Posts Tagged ‘Tom Debley’

Books and publications about Kaiser Permanente history

posted on March 23, 2015

Lincoln Cushing
Heritage writer

 

If you are interested in learning more about the history of Kaiser Permanente, the books listed here are all good resources. With the exception of The Story of Dr. Sidney R. Garfield and Permanente in the Northwest, these books are out of print, but copies can often been located through libraries and mainstream used booksellers, such as AbeBooks (external), Alibris (external), Barnes and Noble (external), Half Price Books (external) or Powell’s Books (external).

 

In Print

The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care Into Health Care
Tom Debley with Jon Stewart

The first biography of Dr. Garfield tells the story of his long and eventful career, during which he turned his 1930s Mojave Desert industrial health care dream into a thriving and enduring reality that continues to offer a practical model for the future of American health care.

The Permanente Press, 2009, 148 pages

Available from The Permanente Press (external)

 

permanenteinthenorthwestPermanente in the Northwest
Ian C. MacMillan

This book fills a large gap in the history of Kaiser Permanente – the unique contribution made by the Northwest region, especially in the early years. The author, retired Northwest internist Ian C. MacMillan, demonstrates an insider’s insight and enviable access to details that thoroughly enrich this account.

The Permanente Press, 2010, 313 pages

Available from The Permanente Press (external)

BuildEmBuild ‘Em by the Mile, Cut ‘Em off by the Yard: How Henry J. Kaiser and the Rosies Helped Win World War
Steve Gilford

A good overview of the World War II Home Front experience in the Kaiser Richmond shipyards. The book is written for the general reader and includes many personal anecdotes about Home Front life.

Richmond Museum of History, 252 pages, 2011

 

Out of Print

A Model for National Health Care: The History of Kaiser Permanente
Rickey Hendricks

This extensively researched book is the definitive academic history of Kaiser Permanente that tells the story of its growth and impact on American health care.

Rutgers University Press, 1993, 265 pages

Embattled Dreams: California in War and Peace, 1940-1950
Kevin Starr

Part of an extensive history of California series, this book includes discussion of Henry J. Kaiser, his wartime industrial efforts, and the founding of Kaiser Permanente.

Oxford University Press, 2002, 386 pages

Henry J. Kaiser: Builder in the Modern American West
Mark Foster

In this academic biography, historian Foster offers the definitive balanced view of Kaiser, covering his mistakes as well as his colossal strengths and successes.

University of Texas Press, 1991, 358 pages

Henry Kaiser, Western Colossus
Albert Heiner

This very readable biography is by a former Kaiser Steel executive who was an eyewitness to much of Henry Kaiser’s career.

Halo Books, 1989, 434 pages

Kaiser Wakes the Doctors
Paul De Kruif

This book by America’s foremost medical writer of the era was the first ever written about the revolutionary medical care available in the Kaiser World War II shipyards.

Harcourt, Brace & Company, 1943, 158 pages

Kaiser Permanente Health Plan: Why It Works
Greer Williams

The author was commissioned to investigate Kaiser Permanente to assess “what it is, how it works, and whether it is good or bad.”

Henry J. Kaiser Family Foundation, 1971, 92 pages

Can Physicians Control the Quality and Costs of Health Care? The Story of The Permanente Medical Group
John G. Smillie, MD

Smillie, an early Northern California Permanente physician, offers an insider’s view of the beginnings of the Kaiser Permanente medical care program.

McGraw Hill, 1991, 283 pages

The Kaiser Story

When Henry J. Kaiser passed away in 1967, Kaiser Industries published this short book as a tribute to the company’s founder.

Kaiser Industries, 1968, 72 pages

Life Among the Doctors
Paul de Kruif

A collection of essays on people the author regarded as pioneers in medicine, including: Sidney Garfield, MD, in a section titled “The Last Maverick;” Edna Schrick, MD, whom de Kruif quotes as suggesting to Dr. Garfield that “we learn how to teach the well to take care of themselves…to keep away from doctors”; and Herman Kabat, MD, who founded the Kabat-Kaiser Institute, now the Kaiser Foundation Rehabilitation Center in Vallejo.

Harcourt, Brace & Company, 1949, 470 pages

Mr. Kaiser Goes to Washington: The Rise of a Government Entrepreneur
Stephen B. Adams

Historian Adams offers Kaiser’s story as a case study of “government entrepreneurship.” He explores the symbiotic relations forged by Kaiser and President Franklin D. Roosevelt.

The University of North Carolina Press, 1997, 239 pages

The Rich Neighbor Policy: Rockefeller and Kaiser in Brazil
Elizabeth A. Cobbs

Cobbs details how Henry Kaiser’s participation in the Brazilian auto industry impacted U.S. foreign relations and how postwar businessmen sought accommodation with Latin American nationalism by evolving a code of ‘corporate social responsibility.’

Yale University Press, 1992, 273 pages

Historical Review of the Southern California Permanente Medical Group: Its Role in the Development of the Kaiser Permanente Medical Care Program in Southern California
Raymond M. Kay, MD

A history of the SCPMG written by Dr. Raymond Kay, who was Sidney Garfield’s close friend, a pioneer of the Permanente Medical Groups, and the founder of the Southern California Permanente Medical Group.

SCPMG, 1979, 174 pages

 

Other Publications

Kaiser Permanente: A Short History
Gerry Gaintner

Gerry Gaintner, EdD, was a Kaiser Permanente employee for 15 years, all in the Information Technology department. He wrote this concise history in 2010, and upon his retirement, gifted it to KP Heritage Resources.

Unpublished, 2011, 42 pages
Available for download (pdf)

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

posted on June 30, 2012

This blog was originally posted on August 7, 2009

By Ginny McPartland
Heritage writer

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

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

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

Garfield—A grass roots approach

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

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

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

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

Garfield’s troubles begin

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

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

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

A great model of health care

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

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

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

Health care reform still a discussion

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

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

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

 

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Remembering our KP history to face the future

posted on December 16, 2010

By Tom Debley 

Director of Heritage Resources 

Debley with 1953 Kaiser Manhattan at the dedication of the new Kaiser Foundation Rehabilitation Center in Vallejo February 2010. The center was first established in 1947.

It’s time for me to say farewell after 15 years with Kaiser Permanente.  The last seven years have been as founding director of Heritage Resources, our history program.  But at the end of the day on Dec. 17, I will head off to new adventures in retirement.  

Do not fear, my able colleagues Bryan Culp and Ginny McPartland will carry on the history work in Heritage Resources!  

So what does one say to many friends, colleagues and Kaiser Permanente history buffs other than good-bye?  

For me, I quote the literary great, Robert Penn Warren: “History cannot give us a program for the future, but it can give us a fuller understanding of ourselves, and of our common humanity, so that we can better face the future.”  

Recently, I was reminded of the importance of this – and a key reason why we maintain a historic archive at Kaiser Permanente.  It came as an inquiry on our History of Total Health Blog from John Herron, a history professor at the University of Missouri, who had read a blog about Rachel Carson and Kaiser Permanente’s environmental history by our intern, Jac Brown.  

Carson’s last public lecture prior to her death was delivered at an October 1963 Kaiser Permanente symposium attended by 1,500 doctors, scientists, medical students and journalists at the Fairmont Hotel in San Francisco.  

Debley is a familiar figure at the Rosie the Riveter/WWII Homefront national park in Richmond. This is from our KP history booth at the annual homefront festival.

This was a year after publication of Carson’s then very controversial book “Silent Spring,” critiqued in 1962 in Time Magazine, which concluded: “Many scientists sympathize with Miss Carson’s love of wildlife, and even with her mystical attachment to the balance of nature. But they fear that her emotional and inaccurate outburst in Silent Spring may do harm by alarming the non-technical public, while doing no good for the things that she loves.”  

Today, of course, Carson’s “Silent Spring” is a classic of the 20th century and she is considered the catalyst for the modern environmental movement.  

Quite naturally, Professor Herron wanted to know why the then vice president, and later president, of Kaiser Foundation Health Plan and Hospitals, Dr. Clifford Keene, invited such a controversial figure to lead off a public service symposium, the theme of which was “Man Against Himself.”  We sent him materials for writings he and other scholars are preparing for the 50th anniversary of the publication of “Silent Spring.”  

And that’s one of two reasons why we have a history program.  One is to share stories of our history with our physicians, staff and communities.  The other is to be here for scholars, museums and others who seek historical insights.  

Debley speaking about his biography of Sidney Garfield, MD, at the Commonwealth Club August 2009. Photo by Joe Paolazzi

I started our Heritage Resources program in 2003.  Professor Herron’s recent question reminded me of the day in 2003 that I first read a one-paragraph item about Rachel Carson’s lecture in a list of “highlights of the year 1963” in an old annual report.  

Immediately, I flagged this event as something around which to begin collecting documents for archival purposes.  Why?  This was a high-water mark that helps illustrate why Kaiser Permanente is a recognized leader in sustainability, because sustainability is important to building healthy communities.  

Today, we have Ms. Carson’s lecture text, copies of the correspondence between her and KP planning for her presentation, and other documentation.  

As a result, we have collected and archived a wide array of historical materials.  A mere handful of these documents illustrate how we stand on the shoulders of other leaders like Rachel Carson:  

  • Founding physician Sidney Garfield was looking for sustainable practices and was recycling in the Great Depression and during and after World War II;
  • It was a Kaiser Industries executive who was among those who founded The League to Save Lake Tahoe in 1957, and coined the phrase seen on bumper stickers and elsewhere to this day: “Keep Tahoe Blue”;
  • Kaiser Steel was pioneering pollution control equipment in the 1950s and 60s – before the modern environmental movement and before the first Earth Day in 1970;
  • In the early 1970s, employees at the Kaiser Permanente Medical Center in Santa Clara, California, formed an Ecology Committee with an objective of teaching employees “ecological common sense”;
  • In the 1980s, employees in Vallejo, California, were honored for reducing energy consumption by half in five years;
  • Today, the efforts continue with Kaiser Permanente adding solar power generation to 15 of our facilities by next summer.  These groundbreaking projects will eliminate purchase and disposal of 40 tons of harmful chemicals and dramatically reduce KP’s use of fossil fuels.

Our commitment to sustainability is but one example of Kaiser Permanente’s mission to improve the health of its members and of the communities in which they live. 

History reminds us, as Robert Penn Warren said, of who we have been, why we are who we are, and where we are headed if we remain true to our values and mission – as individuals and as institutions.

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Tom Debley Earns National Park Service Award

posted on June 4, 2010

By Ginny McPartland 

RICHMOND – The National Park Service presented its Home Front Award to Kaiser Permanente’s Heritage Resources Director Tom Debley Monday (May 24) as part of the city’s 2010 Historic Preservation Awards.

Debley is being cited for leading “initiatives to create and support” the home front park, which is on the site of the World War II Kaiser Richmond shipyards. 

The National Park Service Home Front Award is to recognize people, projects, programs or publications that preserve a home front site or structure, or that promote recognition and understanding of the WWII era in Richmond’s and the nation’s history. 

The purpose of the city’s historic awards program is to increase public awareness of Richmond’s heritage by recognizing individuals, organizations, businesses and agencies whose contributions demonstrate outstanding commitment to excellence in historic preservation, local history or promotion of the city’s heritage. 

Click this link to hear Tom’s remarks on receiving the award 

 streaming video courtesy of the KCRT Information Network

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Rosie park in Richmond not just for Rosies

posted on May 19, 2010

By Ginny McPartland   

World War II changed everything. Women dared to strike out for the first time into a man’s world of work. America’s harbors sprouted hyperactive shipyards, and a burgeoning U.S. heavy industry turned out the steady stream of weapons and vehicles needed to outlast our enemies. “We won the war because we out-produced everyone else,” observed Lucille “Penny” Price, a Richmond, California, shipyard electrician during the war. 

Diverse shipyard workers in class

A grateful American society has been thanking the stereotypical “Rosie the Riveter” for her role in war production ever since the war ended 65 years ago. About 25 percent of the hundreds of thousands of West Coast shipyard workers were women, but the park is really dedicated to all home front workers – welders, electricians, pipe fitters, cleaners, helpers – everyone. 

Telling the “Rosie” stories, as well as chronicling the dramatic societal changes the war spawned, is the mission of the Rosie the Riveter/World War II National Historical Park in Richmond. The park sits on the Richmond waterfront where the wartime Kaiser shipyards were situated. 

Celebrating World War II’s home front legacy 

As the nation marks the 65th anniversary of the war’s end this year, the Rosie park celebrates its 10 years as an institution dedicated to keeping the lessons of World War II from being forgotten. Kaiser Permanente, whose medical care program started in the Kaiser West Coast shipyards in 1945, also celebrates its decade-long association with the park to keep the war’s legacy alive. 

The health plan’s contributions to the park’s mission will be formally recognized on Monday, May 24, when the city of Richmond and the National Park Service present Kaiser Permanente Heritage Resources Director Tom Debley with the 2010 Home Front Award. Debley is being honored for “initiatives to create and support the Rosie the Riveter/World War II Home Front National Historical Park.” 

Ambulances at the ready in Richmond

The powerful synergy of the national park-Kaiser Permanente partnership was highlighted at a recent party to raise funds for the Rosie the Riveter National Park Trust. Debley was guest speaker and gave his talk about the history of health care reform. 

About 150 people attended the annual event in the old cafeteria on the former site of Kaiser Shipyard No.3, raising $38,000 for various trust community projects. These projects include Rosie’s Girls, a summer camp for adolescent girls; restoration of Atchison Village wartime housing, which is on the National Register of Historic Places thanks to work by the Rosie trust. You can find out more about trust projects at http://www.rosietheriveter.org 

The cafeteria, an ugly duckling the day before, was transformed into a lovely swan by Saturday night. NPS Ranger Elizabeth Tucker, along with Rosie Trust dinner co-chairperson Jane Bartke and others, dressed up the place with a couple hundred posters, photos and other war era artifacts. Rosemary Blaylock, a friend of Bartke, collected products and household items that recalled a simpler time before the war. She made up see-through packets that contained wartime candies M&Ms, malt balls, and bite-size York’s Peppermint patties. 

Among the guests at dinner was a sunny Kaiser Permanente President and CEO George Halvorson and his photographer wife Lorie Halvorson; pioneering Permanente physicians Morris Collen and Ed Schoen, who treated shipyard workers; Diane Hedler, director of Quality for the Permanente Federation and Rosie trust board member; Alide Chase, senior vice president of Quality and Safety; Robert Erickson, retired chief counsel for Kaiser Foundation Health Plan and Hospitals; Glen Hentges, chief financial officer for the Permanente Federation; Clair Lisker, retired hospital nursing administrator and educator, her family including her son Wes Lisker a physician at Hayward Medical Center; John August, executive director of the Coalition of Kaiser Permanente Unions; Dianne Dunlap, August’s deputy and member of the Rosie trust board; Holly Potter, vice president, public relations and stakeholder management, Brand Strategy, Communications and Public Relations; Bill Graber, Kaiser Foundation Health Plan and Hospitals Board of Directors member; Richard Reed, senior project manager, Health Plan Process Administration; and Mark Aquino, Patient Care Services. 

Of course, the national park service was well represented by Ranger Betty Soskin Reid, our most celebrated local Rosie who worked in the shipyards and is the oldest ranger in the park system; park Superintendent Martha Lee; Ric Borjes, Chief of Cultural Resources for four Bay area park sites; and Elizabeth Tucker, park ranger and all-around get-things-done person. Other special guests of the night were Bernice Grimes, of Walnut Creek, who was a scaler at the Kaiser shipyards,  Mary Gillum, of Portland, Ore., who was a machinist in an Oregon Kaiser shipyard, and Marian Sousa, a draftswoman in Shipyard #3. 

Rosie Marian Wynn, a wartime pipe welder, Marjorie Hill, a Red Oak Victory volunteer, Amanita Cornejo, a Contra Costa College volunteer, and Marian Sousa helped with set-up and clean-up for the dinner. 

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Kaiser Permanente’s Historical Role in Rehabilitation Medicine

posted on January 23, 2010

By Tom Debley
Director, Heritage Resources, Kaiser Permanente

Since the late 1940s, the Kaiser Foundation Rehabilitation Center (KFRC) in Vallejo, California has treated thousands of patients with acquired neurological disorders, trauma, and neuromuscular and orthopedic conditions. This inpatient rehabilitation hospital and outpatient center also is Kaiser Permanente’s Center of Excellence for people with disabilities.

Less known is the role industrialist Henry J. Kaiser played in its inception, thereby establishing himself as a national philanthropic leader in helping establish the field of rehabilitation medicine.  Recognition for that historic accomplishment is remedied in a new book by Richard Verville titled “War, Politics, and Philanthropy: The History of Rehabilitation Medicine” (University Press of America, 2009).

Verville describes the birth of this field in part out of the need to treat soldiers who suffered combat injuries in World Wars I and II.  He traces its evolution to the present.  In his chapter “The Immediate Postwar Years,” he covers Henry Kaiser, Dr. Sidney R. Garfield and Dr. Herman Kabat in the formation of the Kabat-Kaiser Institute in 1946 – today’s KFRC.   Anyone interested can view our 11-minute video  The Power of Science and the Human Spirit  about the history of KFRC and get the full story in the context of American medical history in Verville’s book.

To sum up the historic role of Henry J. Kaiser, Verville places him in a pantheon of important leaders that includes President Franklin D. Roosevelt in setting the stage for the growth of rehabilitation medicine after World War II:  “Kaiser thus took his place along with Bernard Baruch, Jeremiah and Samuel Milbank, and FDR as philanthropists who assisted in the early development of the medical rehabilitation facility movement in the private sector. Without their initiative and willingness to back new methods in health care, the eventual growth of rehabilitation medicine might never have occurred.” (Emphasis added.)
 
To be sure, as Verville points out, the trigger for Henry Kaiser’s actions was news in 1945 that his son, Henry J. Kaiser Jr., had multiple sclerosis. When the elder Kaiser learned that Kabat, a neurophysiologist and clinical neurologist, was achieving success in treating multiple sclerosis and paralytic poliomyelitis, he asked Kaiser Permanente founding physician Sidney R. Garfield to meet with Dr. Kabat.  “He had people walking who hadn’t walked for years,” Garfield recalled.  The Kabat-Kaiser Institute was born.

Not covered in this book is the fact that Kaiser already had experience with addressing the needs of people with disabilities on the Home Front of World War II.

An early Permanente physician, Clifford Kuh, a specialist in industrial medicine, did research in the Kaiser Shipyards in Richmond, Calif., looking at workers for their capabilities despite their physical disabilities rather than viewing them as “handicapped” and incapable. It was a visionary’s viewpoint that did not become prevalent for another 30 years with the rise of the Disability Rights Movement of the 1970s and subsequent Independent Living Movement.

The importance of Dr. Kuh’s work was recognized immediately, however.  In reporting on it, the New York Times (May 21, 1944) quoted William K. Hopkins, regional director the War Manpower Commission, which collaborated on the study.  Hopkins called it “pioneering” work that would prove “invaluable in the post-war period” with service men and women who would return to the civilian workforce with disabling injuries.

As a charitable trust, Kaiser Foundation Health Plan (then “Permanente Foundation”) provided funds in 1944 to distribute the research results nationwide as a public service so that communities across the country could use it help assimilate disabled veterans into the postwar workforce.

(The Kaiser Permanente Heritage Resources program offers special thanks to its history colleague Dr. Elizabeth Sandel, chief of physical medicine and rehabilitation at KFRC today who Verville notes reviewed an early draft of his book and provided him with historical material on the history of The Permanente Medical Group and Henry J. Kaiser.)

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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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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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