By Edward J. Derbes
If Dr. Paul E. Stange had not attended medical school, he probably would have been a football coach, said his son, Paul V. Stange, who works as a policy analyst for the Centers for Disease Control.
Instead of coaching, though, Dr. Stange served as the physician-in-chief (PIC) at Kaiser Permanente’s Vallejo Medical Center for 22 years, one of the longest-term PICs in Kaiser Permanente history. But, his son added, those two career paths were not far off. That’s basically what he became: a head coach. He was a great leader (to the doctors). Firm, but fair.”
Dr. Stange passed away earlier this year on April 28. He was 90 years old.
At his retirement in 1991, his portrait was displayed in the lobby of the original Vallejo Medical Center, which was replaced with a new facility in 2010. His portrait remains near his former office in the old facility, which still houses administrative offices.
“That looks like an intelligent man and a superb leader,” Dr. Donald Nix recalls saying when he first saw the portrait. Dr. Nix was Dr. Stange’s best friend, colleague and long-time golf buddy. “I think those are the qualities that best describe Paul,” he added recently.
Career starts in left-over World War II barracks
Dr. Nix said that although Dr. Stange was their boss, the Vallejo doctors loved him. His two executive secretaries dubbed him “Mr. Wonderful.” When Dr. Stange began his tenure as PIC in 1965, the Vallejo Medical Center was housed in barracks-type buildings originally constructed for the Mare Island Shipyard war workers. His son, Paul, described them as rickety, green-finished wood buildings that Kaiser Permanente took over from the government when they opened a makeshift medical center in Vallejo right after World War II. Dr. Stange served through the construction of the $12 million, seven-story medical center, w hich was dedicated in 1973.
After stepping down as PIC, Dr. Stange continued his medical practice until 1991. He continued to lend his medical expertise by returning to the facility to give follow-up readings of radiology reports and mammograms. Maribel Guerrero, the breast care coordinator for Kaiser Permanente’s Napa-Solano Service Area, writes in gratitude to Dr. Stange in a 2006 letter: “The Kaiser Permanente organization should be proud to have you in its midst. . . . My job as breast care coordinator would not have been possible without your gracious help.”
Born in Milwaukee, Wisconsin, in 1921, Dr. Stange attended the University of Wisconsin School of Medicine during the mid-1940s. He served in the U.S. Navy from 1947 to 1951. After initially failing to get a residency in obstetrics, he completed a residency in pathology in Washington, D.C., in 1950. Three years later, he finished a residency in his preferred field, obstetrics, at the Kaiser Permanente Oakland Medical Center. Dr. Stange joined the Vallejo Medical Center’s OB/GYN department later in 1953.
Dr. Stange also had an active community life. He served on the board of directors for both the Vallejo Housing Authority and the Solano County Medical Society, which honored him with a lifetime achievement award in 1997.
Stange inspires two generations of medical professionals
Perhaps his greatest legacy to the medical community, though, is his family. Three of his daughters are registered nurses – Joan Pottenger, Gail Stange and Cynthia Stange-Zier. Another daughter, Susan Stange, works in patient care in Santa Rosa, California. And two of his grandsons are well on their way to becoming doctors; one of whom, Lucas Zier, recently received his medical degree from the University of California, San Francisco, where he is in his third year of residency for Internal Medicine. Brent says that Lucas plans to complete a cardiology fellowship next to finish up his training.
Brent C. Pottenger, another of Dr. Stange’s grandsons, will attend the Johns Hopkins University School of Medicine in the fall. He wrote the following essay about Paul E. Stange’s legacy, and how his grandfather influenced his decision to pursue a career in medicine.
Carrying on the tradition of physician leadership
By Brent C. Pottenger, MHA
From a hospital bed at Kaiser Permanente’s Vallejo Medical Center, where he served as a physician and leader for five decades, my grandfather, Dr. Paul E. Stange, first heard that I had been admitted to the Johns Hopkins University School of Medicine, often ranked the top medical school in the nation.
“Number one!” he proudly exclaimed when my mom, his daughter Joan Pottenger, herself a registered nurse for over thirty years, shared the news.
Upon hearing this story, I felt a responsibility to build upon his legacy of physician leadership; a legacy that, thankfully, my mom fostered in me by connecting her own experiences as a health care leader with memorable stories about my grandfather’s career.
My grandfather passed away at 90 years old on April 28, 2011. I decided to write this memorial essay for him not only because he inspired me to pursue a career in medicine, but also because of his dedication to managing the quality and cost of health care as a physician leader – a passion that ties in deeply with the legacy of Kaiser Permanente.
While I pursued a master of health administration degree at the University of Southern California, there was a primary question that drove my research: “Can physicians manage the quality and costs of health care?” The question is derived from Dr. John G. Smillie’s book, “Can Physicians Manage the Quality and Costs of Health Care: The Story of The Permanente Medical Group,” which traces the history of Kaiser Permanente. (The book also features a photo of my grandfather with fellow physician executives of The Permanente Medical Group sitting around a table during the early 1950s.)
In many ways, my grandfather has shown that, yes, physicians can help manage the quality and costs of health care. Throughout his career as PIC, for example, he constantly balanced budget constraints with optimal medical care delivery to provide the most effective health care services to Kaiser (Permanente) patients. After retiring, he also spent about five years leading the creation of a partnership program in Solano County that established a much-needed safety net for patients from underserved communities.
Building bridges defined my grandfather’s legacy – he constantly thought broadly about how to create partnerships that could benefit wider communities. Genuine efforts like those mentioned above capture his interest in health policy and administration considerations: Dr. Stange was passionate about Kaiser Permanente because he believed deeply in the tremendous value that its integrated health care system provides to patients. From prevention to efficiency, my grandfather’s personal values magnificently matched those of Kaiser Permanente.
At Johns Hopkins, I hope to build on my grandfather’s legacy to improve our health care systems. In an effort to combine lessons learned from both my grandfather and my mom, for example, I hope to found the Doctors-Nurses Alliance (DNA) at Hopkins to better integrate the medical training of our future clinicians. The DNA program at Hopkins would facilitate increased interaction between the medical students and the nursing students. I believe that Doctor-Nurse-Aligned teamwork forms the double-helix DNA of medical care delivery, so hopefully I can contribute to this cause during my medical training.
With projects like DNA, I plan on carrying with me throughout my career those inspirations that led to my grandfather’s steadfast dedication to Kaiser Permanente – his legacy inspires me to learn, serve, and lead.
*Edward J. Derbes is a 2010 graduate of the University of California, Berkeley (UCB), earning a bachelor’s degree in Rhetoric with High Distinction (Magna Cum Laude). He co-founded and was senior editor of Divergence Magazine of Cypress, California, and formerly served on the editorial staff of the College of Environmental Design e-News at UCB. Derbes grew up in New Orleans, Louisiana.
By Laura Thomas
Second of two parts
In the 1970s, Kaiser Permanente responded to the rising influence of feminism and a popular trend calling for home births, drug-free deliveries and family participation by establishing the Family-Centered Perinatal Care Program (FAMCAP) at the San Francisco Medical Center.
With patients demanding a more natural birthing experience, the Kaiser Permanente family-centered birth program zeroed in on one particular aspect of the trend: Shortening the mother and infant’s postpartum stay in the hospital. KP San Francisco’s then Maternity Coordinator Deloras Jones, RN, BSN, began recruiting participants in 1973 and found many expectant parents were enthusiastic.
“The parents wanted increased father involvement, less family separation after birth, and treatment of mother and infant as though they were well, not ill,” Jones wrote in “Home After Delivery,” a 1978 article in the “American Journal of Nursing,” after 1,200 families had used the program successfully.
In the decades after World War II, the length of stay standard for childbirth had risen to as many as 10 days, keeping mothers away from their families and in the sterile environs of the acute care hospital. A picture in a KP newsletter from the late 1940s shows a new mother preparing to leave the hospital after 10 days of rest and recovery.
Patient education key in shortening hospital stay
As an essential part of the 1970s shortened-stay program, KP began to offer prenatal classes and encouraged the father’s participation in childbirth preparation as well as in labor and delivery. The hospital experience included rooming-in for mother and infant after 24 hours of observation in the nursery, breast feeding training, and infant care classes.
With an eye to shortening stay, the program focused on protocols for assessing mother and baby’s health and ability to go home within 12 to 24 hours. A nurse was assigned to visit the family at home for three days and to be available for questions and assistance for up to two weeks.
In 1976, Jones and colleagues Mark J. Yanover, MD, and Michael D. Miller MD, published a report of their study of the experience in the San Francisco family-centered program. They compared a group of 44 low-risk mothers who delivered their babies along the typical routine with 44 others who elected the early discharge program. The researchers concluded that “this method of perinatal care is as safe as that traditionally provided at our medical center.”
FAMCAP had a major influence over early discharge standards developed for both the American College of Gynecology (ACOG) and the American Association of Pediatricians (AAP) and marked an acceleration of a trend toward shorter hospital stays for postpartum mothers.
The shorter stay phenomenon in the 1970s was wholly embraced by cost-conscious health maintenance organizations, often without the follow-up care that was the hallmark of the Kaiser Permanente approach – and became the source of intense national debate in the 1990s.
Shortened stays too short?
According to figures that came out in Congressional hearings, the median length of stay for postpartum women across the U.S. had dropped almost 50 percent between 1970 and 1992 – from four days to less than two days for a vaginal delivery. “Within the last three years, stays have declined from 48 hours to 24 hours. Some (women) were even required to leave the hospital in as little as eight hours after delivery,” according to Debra Kuper writing in the “Marquette Law Review” in 1997.
There were increasing reports of kernicterus, a rare and preventable complication of jaundice, and mental retardation due to failure of postpartum mothers to return for Phenylketonuria testing, amongst other tales of women being kicked out of hospitals before adequate assessment of their or their infants’ readiness to go it alone.
In response, Congress enacted the Newborns’ and Mothers’ Health Protection Act of 1996 to mandate 48-hour stays for vaginal births and 96-hour stays for cesarean births unless mother and physician agree to a shorter stay. Both the national OB-GYN and pediatricians associations revised their standards to reflect the new mandates.
Nonetheless, shorter hospital stays with more choice and control over the childbirth experience have become the norm for parents across the country. Expectant Kaiser mothers and fathers are now given a birth plan to fill out that allows them to select the delivery room environment, methods of inducing labor and controlling pain, delivery position and various postpartum procedures.
Recent national trends show the cesarean section rate for first-time low risk mothers climbing – California rates increased from 20 to 26.5 percent from 2000 to 2005. Statistics also show a retreat from the 1980s surge in women wanting vaginal deliveries after cesareans (VBAC) with California rates for repeat cesareans up from 84.4 to 94.3 percent from 2000 to 2005.
Kaiser Permanente continues to support women who want to deliver vaginally after they’ve had a C-section, and offers programs and procedures that encourage strong mother-baby bonding practices, including breastfeeding. Today, about 75 percent of American new mothers nurse their newborns.
Honors for KP “baby-friendly” hospitals
Kaiser Permanente Southern and Northern California regions were honored in 2008 by the California Breastfeeding Coalition for leadership in supporting nursing mothers while medical centers in Clackamas, Oregon; Honolulu; and Hayward and Riverside, California, were all been named “baby-friendly hospitals” by the Baby-Friendly Initiative of the World Health Organization.
Keeping birth “normal” is still a worthy goal for the organization, Fontana midwife and nurse specialist Iona Brunt wrote in 2005 in “The Permanente Journal.”
“We must empower mothers with the belief that their bodies are made to give birth and, in most circumstances, will do well. We must dissipate the idea that without our high-technology intervention, babies cannot be born healthy and safe.”
“It makes sense,” she said. “It’s cost-effective and it’s the right thing to do.”