Archive for August, 2009

Garfield Biographer Speaks at the Commonwealth Club

posted on August 27, 2009
Photo by Joe Paolazzi

Photo by Joe Paolazzi

Dr. Sidney Garfield’s childhood dream of being an architect was shattered when his Jewish Russian immigrant parents insisted he become a doctor. Little did the young Garfield know that his destiny was not only to become a doctor but also to blaze trails few others had even dared to ponder.

Indeed, 25 years after Garfield’s death, President Barack Obama points to the medical care program Garfield founded as a model for 21st Century health care reform, author Tom Debley said in his talk to the Commonwealth Club in San Francisco Aug. 25.

Debley, author of a new Garfield biography, described the extraordinary life of the pioneering Kaiser Permanente doctor in the book, Dr. Sidney R Garfield: the Visionary Who Turned Sick Care into Health Care.  “Most people know very little of Sidney Garfield, and I try to remedy this with my book (written in collaboration with Jon Stewart),” Debley told the crowd.

Debley recounted Garfield’s 20th Century journey from his birth in 1906 in Elizabeth, New Jersey, through the Great Depression, World War II, the Cold War, and the 1950s and 1960s battles to gain acceptance for a different type of medical care.

Garfield’s formula for the best health care emphasized ways to keep people free of disease and thus not needing sick care. In 1933, Garfield found he could provide affordable care to the workers on the Colorado River aqueduct project by collecting weekly dues to cover all members whether they required care or not.

“After nearly going broke, Garfield linked two ideas from the debate of his era – prepayment and prevention – in a way that reversed medical economics,” Debley, director of Heritage Resources for Kaiser Permanente,  told the Commonwealth Club audience.

“In 1938, he joined forces with (industrialist Henry J) Kaiser and his son Edgar at the construction site of the Grand Coulee Dam. Here Garfield added the ideas of group medical practice, facilities under one roof, and a family plan,” Debley said.

In the War years, Garfield reunited with the Kaisers to provide medical care for workers in Kaiser’s Pacific Coast shipyards and the Kaiser Steel plant in Fontana, California. “In a mere 18 months, he and his colleagues opened four hospitals and built the largest civilian medical care program on the Home Front of World War II.”

When the War ended in 1945, Garfield and Kaiser were able to keep their health plan alive by opening up to the public and taking care of union members such as the longshoremen and the steel workers.  Soon enough, the University of California, public schools, other government and large employers picked up Kaiser Permanente care for their employees.

“Sidney Garfield was a doer – his is a classic American story – a man passionate about his calling and determined in his quest. Like his ideas or not, he and Henry Kaiser brought health care to millions of Americans – more than any two individuals I can think of in American history,” Debley told the group.

But, wait, the story isn’t over yet.  In the 1950s when Garfield’s run as medical director ended, he resurrected his youthful fantasy to be a builder. Garfield created designs for new Kaiser Permanente hospitals that won him national acclaim.

“Three hospitals opened in 1953 –in Walnut Creek, San Francisco, and Los Angeles – were labeled ‘dream hospitals.’ Dr. Walter C. Alvarez, perhaps America’s most famous physician of the era, told broadcaster Lowell Thomas:  ‘A new day has dawned, where more brains will go into the design and architecture of a hospital.’

“Newscaster Chet Huntley reported: “The use of labor-saving devices, the use of light (both natural and artificial), the gadgets, the décor, and the  personnel are all combined to make the new (Los Angeles) Kaiser Foundation Hospital something special,’ ”  Debley said.

Still, Garfield was not done.  In 1960, he insisted Kaiser Permanente embrace the computer whose development was in its infancy. “Garfield saw computers as a component of a ‘total health’ system of care,” Debley noted. Garfield’s early vision has allowed Kaiser Permanente to become an international leader in the field of electronic medical records and other IT systems.

All in a day’s work for Sidney Garfield.

 – Ginny McPartland


To order your copy of Debley’s book, Dr. Sidney R Garfield: the Visionary Who Turned Sick Care into Health Care, go to The Permanente Press.

To view the talk on, go to Commonwealth Club.

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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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Voice of Permanente Pioneer Martin Reisman, MD

posted on August 12, 2009
fore-n-aft-cover-19440707-without-textWhen I learned that the Centers for Disease Control (CDC) presented Kaiser Permanente with its Pioneering Innovation Award in late July for leadership in combating obesity with its associated rising rates of Type 2 diabetes and cardiovascular disease – news of the award brought to mind a voice from forty-five years ago.

First the award.  Dr. William Dietz, the Director of CDC’s Division of Nutrition, Physical Activity and Obesity cited Kaiser Permanente’s comprehensive assault on the health risks associated with the obesity epidemic. Dietz praised Kaiser Permanente’s evidence based clinical programs, its interventions and grassroots coalitions to improve food and physical activity environments, and its advocacy for public policies that promote healthy eating and active living.  Now let’s take note of an early pioneer in this effort.

In January 1965, Dr. Martin Reisman, a pediatric cardiologist at the Kaiser Foundation Hospital, Los Angeles and a professor in the Department of Pediatrics at the UCLA School of Medicine published an article “Atherosclerosis and Pediatrics” in The Journal of Pediatrics. This was the first article in the pediatric literature to suggest that atherosclerosis was a “pediatric disease” with onset within the first two decades, and that pediatricians should begin to participate in appropriate research and possible clinical primary interventions.

The current relevant literature and research were reviewed by Dr. Reisman with special emphasis on the pathologic studies from the Korean War casualties. A significant degree of coronary arteriosclerosis and narrowing of the coronary lumen were noted in the young American casualties in their early twenties. In contrast Chinese and Korean war dead showed virtually no evidence of this early onset of heart disease.

Dr. Reisman noted, “As a pediatric cardiologist, I find myself uncomfortable at the thought that standard pediatric practice might be contributing to the development of acquired heart disease.  These considerations have prompted many observers to believe that the present standard American diet is a major contributing factor in the etiology of atherosclerosis. The larger part of the incubation period of this disease may very well be the first two decades of life, and a modest change initiated early and sustained through life might be clinically significant.” He went on to say:  “It is time for us to join intellectually with colleagues in adult medicine and concern ourselves with a disease that is probably a mutual responsibility.”

Dr. Reisman, during his career as a pediatric cardiologist worked to encourage screening for hyperlipidemia and intervening when appropriate with dietary / life style changes and use of lipid lowering medications. This effort has been continued and expanded by colleagues who followed him.

Bryan Culp

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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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Today’s Research and the Earliest Computer Medical Records

posted on August 4, 2009

Did you catch any of the news stories about the researchers who reported that elevated cholesterol levels in midlife significantly increase the risk of Alzheimer’s disease and dementia later in life? This was a collaborative piece of work by researchers from Kaiser Permanente and the University of Kuopio in Finland. And I’ll I bet you didn’t know that it was only possible because they could track almost 10,000 patients over four decades because of some of the earliest computer medical records in history!

Let me share the back story.

Recently, my colleague, Bryan Culp, and I got to spend an afternoon with Dr. Lester Breslow. He is the great public health leader in California who invented the “multiphasic exam” after World War II. The idea was to develop and use mass screening techniques to improve public health. He later became director of the California State Department of Public Health and served as dean of the School of Public Health at UCLA.

Dr. Breslow shared his memories of how an illustrious Permanente physician and classmate from the University of Minnesota Medical School, Dr. Morris F. Collen, adapted the “multiphasic exam” for use with thousands of longshoremen who joined Kaiser Permanente in 1951. Within a year, the exams were being expanded to other patients.

But the big news came in 1963-64 when, with partial support of a grant from the U.S. Public Health Service, Dr. Collen replaced paper records with a computerized “automated multiphasic screening program” that provided a total of a half million examinations in its first decade. Those were among the first computerized medical records in history and have been providing important long term medical information for researchers for more than four decades.

So, how does that relate to the new study? Well, the research findings came from tracking the medical data of members of Kaiser Permanente’s Northern California Region from 1967 to 2007 by using those very multiphasic testing records pioneered by Dr. Collen, who is widely regarded worldwide as pioneer of the field of medical informatics.

–Tom Debley

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