By Lincoln Cushing, Heritage Writer
Being able to see inside a living human body has always been a holy grail for medical diagnosis. But X-ray photographs and fluoroscopes had their limitations, so Dr. Benedict Cassen (1902-1972) invented the scintillation scanner, or “scintiscanner” in 1951. This imaging device was based on plotting radioisotopes introduced into the patient. Dr. Cassen’s work with UCLA’s Laboratory of Nuclear Medicine and Radiation Biology launched the field of nuclear medicine that has become important throughout the world for medical diagnosis.
The scintiscanner produced a crude picture by moving a scintillation detector over the area to be scanned and recording the intensity levels with a dot-producing mechanism. It was first used to image the thyroid gland after the administration of radioiodine. With the development of organ-specific radiopharmaceuticals, the scanner was widely used during the late 1950s until the early 1970s.
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by John Fagundes. Heritage writer
Fall has arrived and it’s time to prepare for Winter. For over sixty years Kaiser Permanente has offered flu vaccines, yet it appears that we still need as much persuasion as they did in 1951.
Then, as now, the messaging emphasized the public health danger of this class of viruses – “…The virus was strong enough to indispose whole segments of cities…last year in areas up and down the Pacific Coast” – and the ease of the vaccination.
As part of its commitment to preventive care, Kaiser Permanente is providing free flu vaccinations once again for employees and Plan members.
Check here for more information, including vaccination dates and locations.
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by Lincoln Cushing, Heritage writer
The Caldecott Tunnel channels one of the major highways that wends its way east from the San Francisco Bay Area through the Berkeley Hills. A much-anticipated fourth bore is due to be finished in late 2013. But few today know that Henry J. Kaiser’s construction firm was part of the consortium that built the original two tunnel bores.
The 5,820 foot-long tunnels opened to traffic on December 5, 1937 and cost around $4 million dollars.
Read this blog next week for the whole story.
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by Lincoln Cushing, Heritage writer
Organized sports were a great way to stay fit and let off steam during the frantic construction pace in the World War II shipyards. Here, the Swing Welders duke it out with the Prefabrication workers, from the Kaiser Richmond newsletter Fore ‘n’ Aft April 14, 1944.
Fast forward to the present day “Own Now” campaign. Stephen Curry (Golden State Warriors) and Chris Paul (Los Angeles Clippers) have joined Kaiser Permanente as Total Health Ambassadors to inspire young adults to prioritize their health by leading active lifestyles and securing the coverage they need.
For more on Own Now, see this release.
By Ginny McPartland, Heritage writer
Second of a series
Forty years ago, before advanced nursing positions existed, a group of Kaiser Permanente nurses were cutting their teeth in new fields as specially trained nurse practitioners. In the beginning of this journey, these nurses worked in preventive medicine, well baby care and OB-GYN.
Dorola Haley began work with OB-GYN physician Albert Kahane when Kaiser Permanente first opened in Sacramento in 1965. Around 1970, Dr. Kahane received a Kaiser Foundation Research Institute grant to study the role of the nurse practitioner in OB-GYN practice. At the same time, Haley completed the requirements to become a nurse practitioner, and soon she and Dr. Kahane began to take turns seeing patients.
Dr. Kahane was the first in Sacramento County to propose the then-radical idea of fathers in the delivery room. Haley says there was a lot of resistance to this in the medical community, but he believed it to be beneficial for the family and was proven right.
“They wanted to run Al out of town on a rail,” Haley said. (OB-GYN physician Sidney Sharzer pioneered this in Kaiser Permanente in Southern California.)
Dr. Kahane felt that couples would find another way to be together during childbirth if hospitals didn’t modernize. He had been in the U.S. Air Force for four years in Alaska, where this was established practice.
More time to get to know patients
At a recent reunion, several of the early Sacramento NPs talked about how the extra time they spent with patients – a full, uninterrupted 30 minutes – was crucial to the member’s total health. Busy physicians could only rarely devote this much time to a single patient. The NPs’ stories are about striving to reach the ideals of preventive medicine, about getting to know the “whole” patient, and helping him or her to maintain good health.
“We knew our patients’ social history,” said Dianna Costa, an OB-GYN nurse practitioner still working part time for Kaiser Permanente today. “We knew whether the family had a dog, and if they did, who fed the dog. We knew what you (the patient) were eating, and if you exercised. In a 30-minute physical you learn it all. It (preventive care) was huge to us. It was life, not just a physical.”
“If you listen to a patient, really listen, you learn everything you need to know,” remarked Haley. “I’d ask them to tell me what’s going on. For prenatal patients, I’d talk to them about what’s going to happen in the next month.”
Nurse practitioner pioneers praise mentors
Carl Henriques, MD, medical director of the Sacramento Preventive Medicine program, now deceased, was ruthlessly strict in expecting his students to conduct physical examinations and medical histories perfectly. “You could say he was a tough task-master,” recalled Betty Taisch, one of the pioneer NPs.
Taisch recently attended a lecture by Abraham Verghese, MD, author of “Cutting for Stone,” a current best-selling novel. The Stanford University School of Medicine professor described the importance of caregiver-patient trust and rapport – and of touch. “You walk into a room and someone is sitting there with only a piece of paper covering them, and you ask them the most intimate questions,” noted Taisch.
“You have to quickly develop a bond of trust with this person. You have to understand the simple art of putting your hand on their shoulder. As I was listening to him (Dr. Verghese) describe his bedside manner, I was sitting there so proud because I recalled being taught exactly the same things by Dr. Henriques,” Taisch said.
Marge Geary, a nurse practitioner pioneer and health appraisal manager from 1978-1984, chimed in: “The way he taught us was systematic, so that we didn’t miss anything.” Dr. Henriques began all of his progress reports on student Marge Geary in 1972 with “This young lady . . .” Today she is both the assistant medical group administrator and director of nursing practice at Kaiser Permanente South Sacramento.
The early NPs have nothing but praise for Millie Kahane as well. They say she helped them reach for a higher level of professionalism through education and training. “She took a broad view of everything,” Geary recalled.
John Mott, MD, physician-in-chief at Sacramento Kaiser Permanente, summed up the experiment: “(In 1970) the medical climate for NPs was quite different than it is now. The status of the nurse practitioner was not clarified by the California Legislature until 1975.
“Had Dr. Henriques and Mildred Kahane, (BS, MA), slipped, the stature of NPs in California could have been delayed many years. Such are the dangers of living very close to the State Legislature, the Board of Nursing, the Board of Medical Examiners and the Attorney General. . . . (KP) Sacramento membership includes many articulate, highly educated, health-oriented groups . . . who might or might not approve of being examined by a nurse practitioner (rather than a physician).
“Credit should go where credit is due, and Dr. Henriques and Mildred Kahane did a tremendous job pioneering this field.”
By Lincoln Cushing, Heritage writer
Kaiser Permanente’s Procurement and Supply print magazine The Source won “Best Print Publication” in the Ragan Communications 2013 Health Care Public Relations & Marketing Awards.
The special issue is titled “Our Heritage, Our Future” and Kaiser Permanente Heritage Resources contributed images and text.
“In this issue of The Source we pay tribute to our heritage by presenting stories from our past paired with stories from today.
“From innovation to diversity to environmental sustainability and responsible resource stewardship, the stories in this issue show a continuum of successes that are paving the way for future achievements as we work to transform health care.”
Subjects include collaboration, the Labor Management Partnership, diversity and inclusion in the workforce, “green” hospitals and purchasing practices, shared services, and efficient “just in time” inventory.
Laurie Spoon is the managing editor of The Source. She is supported by editors Marion White and Ross Wilken; graphic design was handled by Esperanza Garcia and layout by Kaiser Permanente Southern California Multimedia Communications. Contact Marion.White@nsmtp.kp.org for a digital copy.
Our history helps differentiate us from other health care providers, and Heritage Resources is proud to be able to share that story.
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By Ginny McPartland
First of a series
It’s 1970 and Kaiser Foundation Health Plan’s operation in Sacramento is just five years old. The state of California and the federal government have both recently set up health benefits for their employees with Kaiser Permanente as a popular option.
The Northern California Health Plan is quickly approaching its million members mark, and the Sacramento facility is overflowing with patients.
Meanwhile, Mildred “Millie” Kahane, BS, MS, a New York transplant teaching nursing at California State University, Sacramento, thinks her students are bright enough to contribute more in the burgeoning field of health care. The destiny of nurses, she believes, is to rise above the traditional hospital bedside role and to take on more responsibility in an outpatient setting.
She believes her students can learn new skills that could eventually be included in a bachelor of science nursing program and that these advanced nursing capabilities would provide the core content upon which to build clinical specialties.
John Mott, MD, physician-in-chief at Kaiser Permanente Sacramento, is facing increasing pressure to welcome and serve new members. His resources for providing primary care and new member health assessments can’t keep up with the demand. What is he to do?
Fortuitously, Mott and Mrs. Kahane have occasion to meet – through her husband Kaiser Permanente Sacramento chief of OB-GYN Albert Kahane – and their collaboration sets in motion a revolutionary program to elevate the nursing role and to solve Mott’s shortage of primary care providers.
Some of Millie Kahane’s students will become “nurse practitioners,” a title unheard of at the time in Sacramento County, and Kaiser Permanente members will get comprehensive evaluations in what will become known as the Department of Preventive Medicine.
Origin of advanced practice nursing
The story of Mrs. Kahane and her hand-picked nurse practitioner pioneers was not unique in the 1970s health care landscape. Indeed, medical providers throughout the United States were looking for solutions to a manpower shortage. In that era, the federal government provided special funding to identify ways to maximize health care dollars.
Within Kaiser Permanente in particular, physicians in Southern California, Oregon and Hawaii began to train nurses to examine seemingly well patients and identify any abnormalities for follow up with a physician.
Pediatrician Sam Sapin, MD, in Panorama City worked with Southern California Permanente Medical Group Director Raymond Kay, MD, to train nurse practitioners to provide well-child check-ups, along with physicians.
In Oakland in the early 1970s, Drs. Morris Collen and Robert Feldman employed NPs in the “Multiphasic,” an annual physical program originally set up for the longshoremen’s union in 1951.
After nurse practitioner programs were well established in Northern California, The Permanente Medical Group developed a certification process for those who were to work as nurse practitioners within the organization. This process later helped Kaiser Permanente nurses meet California nurse practitioner requirements.
The first formally educated Kaiser Permanente nurse practitioner was Linda Lee, who was one of Mrs. Kahane’s students at Sacramento State. Upon graduation, she attended the nurse practitioner program established by Henry Silver, MD, at the University of Colorado in 1965.
Silver’s program was the first university-based pediatric nurse practitioner program in the United States. After completing the program, Lee came back to California and worked with Sacramento Kaiser Permanente Chief of Pediatrics Clifford Skinner, MD.
Synergistic forces converge in Sacramento
Why is the story of the Sacramento Kaiser Permanente Nurse Practitioner and Preventive Medicine Program of the 1970s remarkable? Looking back after 40 years, the program’s pioneers – many still working for Kaiser Permanente – marvel at the phenomenon of a close-knit group of advanced practice nurses who loved their mentors and their patients and whose lives were marked indelibly by the experience.
Nurse educator Mildred Kahane and Physician-in-Chief John Mott’s alliance to develop a nurse practitioner program found fertile ground in the hearts and minds of certain of Mrs. Kahane’s graduates. In 1970, Mrs. Kahane set completion of a bachelor of science degree as the basic program requirement and recruited four candidates to begin work (and training) in the Health Appraisal Evaluation center to be located in an older Kaiser Permanente building at 3240 Arden Way, Sacramento.
Kaiser Permanente allergist Carl Henriques, MD, formerly a general practitioner in Susanville, Calif., became the center’s physician leader and primary teacher. As the program progressed, the University of California at Davis Medical School was developing a mid-level practitioner master’s in Health Services program for nurses.
UCD lacked clinical facilities, which Kaiser Permanente had. Eventually KP and UC partnered, and UC students were able to enhance their clinical experiences at Kaiser Permanente with Mrs. Kahane and Dr. Henriques as members of the UC clinical faculty. Kaiser Permanente nurses were given the opportunity to apply their education and training toward the master’s degree.
Next time: Kaiser Permanente preventive care patients benefit from more time with their provider.
This blog is dedicated to the memory of Eileen O’Hagan McCauley and Linda Lee (both deceased), two of the first NPs at KP Sacramento, and the late Carl Henriques, MD.
By Ginny McPartland, Heritage writer
Part of a series about our regional origins
Kaiser Permanente picked J. Harper Gaston, MD, a Georgia native and graduate of Emory University, to test the Atlanta metropolitan area waters and bring the Health Plan to Georgia in 1984. Dr. Gaston re-established his life in Georgia after 23 years with The Permanente Medical Group in Northern California.
His wife, Anne Hendrick Gaston, MD, a Permanente pediatrician in Northern California, also returned to Georgia in 1984. Harper Gaston reconnected with friends, colleagues and institutional representatives to build a strong base for The Southeast Permanente Medical Group, established in 1985.
Kaiser Permanente of Georgia’s physicians saw their first patients in the Northlake Medical Office in DeKalb County, opened in October 1985. Three months later, Kaiser Permanente opened the Cumberland medical office, and then established a facility near the Southwest Community Hospital to serve residents there, who were mostly African-American.
Gaston selected several prominent members of the Atlanta community to serve on Kaiser Permanente of Georgia’s Board of Directors: banker John W. McIntyre; physician Louis Wade Sullivan, who was also dean and director of the Morehouse College of Medicine and later appointed secretary of the U.S. Department of Health and Human Services); and community leader Laura Jones Hardman.
Kaiser Permanente acquired financially failing Maxicare Georgia, a health maintenance group with 35,000 members in 1988, and the Health Plan grew from 265 members at the end of 1985 to 100,000 members by 1989. Throughout the 1990s the Atlanta area continued to boom, and by 2010 the Health Plan membership had expanded to almost 250,000.
In recent expansions, Kaiser Permanente of Georgia has added new facilities in 13 locations. Today, Kaiser Permanente has 28 medical facilities in the 28-county Atlanta metropolitan area, and 400 physicians taking care of its members.
Gastons enjoyed illustrative California careers
As a Permanente pediatrician and neonatologist, Anne Gaston taught medical students and residents in the Intensive Care Nursery at University of California in San Francisco for 20 years. In 1979, she became professor of pediatrics there. She also served as director of the Intensive Care Nursery at Marin General Hospital under a special contract with The Permanente Medical Group.
Harper Gaston, an internist/cardiologist, served as physician-in-chief at Kaiser Permanente Hayward Medical Center before returning to Georgia in 1984. He served with the California Heart Association for 20 years, taking a term as president, and was an adviser to the Emory University System of Healthcare Board of Directors and a member of the Emory Board of Visitors. He retired from The Southeast Permanente Medical Group in 1992.
Emory recognizes Gastons for community service
For the Gastons, moving back to Georgia after a quarter of a century in California enabled them to renew their commitment to the Emory Medical School community that had helped launch their careers.
In 1996, both Harper and Anne Gaston were honored by the Emory University Medical Alumni Association with its Award of Honor for their career-long community activities in Georgia and California.
Since 1994, the Gastons have sponsored the Gaston Service Award Scholarships for Emory medical students who have amassed impressive records of community service.
Roots in medicine go back to early California
In 2009, Harper Gaston published A Heritage Lived up to & Beyond, a collection of stories told to Gaston by his grandmother Louise Frederick Hays, who was the Georgia State Historian from 1937 to 1951.
In 1942, Hays wrote an article about Gaston’s great-great grandfather, her grandfather, Benjamin Franklin Keene, MD, the first president of the California Medical Society in 1856. First published in 1942 by the CMA, it was reprised in 2004 in The Permanente Journal, the quarterly publication of the Permanente Medical Groups.
Dr. Keene, a Georgia physician, went to California in 1849 to seek his fortune in the Gold Rush. After a mining stint, he settled in El Dorado County to practice medicine. He represented the county in the California Senate for three terms, leaving office in 1856.
Also in 1856, he helped found the medical society that was the precursor of the California Medical Association. Dr. Keene died of paralysis, also in 1856, and was buried in Placerville, Calif. In 1912, Hays located the grave, and CMA replaced his broken headstone in 1923.