By Lincoln Cushing
World AIDS Day – set for December 1 every year – was established in 1988 by the World Health Organization to draw attention to the need for international medical and governmental cooperation in addressing this catastrophic disease.
The WHO adopted one theme for the years 2011 to 2015: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One focus of “Getting to zero” has been a global effort to ensure a safe and ample supply of that renewable potion of life – human blood.
In its 67 years of operation, Kaiser Permanente has been an active partner in the ongoing quest to keep blood available and free of dangerous contaminants.
In 1948, three years after the Permanente Health Plan was opened to the public, the Permanente Hospital in Oakland started its own blood bank. It was the only private hospital in the San Francisco Bay Area to offer such a service to patients. The single requirement was that blood recipients had to arrange to replace the blood. Members could give blood ahead of time to ensure availability when they needed it.
KP gets out of blood bank business
By the mid-1960s, however, 80 percent of the blood used in KP’s Northern California hospitals came from community blood banks, costing $25 a pint. KP offered a Permanente Medical Group Blood Transfusion Insurance Program, which credited the donation of a single pint against unlimited blood needed by that member for two years, or one year if applied to a family.[i]
The math worked out – Permanente Medical Group Executive Director Cecil Cutting, MD, noted: “. . . Participants are a relatively healthy lot of members whose transfusion requirements account for fewer than 3 percent of total Health Plan transfusions, while their contributions are running equivalent to 30 percent of the total blood used.”[ii]
In the past four decades, blood bank operators have been faced with the reality that the use of donated blood – its drawing, storing and administering – poses risks for transmission of disease, such as HIV/AIDS and Hepatitis B and C. In 1971, blood banks began to test donated blood for Hepatitis B.
Keeping blood supply safe
In 1983, U.S. blood banking groups issued their first warnings about AIDS. This action was taken after researchers learned HIV/AIDS was a blood-borne disease that could be transmitted by blood transfusion, as well as by sexual contact and shared hypodermic needles.
In 1985, immediately after the U.S. Food and Drug Administration licensed the first test to detect the antibody to HIV, Red Cross Blood Services regions began testing all newly donated blood for HIV. Since then, there have been an estimated 10,000 cases of HIV in the United States resulting from contaminated whole blood administered to patients between 1978 and 1985. (A heat treatment developed in 1985 renders blood plasma safe.)iii
In 1988, the federal Centers for Disease Control notified Kaiser Permanente that community blood banks in KP’s Bay Area service areas had not screened blood donations properly to prevent contamination in the supply.
Kaiser Permanente, not responsible for independent blood bank procedures, contacted Health Plan members who had received blood from local banks between 1978 and 1985. Affected members were told that the risk of transmission of HIV might be higher than the nationwide average due to the blood banks’ improper and inadequate blood screening.
KP encouraged these members to obtain free HIV screening tests. iv The 1985 cutoff date reflected the increased blood screening that virtually eliminated transfusion transmission.
KP has also aggressively reduced other HIV blood transmission risks, such as hospital staff needle sticks, but addressing member risk through contaminated blood was a major first step. The task of addressing the epidemic was huge, but KP took the challenge seriously.
By 2000, a KP Northern California spokesperson could safely affirm: “Our efforts make a difference. Kaiser Permanente is making profound efforts to stop the spread of AIDS.” v
Editor’s note: Heritage writer Lincoln Cushing is a regular blood donor and encourages all readers who are medically able to donate as well. This crucial renewable resource depends on volunteer donors. Blood agencies regularly schedule mobile units at large institutions. Please step up when you have the opportunity.
[i] Permanente Medical Group Blood Program brochure, 1967.
[ii]Newsletter from the Desk of the PMG (Permanente Medical Group) Executive Director (Cecil Cutting, MD), October, 1967.
iv “AIDS Update,” Planning for Health, Fall 1988
v California Wire, 11/20/2000
By Steve Gilford
Senior consulting historian
In 1938, when Permanente founding physician Sidney Garfield recruited surgeon Cecil Cutting to join him at Grand Coulee Dam, Dr. Cutting persuaded nurse anesthetist Geraldine “Jerry” Searcy to come along.
Cutting had confidence in Searcy, having worked with her at San Francisco General Hospital after he completed his medical training at Stanford University in the mid-1930s. He knew she would be an asset to the medical care program set up for Henry Kaiser’s 5,000 construction workers.
Searcy remained with the program from 1938, through the Second World War, until her retirement from the Oakland Medical Center 34 years later. Jerry Searcy told me an anecdote about a personal experience that reflected Dr. Garfield’s managerial style. She liked the story because it helped her to explain why the medical staff was so fond of him.
Her story begins one evening in the Permanente Foundation Hospital in Oakland during the War. The normally busy hospital was unusually quiet that night with little for the staff to do. On that slow night, head physician Garfield just happened to drop by the ward where Searcy was working. His unexpected visit found the staff taking advantage of the quiet by playing a spirited game of poker.
For poker chips, the crew was using pink and white aspirin tablets they’d taken from the supply cupboard. Searcy recalled that Garfield was upset because this misuse of medication was a waste of hospital supplies. He asked them to stop and of course they did – immediately.
The next day the poker players waited somewhat anxiously to see what additional disciplinary measures they might have to face. Garfield surprised them, though. Instead of criticizing them further or meting out some sort of punishment, he donated a set of real poker chips to the hospital.
“From then on,” Searcy remembered: “staff members on call could play poker without disturbing hospital supplies.”
Garfield ‘not at all bossy’
Searcy, who died in 1993, was quoted in a February 1985 KP Reporter edition honoring Dr. Garfield following his death:
“I remember Sid as a very friendly, humble man, not at all bossy, although he did believe in hard work and discipline. Nothing was beneath him, nor beyond him. Once at Grand Coulee, Sid was walking around the hospital without his white coat, looking very youthful with his bright red hair and casual clothes.
“A patient saw him and shouted, ‘Boy! Would you take care of this?’ pointing to his bedpan. Sid wasn’t at all offended. He laughed and emptied the bedpan. Of course the patient had no idea who Sid was,” she said. She continued: “Dr. Garfield liked to sing ‘My Heart Belongs to Daddy’ while performing surgery at Grand Coulee.
“To me Sid was a colleague and a friend. He must have been a leader, though he never waved a flag or beat a drum.”