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.)
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.
Kaiser Permanente founding physicians Sidney Garfield and Raymond Kay, fast friends from their days as residents at the University of Southern California-Los Angeles County Hospital, shared a dream to practice medicine as they had experienced it in an academic setting. The teaching hospital’s proximity to research; complement of specialties; “doctor-to-doctor” consultation; peer review; and pedagogy of apprenticeship were features they would knit into Permanente medicine. When the California Permanente medical groups were forming in the 1940s and 1950s, Garfield and Kay recruited physicians who had an affinity for the intellectual rigor of academic medicine. They nurtured a tradition of life-long learning and committed resources for academic symposia that have continued over 50 years.
In November 2008, Southern California Permanente Medical Group sponsored the 50th Annual Pediatric Symposium at which nine distinguished guest faculty lectured on new developments in pediatric medicine. Professor Zvi Laron delivered the keynote address. Laron, author of over 1400 scientific papers and 30 books and the Editor-in-Chief of Pediatric Endocrinology Reviews, is Director of the Endocrinology and Diabetes Research Unit at Schneider Children’s Medical Center of Israel and Professor Emeritus at Tel Aviv University.
Dr. Benjamin Fass, chairman of the symposium since 1993, celebrated the 50th year achievement in his opening remarks, “The Meaning of a Number.” Dr. Fass practices pediatric endocrinology and general pediatrics at Kaiser Foundation Hospital West Los Angeles and is Associate Clinical Professor of Pediatrics, David Geffen School of Medicine, UCLA.
The Meaning of a Number
On a winter day in 1955, a man stepped off a train at Union Station in downtown Los Angeles. He was wearing a gray Fedora and a brown winter coat, and was easily recognizable to the two men who came to pick him up. They were from Kaiser Permanente. They knew that he took the three day train trip from New York because he had a fear of flying. His name was Hodes, Dr. Horace Hodes, and the men were Dr. Erwin Goldenberg and Dr. Sam Sapin. Dr. Hodes was Chair of the Department of Pediatrics at Mt. Sinai Hospital, New York, and renowned in the world of infectious disease. He had been invited to this new medical organization, Kaiser Permanente, by one of its early members – Sam Sapin – of a budding pediatric department, to discuss the recent polio epidemic and the Cutter vaccine catastrophe. Little did these two men know that this episode would initiate a long tradition of pediatric symposia of which we celebrate the 50th event this weekend.
In 1953, Dr. Raymond Kay and 16 physician associates organized the Southern California Permanente Medical Group (SCPMG). At that time, there were only three Kaiser Medical Areas, Fontana (the first) and Sunset, both with their own Hospitals, and Harbor City. These new and outstanding pediatricians, spearheaded by Dr. Erwin Goldenberg, determined to build an organization based on an ethos of life-long learning… The man in the gray Fedora and brown winter coat could not have imagined that he not only helped birth these symposia, but also helped set a very high bar as to the extraordinary quality of all future conferences.
The first 10 years of the symposia were “chaired” by different pediatricians, but in truth, organized and managed by Shirley Gach, who was then what is today the Department of Physician Education. By 1965, the symposia, which previously were held at Sunset and generally consisted of one nationally prominent speaker, grew in scope and became more formal. The Chiefs of the Pediatric Departments at that time wisely chose Dr. Billie Moore to officially Chair the symposia, aided by a committee composed of pediatricians from each medical area. I was fortunate enough to be one of those members in later years and learn at the master’s knee. Billie chaired the symposia from 1965 to 1992 with unparalleled success. She was kind enough to ask me to chair subsequently, and I began in 1993.
Those early “founding fathers” conceived of these symposia as not only superior educational opportunities, but also as a way to bring together the pediatricians of all areas and to network and socialize in order to help knit the pediatricians into a solid and interconnected group. Today, there are over 300 pediatricians in the Southern California area and to a great extent we have been wildly successful in achieving both goals.
Over the course of these symposia, things changed due to the nature of our expanding group, the growth of subspecialties, the question of pharmaceutical support, and the emergence of the internet as an important educational tool, to name but a few. The unspoken understanding by our early founders that these symposia would be part of the Kaiser Permanente experience and offered at no charge, also changed. In 1999, the first registration fee of $50 was imposed to a great outcry from the group. But let us speak of happier things. Despite these changes, the symposia have continued to attract speakers of the highest caliber to present topics that are current, useful, and are on the cutting edge of medical research and medical practice.
So, the meaning of a number, of our number, 50, is simply an opportunity to not only celebrate the success of these symposia, but also to reflect on our beginnings and to thank our “founding fathers” who conceived of these symposia; to thank those who, as a labor of love, have been involved with the creation of each of these conferences: our chairs, chiefs, committee members, presiders, moderators, and educational coordinators, and mostly you, the attendees, who have been faithful to our historical educational mission. Our sincere hope is that our organization unwaveringly continues to support these symposia for another 50 years.
As the man from New York in the gray Fedora might have said at this point, “fuhgidehbowdid,” and go find your dear friends, have a cup of tea … learn from this outstanding guest faculty, and enjoy this superb conference.