Posts Tagged ‘Southern California Permanente Medical Group (SCPMG)’

Thieves abscond with bronze historical marker at Desert Center

posted on August 8, 2013

By Steve Gilford, Senior Consulting Historian

Southern California physicians to replace plaque dedicated in 1992 to commemorate Sidney Garfield’s Contractors General Hospital

Plaque placed in 1992 commemorating Sidney Garfield MD's desert hospital. Recently, thieves pried the 110-pound marker from the boulder presumably to turn the bronze into cash.

Plaque placed in 1992 commemorating Sidney Garfield MD’s desert hospital. Recently, thieves pried the 110-pound marker from the boulder, probably planning to turn the bronze into cash.

I’ve recently returned from Southern California where I assessed the damage vandals and thieves wreaked to the historical marker near the site of Dr. Sidney Garfield’s 1933-built Contractors General Hospital.

This location is significant because it’s where Kaiser Permanente’s pioneer physician first discovered how prepaid, preventive medicine could make health care more affordable.

The 110-pound bronze plaque, placed at the historical site 21 years ago, has been pried off its base and stolen, presumably for the value of the metal. This is another occurrence of the national trend of thieves dismantling historical markers to turn bronze to cash.

I traveled to the desert not only to evaluate the loss but also to arrange for a replacement plaque. My journey was successful: I found a safe location for a new plaque and an enthusiastic benefactor to pay the bill.

In 100-plus-degree heat that is usual for the area, I surveyed nearby Chiriaco Summit, an active way station for desert travelers, with Margit Chiriaco Rusche, the daughter of founders Joe and Ruth Chiriaco. We found an appropriate site for a new plaque in an island of green vegetation which many visitors pass.

Locating historic hospital site

For me, this mission was personal. Twenty-seven years ago, I uncovered the hospital site where, in 1933, Kaiser Permanente’s founding physician had started his prepaid health plan for workers on the Colorado River Aqueduct Project.

Google Map of the location of the Contractors General Hospital in 1933

Google Map shows the vicinity of where the Contractors General Hospital stood in 1933.

In 1986, Stanley Ragsdale, self-described “desert rat” and owner of Desert Center in Southern California, accompanied me on an expedition to find the long lost site of Garfield’s hospital, six miles west of the little town on Interstate 10.

As we approached the area, we could make out the foundation outlines, which were all that remained of the facility abandoned in the late 1930s.  As someone with experience in archeological digs, I headed for the nearby garbage pit, in which I found medical artifacts that positively identified the site.

With this information and other research, I prepared an application and supporting materials for the site’s designation as a historical landmark. The California State Historical Commission unanimously authorized an official plaque recognizing the importance of the tiny hospital to American medicine.

In a 1986 ceremony, Sally Garfield Blackman, Dr. Garfield’s elder sister, unveiled the bronze plaque attached to a boulder near the spot where the once bustling hospital had stood.

Southern California physicians sponsor replacement plaque

Over the past two decades, the dusty town of Desert Center, with its two-block long main street, has fallen on hard times. The restaurant, gas station, general store, and ice cream stand are all gone. With no one around the abandoned town, the plaque was easy pickings for thieves, and several weeks ago they struck.

Raymond Kay, MD, friend of Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong on the hospital site.

Raymond Kay, MD, friend of Garfield and early leader of the Southern California Permanente Medical Group, playing ping pong on the hospital site.

I mentioned the loss to Paul Bernstein, MD, San Diego area medical director for the Southern California Permanente Medical Group.  Bernstein (Twitter: @sdthinkbig), personally interested in the history of Contractors General, is as chagrined as I am by the marker’s disappearance.

He approached the Southern California Permanente Medical Group, and they have agreed to replace the plaque as part of SCPMG’s 60th anniversary celebration in September. This year also marks the 80th anniversary of the hospital’s founding.

Chiriaco motorist stop fitting site for new historic marker

Joe and Ruth Chiriaco founded their first store the same year that Dr. Garfield opened Contractors General Hospital; they knew the hospital and Dr. Garfield well.

Ruth Chiriaco, a registered nurse, had worked in nearby Indio with Betty Runyen, Dr. Garfield’s first nurse. Having met the Chiriacos in my previous research, I was pretty sure the family would be amenable to putting the new plaque near their business that includes a store, restaurant and gas station.

This fall, Dr. Garfield’s favorite nephew and closest living relative, Dr. Robert Blackman, and Blackman’s two sons will participate in the dedication, as will nurse Betty Runyen’s three children. Betty’s daughter Susan, a nurse with Kaiser Permanente in Hawaii, has just finished a novel based on her mother’s life at Contractors General Hospital. 

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Kaiser Permanente Southern California steps up physician training

posted on February 20, 2013

By Marc Klau MD Kaiser Permanente Southern California
 

The Free Clinic of Simi Valley, which marked its 40th anniversary in 2011, is one of the locations where KP Southern California Community Medicine residents provide free care. Pictured here, at center, is clinic executive director Fred Bauermeister and, at far right, Adriana Trujillo, a former KP resident. Also pictured, from left, are Citlali Maldonado, Olga Lafflitto and Lupita Gonzalez of the clinic staff. Photo by Bill Sparkes/Acorn Newspapers

The Southern California Permanente Medical Group has taken giant steps in recent years to enhance our physician training curriculum so we can better meet the needs of our communities. Since 2007, we have instituted new programs to address a looming nationwide shortage of physicians, and we’ve launched two new programs to broaden the scope of our charity care.

Started in 1955, the SCPMG graduate medical education program has grown to include eight different specialties and 27 independent residency programs at six Kaiser Permanente medical centers in Southern California. With this flourishing GME program serving as a springboard, we have added community medicine fellowships and a KP-UCLA internal medicine/master of public health degree program.

These enhancements are designed to prepare new physicians to practice in today’s ever-changing and progressively challenging world of medicine.

Community medicine fellowship

The community medicine fellows practice in safety-net clinics in the greater Los Angeles area and study topics essential to the understanding of community health needs and the allocation of resources. The fellows learn how to approach the care of people of different cultures and to identify special needs in the community.

Pictured here from left to right are the 2012-2013 fellows of the KP Southern California Community Medicine program: Maegan Dupper, MD, Nzinga Graham-Hines, MD, Janani Krishnaswami, MD, Kiran Mitha, MD, Diana Hoffman, MD, and Long Nguyen, DO.

They also learn to develop and foster partnerships with safety-net providers and to find ways to share KP’s evidence-based practice with clinic staff.  One goal of the program is to inspire new physicians, residents and students to take part in community care opportunities and to share their new knowledge through teaching.

The community medicine fellowship, begun as a pilot with one resident at the Kaiser Permanente Woodland Hills Medical Center, has grown to six positions shared among Woodland Hills, Los Angeles, Fontana and Orange County medical centers.

The fellows, new graduates of residency programs, spend half of their time in community settings, providing care and supervising residents and medical students.  They collaborate with site leaders to identify needs and plan development of new systems or programs.

Marc Klau, MD, is the physician director of education for the Southern California Permanente Medical Group.

The other half of their time is at their home medical centers, providing care to Kaiser Permanente members or mentoring/teaching residents and medical students.

In recent years, the fellows have accomplished much: putting Kaiser Permanente’s pediatric weight management program into practice at Saban Clinic at Hollywood High School; and charting improvements in blood pressure measures and screening assessments of diabetics at the Inland Family Community Clinic.

Kaiser Permanente community medicine fellows have also taken medical care to a number of non-traditional sites, including a mobile clinic set up outside of court for homeless people in trouble with the law, as well as a diabetes clinic on an Indian reservation near Indian Wells. They’ve also offered care at the Motor Inn in Costa Mesa and in Duroville, the largest mobile home park in the Riverside County desert.

Connecting internal medicine with public health

John Su, MD, MPH, Director,
KP Southern California Community Medicine Fellowship Progam.

The person who participates in the SCPMG internal medicine-public health program has the opportunity to train with Kaiser Permanente and then directly enter the UCLA School of Public Health to complete the coursework and earn a master of public health degree.

The goal of this program is to enhance the training of future Permanente physicians and leaders by developing a broader knowledge base in the public health arena, including biostatistics, epidemiology, chronic disease management, injury prevention, health promotion, health policy and management, and disaster preparedness.

We also hope to gain an in-depth understanding of the interaction of biological, psychological, economic, cultural, and political factors that contribute to health outcomes and to share this knowledge with community clinics.

Addressing a nationwide shortage of physicians

Statistics from many sources predict in the near future a severe shortage of primary care physicians, general surgeons, emergency room specialists and psychiatrists. The American Association of Medical Colleges estimates a shortfall of 150,000 physicians by 2025.

To attack this shortage, medical schools and hospitals need to step up efforts to produce new physicians. To properly meet demand, 45,000 of the new physicians should be trained in primary care.

Other sources predict shortages of emergency room doctors and psychiatrists, particularly physicians trained to care for children with mental health problems. In the San Diego area, the supply of psychiatrists dropped by 27 percent between 1990 and 2002 while the demand for these services increased by about 16 percent.

Also in San Diego, where there is no county hospital to care for disadvantaged patients, primary care clinics and emergency rooms are seeing a rising number of patients. In 2009, 32.7 percent more patients were seen in San Diego community clinics than in 2005.

Adding specialties to the curriculum

To address these trends, SCPMG is adding new residency programs in disciplines where the need for more well-trained physicians is greatest, and enlarging the enrollment in many of its existing residency programs.

In San Diego, Kaiser Permanente is launching new pipeline programs in family medicine, emergency medicine and internal medicine. Family medicine is starting with six residents and increasing to 18 by 2014. Emergency medicine will have six residents when it opens in 2014 and is expected to increase to 18 by 2016. Internal medicine will open in 2015 with six residents with plans to increase to 18 by 2017.

In Fontana, we are opening a new internal medicine program, to begin with six residents in 2013 and increase to 18 by 2015. A psychiatry residency program will launch in 2014 with six residents and increase to 18 by 2016.

Existing programs to grow

Also, our Orange County family medicine program will increase its number of residents from 18 to 24 this year. Los Angeles Medical Center has added one resident in general surgery, bringing its total to 29; in neurology, the number of residents will increase to 12 by 2014; and in diagnostic radiology, the number will increase from 10 to 15 by 2016.

We continue to discuss plans to open a general surgery program at Riverside with a complement of 10 residents by 2015 and an internal medicine program at Antelope Valley with five residents from Olive View–UCLA Medical Center.

In the past, between 30 and 40 percent of Kaiser Permanente residency graduates have chosen to continue their professional careers with us. By the expansion outlined above, we are ensuring a supply of well-trained young physicians both for Kaiser Permanente and the general community.

Through its graduate medical education programs, Kaiser Permanente Southern California has responded to community needs for better care for the uninsured, as well as planning ahead to ensure we have enough qualified physicians to care for our patients now and in the future.

 

Marc Klau, MD, is chief of head and neck surgery and former director of medical education at KP’s Orange County Medical Center. He is also chair of the Institutional Graduate Medical Education Committee, Physician Director of Medical Education and Designated Institutional Official providing administrative oversight for all GME and continuing medical education programs for the Southern California Permanente Medical Group.

 

 

 

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

posted on April 18, 2012

By Ginny McPartland
Heritage writer

Last in a series

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

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

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

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

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

LA Center for Medical Education honors Sapin

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

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

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

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

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

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

Setting up pediatric cardiac ‘cath’ lab

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

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

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

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

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

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

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

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

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

Growth of research and education spawns new department

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

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

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

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

What makes a successful prepaid group practice?

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

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

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

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

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

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

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

KP sticks to original HMO model

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

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

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

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

 

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

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

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

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

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