be found in Garfield’s story,” Speroff wrote.

The reviewer also refers to the history of Kaiser Permanente presented in Rickey Hendricks’ 1993 book “A Model for National Health Care: The History of the Kaiser Permanente” “It would be useful for present-day legislators to read,” Speroff wrote. Debley also recommends Hendricks as a source of more information about Sidney Garfield’s life and work.

Speroff, an OB-GYN, is founder and former director of the Women’s Health Research Unit at OHSU. He is the author of many books on women’s health as well as several historical books. His works include: “A Good Man: Gregory Goodwin Pincus, the Man, His Story, and the Birth Control Pill,” as well as the biography of Carlos Montezuma, MD, an American-Indian physician who was a prominent activist for Indian rights in the early 1900s.

“Dr Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” may be purchased on the Permanente Press Web site. The book is also available as a Kindle book on Amazon.com.

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Tom Debley to speak about Garfield biography on Red Oak Victory

posted on October 2, 2009
SS Red Oak Victory

SS Red Oak Victory

Heritage Resources Director Tom Debley will speak about his biography of Kaiser Permanente pioneering physician Sidney R. Garfield as part of the Richmond Home Front Festival this Saturday, Oct. 3, at the Rosie the Riveter/World War II Home Front National Historic Park.

Debley, author of Dr. Sidney R. Garfield: the Visionary Who Turned Sick Care into Health Care, begins his talk at noon on the main deck of the SS Red Oak Victory docked at Historic Shipyard No. 3. Debley will focus on the largest civilian medical care program on the World War II Home Front, which was created in the West Coast Kaiser Shipyards.

Also on the main deck of the Red Oak Victory, Bay Area Historian Steve Gilford will discuss why the ship was named after Red Oak, Iowa. Gilford‘s talk begins at 2 p.m. The ship boarding fee is $5 general, $4 seniors and children.

The Red Oak Victory, a World War II vessel, is the only ship built in the Kaiser Shipyards to be restored and maintained as a museum. The SS Red Oak Victory was launched on November 9, 1944, and commissioned as the USS Red Oak Victory in December 1944. The ship saw service in World War II, Korea, and Vietnam and has the distinction of being the only ship operated by both military and civilian personnel during its career.

USO Dance Friday Night

Another special feature of the Home Front festival is a USO dance Friday, Oct. 2, with The Junius Courtney Big Band.  They’ll be playing 1940s music on the Craneway Pavilion stage in the old Ford Assembly building at the end of Harbour Way South in the Richmond park. Tickets are $25 general, $20 for seniors at the door.  Big fun in Richmond from 7 to 10 p.m. for young and old swing dancers.  You can get in free if you come in period attire, wear a military uniform, or show a military ID.

Free shuttles will run at 30-minute intervals around the Rosie park throughout the day-long festival. For more information on the Home Front festival, go to: homefrontfestival.com

–Ginny McPartland

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Richmond Shipyard Workers Suffered Their Own Casualties of War

posted on September 4, 2009

In 1942, eighteen year-old Lucille “Penny” Price joined the shipyard workforce with little idea what lay ahead for her. Read on to hear a poignant account of what those days were like and the daunting challenges Penny faced.

Building warships was a dangerous enterprise. Workers in the Richmond shipyards during World War II learned the hard way how easy it was to be injured when working at a furious speed to fulfill orders for sorely needed war vessels.

Richmond shipyard workers 1943

Richmond shipyard workers 1943

The odd mix of people who converged at the Kaiser shipyards added to the complexity and worry associated with the safety of workers of all levels of skill and socialization. The majority of them had little or no experience building ships.

There were black and white men and women from the agrarian southern states and other parts of the country. There were native San Francisco Bay Area women and men. There were men who had medical conditions that totally disqualified them from serving in uniform (Class 4F). There were handicapped workers.

Risky Business
Injuries minor and major were common. In fact, working in a shipyard was one of the most dangerous jobs in the wartime industries, more risky than the manufacture of tanks, aircraft, and explosives. The shipyards of America reported an average of 33 disabling injuries per million hours worked in 1943. (This compared favorably to the iron and steel foundries whose average accident rate was 40 injuries per million hours worked.) About 700 shipyard workers were killed during 1943 and 1944 in accidents in the nation’s shipyards.*

Some injuries were purely accidental, some were from carelessness, and others were simply vicious.

“It Wasn’t All Beer and Skittles…”
An eighteen-year-old Oakland girl, Lucille “Penny” Price, joined the shipyard workforce in October 1942. She made good money as an electrician and considered the wartime work a great opportunity. She sums up the experience in this casual understatement: “It wasn’t all beer and skittles.”**

Price, an electrician in Yard 3, was almost scared away from the shipyards when she witnessed a fatal accident on her first night of work. A guide was taking a group of new employees, including Price, on an orientation tour when they heard “beep, beep, beep,” the sound of a crane in motion. “The guide was telling us that when you hear that sound you get the heck out of the way and stay away,” Price recalled. But some other workers didn’t heed the warning sound, and as the crane lifted a heavy sheet of steel aboard a ship, one of the cables broke and the load slipped and killed several of them.

“I tell you I was ready to run, and so were the other people in our group of electricians,” she said.

Price was quickly reassigned to the relative safety of the electrical shop to give her time to get over the shock. She stuck it out and by Christmas was wiring C-4 transporters and LSTs (landing ship, tanks) and continued to work in the yards until early 1945. During her tenure there, she would experience many injuries herself.

Threatened by Male Counterparts
Now 84 years old and living in Windsor, Calif., Price recalls the time a “chauvinist” kicked a ladder out from underneath her and caused her to fall over a stack of pipes. The man who made her fall was fined and fired, never to work again in the shipyards. Penny was taken to the shipyard Field Hospital where she was treated for two cracked ribs.

Price also recalls that men also liked to sneak up on her while she was working from a plank stretched across the open deck with six floors below. “They’d make the board vibrate and that scared the hell out of me.”

Male shipyard workers’ poor treatment of their female counterparts was not uncommon. “When women managed to enter jobs that seemed still to be the prerogatives of men, they were sometimes mistreated; “harassed” is the word we would use nowadays,” said Columbia University professor http://www.columbia.edu/cu/history/fac-bios/Kessler-Harris/faculty.html Alice Kessler-Harris in an interview on PBS.

“Men often played tricks on women by sending them for tools that did not exist. Men also sexually harassed women by whistling and cat-calling to them as they worked. Most of the resistance and hostility towards women workers disappeared as the novelty of women workers wore off, the labor shortage got worse, and women proved themselves, according to Susan M. Hartmann, http://history.osu.edu/people/person.cfm?ID=695 author of The Home Front and Beyond: American Women in the 1940s.

Victim of Double Pneumonia—Before the Days of Penicillin
Penny Price was also a victim of double pneumonia that developed after she was caught in a dark corner on the same level as a dozen hostile workmen during an air raid warning drill. Price had been doing some wiring by herself above the shaft alley when the “whoop, whoop” of the siren came and the lights went out. She huddled in a space near a boiler for two hours, shaking with fear as the burly workers made comments like: “Wait ‘til I get my hands on that little chick over there.”

Lucille "Penny" Price 1943

Lucille "Penny" Price 1943

When the drill was over, her leaderman, Charlie Ryder, swooped her up from the spooky pit. She couldn’t stop shivering, so her coworkers gave her coffee to warm her up. “To this day, I can’t stand the smell of coffee with cream in a paper cup.” She “upchucked” the coffee that night at home and returned to work the next day thinking she was fine. But the shaking returned, and she was taken to the field hospital where they took a chest X-ray and diagnosed double pneumonia.

This was in March 1943 before penicillin was available to civilians. At the Oakland hospital where our doctors were perfecting the treatment of pneumonia, she was given a “horrendous” clear liquid (probably horse or rabbit serum) every few hours. That liquid along with oxygen therapy cured her of the mysterious pneumonia.

Penny Price today

Penny Price today

During the war, Permanente physician Morris Collen experimented with the treatment of pneumonia as he managed a large number of shipyard cases. By the end of the war, Collen had published his findings and earned a national reputation as a pneumonia guru. His prestige was such that he was able to get some of the first civilian penicillin in 1944 to save the lives of the 7-year-old daughter of a shipyard worker in Vancouver, Wash., and a young man in a Richmond yard.

Hospital Visits—Much Too Frequent
Throughout her time at the shipyards, Penny Price was injured numerous times and was a frequent visitor to the First Aid Station and the Field Hospital. “I was in and out of the Field Hospital like a yoyo,” she said. She frequently cut herself using a linoleum knife to cut electrical cable. She vividly recalls the inside-out eyelid treatment administered when she got bits of steel mesh from the cable in her eyes. She also recalls that when working around fiberglass she sometimes got particles down her neck that irritated like a thousand flea bites.

Her most serious injury was caused by an accidental explosion that knocked her down from the ship’s superstructure onto the deck below where workers were using acetylene torches to shrink the deck. As a result of the fall, she suffered burns and an injury to her knee when it struck a bolt on the deck. She was burned so badly that she had to return for treatment for nine months before her leg was healed. “I still have scars on my leg to this day,” she said. She returned to work after a short hospital stay wearing a splint on her knee wound.

Price remembers an inspector coming around to urge the workers to follow the Maritime Commission safety rules to avoid injuries. “He’d show us a glass eye and say ‘do you want one of these?’” We’d shudder, and he would say: ‘then, wear your goggles!”

Safety Program Launched in 1943
In 1943, the U.S. Maritime Commission launched a safety program that ultimately reduced the injuries per million hours worked in the shipyards to 23.2 in 1944. “The work of the (commission) was of value in two ways – by allaying fears that working in a shipyard was more dangerous to life and limb than working somewhere else, and by making this true through insistence on a high standard of protection and precaution,” wrote Frederic Lane in his 1951 book Ships for Victory.

*Of the 655 reported private shipyard fatalities in the nation during 1943 and 1944, vehicles or loads striking workers was the second most common type of accident (25 percent) after falls (39 percent). Half of the “strike by” accidents involved cranes.

**’Beer and skittles’ is shorthand for a life of indulgence spent in the pub. Skittles, also known as Ninepins, which was the pre-cursor to ten-pin bowling, has been a popular English pub game since the 17th century. This definition is according to the Phrase Finder, a United Kingdom Web site: www.phrases.org.uk/meanings/230200.html.

— Ginny McPartland

You can watch a lecture about Dr. Sidney R. Garfield’s long quest for health care reform by Tom Debley to the Commonwealth Club of California.

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Dr. Sidney Garfield: His Ideas at Center of Health Care Debate

posted on August 19, 2009

A recent PBS News Hour with Jim Lehrer opened with this quote from President Barack Obama: “There are examples of how we can make the entire health care system more efficient. …What works? The Mayo Clinic. The Cleveland Clinic. Geisinger. Kaiser Permanente. There are health systems around the country that actually have costs that are as much as 20 percent or 30 percent lower than the national average and have higher quality. What is it that they are doing differently from other systems?”

Added correspondent Betty Ann Bowser: “What they are doing is providing excellent care at a low cost through an integrated system where doctors visits, tests, surgery, hospital care – the works – are all done under one roof.”

I will use this to lead off a talk at the Commonwealth Club of California on Tuesday (August 25) in San Francisco because there was little in the 10-minute report that said anything different from what Dr. Sidney R. Garfield, co-founder of Kaiser Permanente, said back in the 1930s – including his idea to put all needed care “under one roof.”

As author of The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, the theme of my talk will be “The Long Quest for Health Care Reform: A Bay Area Doctor’s Belief in Health Care as a Right.” I will trace the story of Dr. Garfield’s life because so much less is known about him than his co-founder, Henry J. Kaiser.

The evening program begins with a 5:30 p.m. reception; program at 6 p.m. Tickets are $8 for members; $15 for nonmembers. Get tickets.

— Tom Debley

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

posted on August 7, 2009
falk35Isidore “Ig” Falk was a 20th Century hero. But I’m guessing most of you have never heard of him. Am I right? 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 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.

Sidney R. 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.)

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. Yay! 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. 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 attend a talk by Kaiser Permanente Director of Heritage Resources Tom Debley on Tuesday, Aug. 25, at the Commonwealth Club in San Francisco. Debley is the author of Dr. Sidney R. Garfield: the Visionary Who Turned Sick Care into Health Care. The newly released bookilluminates for the first time the details of Garfield’s professional and personal struggles and triumphs.

Debley’s talk is titled “The Long Quest for Health Care Reform: A Bay Area Doctor’s Belief in Health Care as a Right.” The evening begins with a 5:30 p.m. reception; program at 6 p.m. Tickets are $8 for members; $15 for nonmembers. Get tickets.

– Ginny McPartland

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President Obama Cites Kaiser Permanente Model; Learn More About Why Aug. 25

posted on July 29, 2009

Time Magazine reporter Karen Tumulty talked July 28 with President Barack Obama about health care reform, with a transcript published on the web July 29. Kaiser Permanente’s founding physician, Sidney R. Garfield, would have been proud if he were alive to hear the President say, “…If we could actually get our health-care system across the board to hit the efficiency levels of a Kaiser Permanente or a Cleveland Clinic or a Mayo or a Geisinger, we actually would have solved our problems.”

Dr. Garfield would have been proud because his vision on the Home Front of World War II was to build such a system for ordinary Americans. Indeed, it’s interesting, as well, to see Kaiser Permanente in the company of the Mayo Clinic. In 1943, the famed medical science writer Paul DeKruif wrote a book about what Dr. Garfield and Henry J. Kaiser were doing to develop a new model of medical care for working Americans, and nicknamed it the “Mayo Clinic for the common man.”

Interested in learning more about Dr. Garfield and his struggles to bring legitimacy to a revolutionary idea in health care? Kaiser Permanente Heritage Resources Director Tom Debley, author of the newly released Dr. Sidney R. Garfield: the Visionary Who Turned Sick Care into Health Care, will speak on this subject at Commonwealth Club in San Francisco on Tuesday, Aug. 25.

Conversations about Dr. Garfield’s ideas will be nothing new for the Commonwealth Club. As a young man pioneering his prepaid, group practice, Garfield spoke to the club members on two occasions during the war.

Sidney Garfield presented a talk titled “The Permanente Foundation and Shipworkers’ Health” to the Public Health Section of the Commonwealth Club on May 6, 1943. He was engaged again to speak to the club members toward the end of the war (March 22, 1945). The title of his presentation was “A Workable Health Plan on the Basis of Permanente Experience.”

Debley’s talk is titled “The Long Quest for Health Care Reform: A Bay Area Doctor’s Belief in Health Care as a Right.” The evening begins with a 5:30 p.m. reception; program at 6 p.m. Tickets are $8 for members; $15 for nonmembers. For tickets, go to:
https://tickets.commonwealthclub.org/auto_choose_ga.asp?area=1&shcode=1359
– Ginny McPartland

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