Posts Tagged ‘The Permanente Medical Group (TPMG)’

Donovan McCune, MD – Kaiser Permanente pediatrician who made an impression

posted on April 14, 2016

Lincoln Cushing
Heritage writer

 

Reporter 1963-12

Dr. McCune binding a book, from KP Reporter December, 1963

The Beagle Press mark (Dr. McCune), from publication 1968

Donovan James McCune, MD (1902-1976) was a beloved Kaiser Permanente pediatrician with a passion for books.

Dr. McCune was physician-in-chief and chief of Pediatrics at the Vallejo Medical Center from 1953 until his retirement from full-time practice in 1966, and subsequently served as staff assistant to The Permanente Medical Group Executive Director Cecil Cutting, MD. Dr. McCune already had established a distinguished international reputation in pediatrics before coming to Kaiser Permanente in 1951, teaching pediatrics at Columbia University for 20 years and receiving numerous medical honors from U.S. and European societies.

But books were his extraprofessional passion. He was a noted bibliophile with an extensive collection of rare books, including a page from the Gutenberg Bible (the first book to be printed with movable type), and many other books printed prior to 1500. His collection was donated to the John F. Kennedy Library in Vallejo, where it is housed as a special collection. There it is shared with the public in an unusually open manner:

…The McCune collection…is open to everyone with an interest in books. We encourage a hands-on approach. We recognize that there is a big difference between seeing a book through a glass case and actually holding one in your hand (Clean hands, please!). We recognize that there is a special feeling when one actually handles a rare book and knows the history behind it.

Letterpress logo, The Beagle Press (KP Dr. McCune), 1988 [circa]. [NCal production file photos]

Letterpress logo, The Beagle Press, circa 1968

Physicians are a hands-on lot, and mere collecting was not enough for Dr. McCune. Typography, calligraphy, bookbinding, and printing were among his other cherished pursuits, and he frequently hand-set his own proclamations and literary efforts under the name “The Beagle Press,” named for his pet dog You-You.

When he retired from TPMG it gave him an English-built Adana Horizontal Quarto printing press. He took lessons from Roger Levenson at The Tamalpais Press. Another fine printer, Henry Morris of The Bird & Bull Press, taught him how to improve his skills and suggested that Dr. McCune would be happier with a bigger press.

Dr. McCune took Morris’ advice, and imported an Albion hand press manufactured in London in 1852 by Hopkinson & Cope. This six-foot-tall behemoth was 2,000 pounds of iron and steel with a 24 by 28 inch platen. Dr. McCune installed it in his Vallejo, Calif., kitchen, which already housed the Adana press and an inking stand. Dr. McCune only stood 5-foot-6, so he added a platform from which he could bear down on the impression lever.

This year the Book Club of California in downtown San Francisco will honor Dr. McCune with a memorial plaque. Dr. McCune was a long-time member and a contributor to the Club’s scholarly newsletter on the history of the book. His special collection in Vallejo contains over 100 Book Club of California publications including many by the Grabhorn Press – which printed a beautiful limited edition of Henry J. Kaiser’s wartime speeches.

 

Short link to this article: http://k-p.li/1V48LY5

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Dr. Nathan Leonard Morgenstern, KP physician

posted on July 9, 2014

By Lincoln Cushing
Heritage writer

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“Two members of the Cancer Committee in our Oakland hospital review a medical record in consultation”; Krikor Soghikian, MD (left), and Nathan Morgenstern, MD, KP Reporter September 1962

Nathan Leonard (Len) Morgenstern, prominent physician, educator, (San Francisco) East Bay Area civic leader, and dedicated father and grandfather, passed away May 29 from head trauma following a fall. He was 91.

Dr. Morgenstern was a distinguished physician at the Kaiser Permanente Oakland Medical Center for 35 years, starting in 1954 and retiring in 1988 as chief of pathology. He authored several articles on cancer (including “Carcinoma of the Thyroid at Autopsy” in the AMA Archives of Internal Medicine, April 1, 1959), and taught as an adjunct professor of neuropathology at the University of California at San Francisco.

He was an active and beloved figure at the Oakland hospital, and over the years he took on many of the tasks that it takes to make a medical facility great.

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Dr. Nathan Leonard Morgenstern (standing, left), Planning for Health newsletter, Fall 1960

 

A 1959 article in the employee newsletter KaiPermKapsul described how he conducted a training program for students who expected to make a career in pathology.

His one-year course in Medical Laboratory Technology was accredited by the AMA and the State of California, and affiliated with San Francisco State University, which gave credit for the work.

The article noted:

Dr. Leonard Morgenstern with Philippines exchange student Rosario Bautista, KaiPerm Kapsul, May 1959

Dr. Leonard Morgenstern with Philippines exchange student Rosario Bautista, KaiPerm Kapsul, May 1959

Rosario Bautista and Clyde James are among those receiving this thorough training in laboratory work, the former as an exchange student from the Philippines. Medical technologists in this state must all be licensed by the State Department of Public Health, following an examination.

Just to mention a few of the newer procedures they encounter in a Kaiser hospital laboratory: there are the microchemical analyses of blood, the assays on hormones, the tests on sensitivity of bacteria to various antibiotics, the investigation of allergic phenomena and use of new isotopes for the diagnosis and treatment of disease.

In many cases where the purpose of the test is the same, it is the method or equipment used which is the innovation. “Some of the procedures are complex and require very careful manipulation,” Dr. Morgenstern explained. “We try to adopt these as fast as we can satisfy ourselves of their worth. Where there’s doubt of the worth we may return to older, simpler methods. We rather incline toward the scientific caution ‘Don’t be first, and don’t be last’.”

In 1963, a Kaiser Permanente newsletter announced a research article he published in the medical journal Cancer, “Work with Doctors in Community” about early diagnosis and treatment of tumors in children, in collaboration with physicians from Kern County General Hospital, University of Southern California, and the Tumor Tissue Registry of the California Medical Association in Los Angeles.

A 1969 article touted the Oakland hospital’s School of Medical Technology, which had been in place for 20 years; as director of that program Dr. Morgenstern supervised the eight students — six women and two men. Each student in Oakland received a stipend of $3,600 for the year’s internship.

One of Dr. Morgenstern’s colleagues noted after his passing, “He always had time for teaching and clearly enjoyed it . . . He also had a great sense of humor and a wonderful kindness. He was a good man.”[i]

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

[i] Dr. Art Levit, MD, comment in obituary memorial booklet.

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Hope in Brazil: Lori Shearn’s memoir of South America

posted on December 16, 2013
SS Hope
The SS Hope, previously a U.S. Navy hospital ship, sailed as a roving medical oasis from 1958 to 1973. Kaiser Permanente physician Martin Shearn, his wife Lori, and their three children spent time on the ship in Brazil on its last voyage.

Forty years ago, in 1973, Permanente physician Martin Shearn took on a year-long assignment with the humanitarian organization Project Hope. As chief of staff on the SS Hope, Dr. Shearn’s mission was to bring knowledge of modern medical care to a poor coastal town in Northeast Brazil.

Like Permanente physicians who render crisis care in storm-ravaged places like the Philippines and Haiti today, Dr. Shearn and his wife, Lori, embarked on the adventure with a dual goal: to help others and to enrich their own lives by experiencing the culture of a South American country.

Lori Shearn, an active participant in the mission, took copious notes throughout the Shearns’ year in Brazil. In recent years, she has turned those notes into a memoir that reveals the intricacies of adapting to a strange culture and how at times attempts to bridge differences can result in a comedy of errors.

The Shearns’ adventures offered cultural lessons in time warps, creepy and ubiquitous creatures, South American pomp and circumstance, the joys and dangers of Carnaval, the rigors of providing medical care to those never treated before and the thrill of alligator hunting in the Amazon.

 

Lori Shearn took plenty of notes on the Shearn family trip to Brazil in 1973.
Lori Shearn took plenty of notes on the Shearn family mission to northeast Brazil in 1973.

By Lori Shearn, Heritage writer

It’s hard to believe, but it all began because Spanish seemed like the extension course that most conveniently fit into our schedule that fall in 1970.

Oh, of course we knew that they speak Portuguese in Brazil, but it all began with Spanish.

Spanish class was going rather well, so we decided that we should be going someplace where the language is spoken. A Mexican vacation, perhaps, or why not a medical service somewhere in South America?

Martin, my husband, was an internist, a physician who has educated a great many young doctors in a group practice in California, and he was also affiliated with the university where he taught. Inquiries around the medical school produced a slew of opportunities for a Spanish-speaking doctor who wanted to participate in a medical mission to South America. We considered them all.

Then we heard about Project Hope. This is a medical organization that disseminates not only medical treatment, but more importantly, medical know-how. It was made to order for us, and further investigation disclosed that the next mission would be to South America, Venezuela to be exact, and that they were recruiting physicians for a two-month stint and that wives were welcome. We applied.

Project Hope makes a fascinating offer

Pretty soon a most surprising reply arrived: “With your qualifications, would you be interested in the position of director of medical education for this voyage?” What a fascinating offer. Medical education was the subject Martin knew best and to be able to practice it in a cross-cultural setting speaking Spanish was perfect.

Our three children were all in college, and for Martin and me, a leave away from the humdrum world of our suburbia was an attractive prospect. A slight change was mentioned at this point. Instead of two months, in this more complex position, we would need to stay for the full year.

The personal conflict of leaving our children alone for a whole year had to be overcome. I assured them that they could visit us (I got their tickets in advance) as long as they made arrangements with their schools for a leave, and I told them that they would have to have a job when they got there.

The next phone call from the Hope office requested Dr. Shearn to come to Washington to plan next year’s activities. “Oh, and by the way, the ship will not be going to Venezuela, but instead, to Brazil,” they told him.

Can we learn Portuguese in time?

What to do? Our Spanish-speaking adventure was to end up in Portuguese-speaking Brazil. Should we still go? Our emotional commitment had been made, so we felt the answer would have to be yes.

But how do you switch from intermediate Spanish to beginning Portuguese in three months? There were no Portuguese classes in our area. The first experience we had listening to a tape demonstrated the complicated pronunciation, which sounded like a combination of Czech and Romanian. Another totally new language seemed like too much to handle.

With a stroke of good luck, a teacher from Rio just happened to walk into Martin’s office as a patient. She offered to help us delve into the new mysteries of the Portuguese language. Slowly we progressed. She invited all her Brazilian friends to our house often and nobody was allowed to speak English.

Our new friends were all so impressed and grateful that we were going to Brazil to help people in the underdeveloped area of the Northeast that they wanted to help us learn the language.

Another bombshell challenge

In the next phone conversation with the Hope office, a new development was introduced almost immediately. Martin was apprised that there was no chief of staff since the man so designated previously had been reassigned. Would Martin take the position in addition to that of director of education?

Upon meeting the rest of the permanent staff members in the Washington orientation, Martin and I had a lengthy consultation and then decided that he had best accept this challenge too.

The ship was to sail for South America in two weeks with the full contingent of nursing, medical and support staff. Under the existing circumstances, Martin hesitated but felt he had to accept the broader role of chief of staff, however daunting. He vowed to make the year’s project a success, and he never regretted his decision.

Next time: Brazilians stage warm reception for the physician’s family.

 

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KP Northern California marks half a century of stellar research

posted on August 14, 2012

By Lincoln Cushing
Heritage writer

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

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

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

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

This year, The Permanente Medical Group, the oldest of the eight Kaiser Permanente regional medical groups, celebrates the 50th anniversary of the founding of its Division of Research.

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

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

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

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

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

Morris Collen, MD, was the first director of the Northern California research department, established in 1961.

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

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

Antecedents to Permanente medical research

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

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

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

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

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

 

Ernest Saward. MD, medical director of Kaiser Permanente Northwest from 1945 to 1970, launched the region’s research center in 1964.

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

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

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

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

Laboratory of Comparative Biology Annex, 1301 Cutting Blvd., Richmond, CA, October 1961.

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

KP Northern California research evolves

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

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

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

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

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

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

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

Studies to better understand HIV/AIDS impact

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

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

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

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

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

Long chain of clinician-researcher leaders

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

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

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

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

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

 

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

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

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

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

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

 


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

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

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

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

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

[vi]KP Reporter, September 1959.

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

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

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

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Kaiser Permanente Fresno marks its 25th anniversary

posted on December 29, 2011

Sara Beadle, Fresno's first outpatient in 1986, with Larry Coble, MD.

By Ginny McPartland

Heritage writer

It’s been a quarter of a century since Kaiser Permanente (KP) established a prepaid medical care outpost in Fresno, then unbroken territory for the health plan. Since its opening in 1986, KP Fresno has grown from 400 initial area members to over 100,000 today.  Its facilities have expanded from a remodeled space in a shopping center to several large clinics and a hospital the Fresno Bee newspaper labeled KP’s local “crown jewel” when it opened in 1995.

“It’s big, bright and modern and epitomizes health care competition in Fresno,” the Bee writer effused.

KP officials began to ponder a move into Fresno in 1985 when large statewide employers began to expand into the burgeoning Central Valley. The health plan already had a clinic in Stockton, which is north of Fresno and south of Sacramento.

Fresno's outpatient facility opened July 1, 1986.

It made sense to go to Fresno since KP health plan members were moving there and getting their care at other KP facilities, the closest of which was three hours away. Also, employees of big companies, such as Bank of America, Pacific Gas & Electric Company and Pac Bell were retiring and settling in Fresno and other communities in the Central Valley.

“These employers wanted the advantages of having similar benefits for their employees in multiple sites, and the employees wanted access to the same quality of care and service they had grown to appreciate in the Bay Area and Southern California,” explained Larry Coble, MD, retired Fresno pediatrician and physician-in-chief. Dr. Coble wrote a history of the first 13 years of KP Fresno when he retired in 1999.

Behind the scenes, high level KP leaders had been debating about where the boundary should be between Northern California region, with a facility in Stockton, and Southern California region, which was developing a presence in Bakersfield. The argument was settled when Northern California entered Fresno and thus staked its claim in the Central Valley.

To launch a KP facility in Fresno, whose isolation made it different from most other expansion areas, KP leaders had to start at square one. No existing facility could take Fresno under its wing as a satellite.

Checking out Fresno’s potential

In 1984, TPMG executive director Bruce Sams, MD, tapped Albert Kahane, MD, associate executive director and former Sacramento Medical Center’s physician-in- chief, to work with the regional medical group to assess the potential for KP’s entry into Fresno. By early 1985, the decision to go to Fresno was made.

As the medical group facilities planning liaison, Dr. Kahane was called on to spearhead the acquisition and conversion of clinic space where the Fresno medical care program would be launched. He was also responsible for contracting for community hospital beds for KP’s patients.

Fresno's nursing staff June 30, 1986, the day before the outpatient facility opened on First Street.

In the fall of 1985, The Permanente Medical Group (TPMG) and health plan leaders began to assemble a team to make Fresno a reality. They set the opening date for July 1, 1986, and leased a four-story building at First and Shaw streets in the former Fashion Fair Plaza. Remodeling of space for the primary care areas began right away.

The start-up team, affectionately called the A-team, was selected from the Sacramento service area. Led by Dr. Coble, the team members were: John Bowden, medical facility administrator; Shirley Edmons, RN, nursing director; Toni Hays, Support Services manager; and Edie Yoder as secretary.

Selling Kaiser Permanente

In the spring of 1986, Dr. Coble began his quest for willing professionals to make up the KP core team of primary care staff physicians, contracted specialists and laboratory and x-ray professionals. “(I was) literally going from door to door meeting with physicians, optometrists, podiatrists, laboratory supervisors, etc. At times I felt like a salesman, handing out my card wherever I went. . .that’s exactly what I was doing, selling Kaiser Permanente.”

On July 1, 1986, the Fresno team was ready and the doors opened at the medical offices at 1475 First Street, with seven physician offices, 14 exam rooms, two procedure rooms, waiting room and reception area. Seven physicians were there to treat patients the first day. They were physicians Paul Baker, Jose Rendon and Larry Coble; internists Tony Antoniou, Raj Banka and Red Uhrle; and family practitioner Sami Issi.

The first patient was 19-month-old Sara Beadle, who was brought in by her mother (Debra Shriver-Sprinkel) at 8:40 a.m. on the first day. She grew up to be a healthy young woman and distinguished herself on Fresno State University’s equestrian team in the 2003-2004 season. She studied philosophy and business in the Fresno pre-law program.

Most local residents and employers welcome KP

Dr. Coble says the people of Fresno, especially the major employers, for the most part welcomed Kaiser Permanente to the Fresno community. It took the Fresno City Council five minutes to approve a zoning change for 38 acres at Fresno Street and Alluvial Avenue to allow KP to build a 200-bed hospital and medical offices for 180 physicians. At the time, the health plan had no immediate plans to build a hospital, but opened a huge outpatient facility at the site in 1991 and added an outpatient surgery center in 1992.

There was, however, initial resistance from the Fresno area fee-for-service physicians who objected to KP’s prepaid group practice. Dr. Coble recalls: “One very ugly situation occurred in which someone obtained a copy of our contracted physician list and posted it on (a local) hospital’s physician lounge bulletin board.”  The list of specialists taking referrals from KP doctors was circled with black crepe, the symbolic “black ball” meant to intimidate physicians from supporting KP.

Fresno's medical center opened in 1995.

Dr. Kahane says he also encountered resistance when he negotiated with local hospital administrators for KP’s use of hospital beds. He says favorable contracts were elusive because hospital leaders believed KP would eventually build its own hospital in Fresno. He told local hospital officials: “Whether it costs us less (to operate our own hospital) or not is your decision.” He explained that if the community hospitals charged prohibitive fees for contracted beds, KP would be forced to build its own Fresno hospital. “And that is exactly what happened,” he said in a recent interview.

Fresno KP gets its own medical center

In the early 1990s, with rapidly growing membership and medical staff, KP Fresno leaders started making plans for a hospital of their own. Construction began in 1993 on the site at Fresno Street north of Herndon Avenue. In 1994, Ed Glavis was appointed as administrator of the new hospital; Maura Hopkins, RN, as nursing director; and Davidson Neukom as facilities manager.

When the new hospital opened in February 1995, the Fresno Bee said: “The Kaiser Permanente Hospital is the crown jewel in a $100 million Kaiser building project in Fresno, including the $30 million ancillary building which opened in late 1992.”

“I’m terribly excited,” Dr. Coble told the Fresno Bee. “It’s going to be easier because our physicians now will be able to literally walk down the hall to see their (hospitalized) patients. . . In addition, he said, all the ancillary services, such as laboratory, x-ray and pharmacies are close at hand . . . It’s professionally a very satisfying way to provide health care.”

Opening just in time for laboring mom

Madison Ballew, first baby born in Fresno’s Medical Center February 28,1995, with her parents Rob and Angela.

On opening day, KP Fresno swung open the doors to the Birthing Center and the Emergency Department. When the maternity staff unlocked the door at 6 a.m., they were met by expectant mom Angela Ballew who was in labor and gave birth to a daughter, Madison Ballew, the same day.

One-year-old Madison was the star of the show at the party celebrating 1,167 babies born in the center’s first year. Madison’s mom, a Sanger drama teacher, told the Fresno Bee that she would deliver her second child at the center the following August.

The rest of the hospital complex was opened in October of 1995. Having received “full accreditation with commendation,” Dr. Coble reported in his memoir: “We were a full-scale, high-quality medical group and hospital!”

Continued growth and success

From its early milestones, KP Fresno has continued to grow and prosper. The Fresno KP community has been honored recently for its commitment to reduce waste and prevent pollution in its facilities. The staff has also been recognized for its excellence in employee wellness efforts and for its work to overcome obesity in the community.

KP’s Fresno Medical Center, which stopped accepting free baby formula years ago, is close to being designated as Baby-Friendly* with 75.8% of new mothers exclusively breastfeeding their newborns, the highest rate in Fresno County in 2009. The center’s maternity staff places an emphasis on breastfeeding and discourages formula supplementation for infants whose mothers intend to breastfeed exclusively.

KP’s presence in the rest of the Central Valley has continued to expand as well. In 2008, the health plan opened another exquisitely designed hospital to serve the area. The new Modesto Medical Center** follows the current version of the evolving KP hospital design template, which incorporates functionality, as well as sustainability, patient comfort, optimal use of natural light, staff efficiency and accommodation of the latest medical technology.

*Baby-Friendly USA is a national campaign to encourage breastfeeding. Fourteen of Kaiser Permanente’s facilities have received the designation, and KP leaders have vowed to have all 29 medical centers called out as “baby friendly” by Jan. 1, 2013. Already designated are: Los Angeles, San Diego, Fontana, Downey, Riverside, Anaheim, Panorama City, Irvine, Baldwin Park, and Woodland Hills in Southern California; Hayward and South Sacramento in Northern California; Honolulu, HI, and Clackamas, OR.

**For more about the KP facility template, click here.

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