Archive for November, 2014

Henry J. Kaiser through the eyes of critics

posted on November 24, 2014

Lincoln Cushing, Heritage writer


Portrait of Henry J. Kaiser

Henry J. Kaiser, circa 1955

Henry J. Kaiser’s impact on the American industrial landscape of the 1930s through the 1950s was huge, and it’s not surprising that critics from the left and the right scrutinized his operations to draw their own provocative conclusions.

In 1945, French philosopher Jean-Paul Sartre (1905-1980) visited the United States with a delegation of other writers and filed more than 30 stories for Combat, a major independent left newspaper. His June 6 article “American Workers Are Not Yet Proletarians” looked at the then-evolving Permanente Health Plan:[i]

In America, there is no generalized system of socialized medicine. Everything depends on the states and private initiative. …At the beginning of the war, when Kaiser established his enormous shipyards, which employed more than 100,000 workers, he was confronted with a very practical problem: in order to obtain the highest productivity from this enormous crowd of workers, he had to take care of their health. Therefore he created, with Dr. Garfield’s help, the famous Kaiser hospital, whose reputation has spread throughout the United States.

Jean-Paul Sartre, circa 1953.

Jean-Paul Sartre, circa 1953

Sartre then drilled down into the difference in class consciousness between American and European workers, pointing out that even though it was worker’s fees that paid for the health plan and hospitals they felt no sense of entitlement to ownership.

An unnamed Permanente physician, sympathetic to Sartre’s critique, still defended the institution:

Look at the tremendous advantages it provides to our workers: last week a woman came in for a consultation; there was blood in her urine. A private doctor would have charged her $10 for this examination. Diagnosis: tuberculosis in her right kidney. It will require a $500 operation: here everything is free. Don’t forget also that when a worker is hired, there never is a medical examination. Therefore it often happens that we look after workers whose diseases were contracted well before they were hired by Kaiser. And on top of that, it represents a terrible blow to private medicine. As you know, in America health is “big business;” doctors are very expensive, and we have encountered terrible resistance from the American Medical Association.


Ayn Rand, circa 1953

Ayn Rand, circa 1953

Russian-born author Ayn Rand (1905-1982) was the iconic American promoter of laissez-faire capitalism and the philosophy of “Objectivism.” In 1957 she published Atlas Shrugged, her most famous work. Part of that novel is set at the fictional “Rearden Steel,” which was largely based on her visit to the Kaiser Fontana Steel Plant ten years earlier. In 1948 she reflected on some of those impressions in a letter to a friend, using the opportunity to criticize Kaiser for having too cozy a relationship with a populist president (Franklin Delano Roosevelt) of whom she did not approve:

In Chicago, I had a marvelous time on my visit to the Inland Steel plant. That was a real steel mill, not at all like Mr. Kaiser’s WPA [Works Progress Administration 1935-1943; Rand errs here, the facility was built at the beginning of WWII with a loan from the Reconstruction Finance Corporation at the direction of the War Production Board] project in Fontana. It’s funny that I knew that the Fontana plant was a phony, even though I had never seen a real steel plant before.

The General Manager of Inland Steel arranged a luncheon, at which I met all the top executives of the plant. These were… the real working executives of the mills…They were all conservatives and in quite an intelligent way. The stories they told me about their problems with regulations and regimentations are simply hair-raising. Here is a sample:

The Interstate Commerce Commission now controls the distribution of freight cars. They have threatened an embargo on freight cars for deliveries to steel plants, which, if put into effect, would stop the entire steel production of the country. The excuse given is that the steel companies do not empty freight cars fast enough. The real reason—the bureaucrats want freight cars for coal, to ship the coal to Europe.


So there you have it: Henry J. Kaiser was too socialist for Rand and too capitalist for Sartre. Yet Kaiser, and his legacy health care program now known as Kaiser Permanente, continued on and thrived – and remain the targets of social critics.


[i]  “On the American Working Class,” Dissent, January 1, 2001

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A heavy tale of Kaiser ships, graveyards, and uncles

posted on November 19, 2014

Lincoln Cushing, Heritage writer


scrapped Liberty ship bow, Willamette River

Scrapped Liberty ship fore peak, Willamette River, Oregon. [1]

Buried on the banks of the Willamette River in Portland, Oregon, lies an unmarked graveyard of war veterans. And my uncle played a small but important role in their short lives.

At the end of World War II, a parade of proud but battered ships arrived at U.S. scrapyards to be recycled. Many of these were Kaiser-built Liberty and Victory ships completing their destiny after having helped win the war for the Allies. Like spawning salmon, many of these ships were returning to be recycled only miles from the three Portland and Vancouver (Wash.) yards in which they were built. But when workers took cutting torches to these noble vessels, they ran into a problem – solid ballast.

Every ship requires ballast to stay upright, and cargo ships have particularly challenging demands. If ballast is not properly placed fore to aft or side to side, or there’s not enough of it, a ship will not be trimmed properly and risk listing or even capsizing under adverse conditions. In extreme circumstances uneven ballast and cargo loading can break a ship in high seas. And since these vessels are constantly taking on and removing massive quantities of cargo, ballasting is a dynamic problem.

As is typical in large vessels, Liberty ships were built with multiple ballast holds. These included “deep tanks” below the main cargo holds that could contain dry cargo or sea water ballast; even deeper “double bottom” tanks that could carry either fuel oil or seawater ballast; and designated holds for permanent solid ballast.

Liberty ship holdsV3-sm

Diagram of Liberty ship holds, fore peak highlighted. [2]

Solid ballast can be anything from rocks to iron, and has the advantage of being much denser (and thus heavier) than water. Liberty ships were built with a dead weight capacity of 10,800 tons and required 1,500 tons of ballast. The engine was in the center, but to compensate for the aft weight of the rudder, screw, and prop shaft the ship’s lower bow section – the fore peak – was filled with solid ballast. They also produced “movable ballast” cast blocks, usually 9x11x13 inches and weighing about 175 pounds, which could be moved or removed as needs changed. At first pig iron was used, but even that lowly metal was too precious to waste on ballast during the war. Alternatives were sought, and eventually found – in the form of magnetite-infused concrete.

Magnetite is low-grade iron ore, generally unsuitable for manufacturing, with a specific gravity of 5.17. That is less dense than pig iron’s 7.1 but far higher than concrete’s 2.32. The magnetite-concrete mixture was considerably cheaper than metal; a 1948 U.S. Department of the Interior report noted that the substitution saved about $2 million during war production.

Although most of the magnetite used on the Pacific Coast came from California. a major deposit was available from a Lovelock (Nevada) mine controlled by Charles H. Segerstrom, Jr. and John M. Heizer. John was my uncle; my other uncle Robert was working as a steamfitter in the Kaiser Richmond shipyards at the time. As early as October, 1943 rail cars were carrying one carload a day from the mines to ballast fabricators near San Francisco bay.

This is how it was reported in “Nevada iron deposits provide warship ballast,” published in the Mineral County (Nevada) Independent News, June 13, 1945:

The ore is high-grade magnetite (60 to 65 percent iron) of high specific gravity and is in demand by west coast shipbuilders. Crushed magnetite and Portland cement are mixed with magnetite sands recovered magnetically from beaches in California, and the mixture is placed as concrete in the ship bottoms to set as a permanent ballast…

Heizer and Segerstrom have subleased the property to the Dodge Construction company of Fallon to fulfill a contract in excess of 10,000 tons of magnetite iron ore to be used by Kaiser shipyards of Richmond, California. Production of the magnetite started in early July, 1944.

Magnetite iron ore has been used successfully for permanent ship ballast and the Kaiser shipyards have contracted for an additional tonnage. Meanwhile, the shipyards at Portland, Oregon, have also negotiated for a substantial tonnage.


Bows on riverside-sm

Scrapped fore peaks, Willamette River [3]

The ballast was a great solution for shipbuilding, but later on it posed a problem for postwar shipbreaking. The concrete could not be easily separated from the valuable iron, so the fore peaks were deposited at the edge of the river as erosion-control landfill.

Portland shipbreakers at yards such as Zidell tackled more than 183 Liberty ships, buttressing the Willamette River shore with more than 100 fore peaks and other ballast blocks. In 1991, the Naito family created the Portland Liberty Ship Memorial Park, setting it on property they had purchased. In 2006 this park was redeveloped into a high-end condo community, literally built on top of the bows of a marvelous wartime achievement.

Plans are being made to honor this past with an outdoor maritime display on the Willamette River Greenway. Perhaps these battered remnants of the World War II Home Front merchant marine fleet will once again raise their peaks and proclaim “We can do it!”


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[1] Photo from “Portland South Waterfront Greenway: Conceptual Schematic Design Phase,” August, 2004, Buster Simpson; also photo #3.

[2] Liberty ship schematic adapted from Sawyer, L. A., & Mitchell, W. H. (1970). The Liberty ships: The history of the “emergency” type cargo ships constructed in the United States during World War II. Cambridge, Md: Cornell Maritime Press.


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Celebrating Dr. Morris Collen’s Life

posted on November 12, 2014

Lincoln Cushing, Heritage writer



Dr. Morris Collen aboard the “Flying Sorceress” 1957; from “A Bud’s Eye View” photo album by David Steinhardt

On October 27, 2014, a “Celebration of Life” of Dr. Morris F. Collen, M.D. was held at the Kaiser Center Auditorium in Oakland (Calif.). It was a moving tribute to a beloved giant in medicine and medical informatics who passed away at the age of 100 on September 27th.

Tracy Lieu, MD, MPH,Director of Kaiser Permanente’s Division of Research, hosted the speakers and welcomed the audience on behalf of the DOR and the Permanente Medical Group. She led off with a tribute video and slideshow, followed by Kaiser Permanente leaders and a member of the Collen family adding their recollections of Dr. Collen’s – “Morrie’s” – role in our community. These are excerpts from their remarks.


Robert Pearl, MD, Executive Director and CEO of TPMG:

“[Morrie] told me how he was the second physician in the nation to administer penicillin. I still have his paper that he wrote about the different sub-types of pneumococcus, and the particular kind that he was treating, patients never recovered from. And he gave a dose equivalent to a quarter of what we give today, and—for one dose, not for a whole course—and the patient lived. And the miracle, he explained how God had touched the world in a way—[and] he was not an overly religious man—but in a way that allowed us now to have those who would die, now live.”

“How could he see, in 1951, that in 2014 Tracy and the people at DOR would still be using data that he collected in the 1950s to help us understand disease. How could he understand, in the early 1960s, when there were no such things as a computer; there were wired boxes with punch cards that—these punch cards would provide information that would allow us to understand heart disease and stroke, allow us to understand hypertension when at that time there were no medications, there were no treatments? How could he see all of that?”


Philip Madvig, MD, Associate Executive Director, TPMG:

“What I knew about Morrie as a leader and founder and negotiator and clinician within the Permanente Medical Group was enough to have accounted for at least two full careers. And yet what I heard about [at Morrie’s 100th birthday] was all the medical informatics work, and I realized that we, in Kaiser Permanente, think of Morrie as ours. He was our founder and our leader, and he was our guy, and we owe him this huge debt of gratitude. And then here’s a whole additional group of people who said very much the same things. He was our founder, he was our leader, he was our negotiator, he created our specialty. We owe him a huge debt of gratitude.”


Tracy Lieu, MD, MPH, Director of DOR:

“I had the chance to talk with Dr. Ted Shortleff; he’s a past-president of the American Medical Informatics Association, who said, ‘Morrie had a very mild mannered leadership style. He’d come up with these radical ideas, and because he was so respective and persuasive, he could get people to go along.’ Not many research groups in this country can point to their founder as also being the founding father of a whole scientific field that’s not only vibrant, but increasing in both relevance and impact today. We are so happy to be initiating really robust and broad work in clinical informatics at DOR. And this is really a validation of Morrie’s original vision in informatics. We have so many exciting projects; we really look forward to expanding our work in clinical informatics. And we are tremendously proud and energized to be part of his heritage, and to carry on Morrie’s work.”


Joe V. Selby, MD, MPH,Executive Director, Patient-Centered Outcomes Research Institute; Director, DOR 1998-2011.

“I like to think of Morrie as the incidental researcher; not the accidental, but the incidental researcher. He didn’t really set out to be a researcher, although he did manage to get his first two papers published while he was still a resident at LA County [General Hospital], and both of them were on diabetic coma. So that shows that he was a visionary; he recognized a critical role of diabetes in understanding all disease. He really set out to become a physician and, very quickly, a physician leader. Over time he came to appreciate and share Sidney Garfield’s vision of this new model of care and realized that research was gonna be required to get there. So he became a researcher.”

“Morrie taught us that one needs to be prepared to expand one’s thinking at any point in life; to bring research into decision making in health care; and to bring the responsibilities and the concerns of the decision makers into the minds of the researchers to learn to work together on teams. TPMG is the perfect place to do this, the questions and needs are often clearer, and they come into view earlier here. The data and the capacity to do efficient research are better here…The pathways to implementation are shorter and straighter here.”


Gary Friedman, MD, MS,Director, DOR 1991-1998; Research Scientist Emeritus.

“I think most of you—most of the people in the audience probably have known him for maybe a few decades, like Phil. And the person they remember is an avuncular, grandfatherly figure that you see in this beautiful picture. But he was not like that when I first worked for him. He’d always been a gentleman, no question about that. But in those earlier years he was also a very commanding and forceful figure. And he was superbly capable of getting large scale grants, support for his pioneering projects in medical computing and in the multiphasic screening effort. And he was very successful in getting the best from himself and from those of us who worked with him.”


Joe Terdiman, MD, PhD,Director of Information Technology (Retired), DOR.

“In his later years Morrie had two goals, of which one was almost completed and one barely started. The first goal was to complete a revision of his History of Medical Informatics, which only covered the period from 1950 through 1990. He wanted to update the book to cover the years from 1990 to 2010, and would frequently update us at these lunch meetings on the progress of his revisions. As mentioned before, although he didn’t quite complete the book, his long-time friend and colleague, Dr. Marion Ball, assured him that she would complete it, working with others.

The second goal, which represents his inquiring mind and his focus on research, was to study the use and interactions of multiple drugs in the elderly. He would often remind us at these meetings that every morning he would take a dozen pills and down a cup of coffee, as did millions of the elderly. What interactions would occur between those pills and the coffee, he asked. And would any of those interactions reduce or increase the potency of those medications? Until very end he was always thinking about scientific questions that could be answered by mining KP data.”


Jamila Gui (Director, Strategic Programming Group, DOR) read a poem “Secret Pilgrimage” by Rabbi Alvin Fine, which began with a phrase that clearly described Dr. Collen:

Birth is a beginning

And death a destination

But life is a journey.


The memorial concluded with comments and a rhyming verse/limerick by Morrie’s son Randal Collen.

“I hope many of you had the pleasure of dining with Morrie, because that was one of his favorite things to do. I poked fun at him in my limerick poem, for his dining. But his 90th birthday party was kind of a roast, you know, and I don’t think he would mind if we had another laugh again.

Dad always loved to laugh; he always had a story or a joke or a pun. Dining was a great celebration for Morrie. My mom’s maiden name was Diner; Morrie’s mom, my Grandma Rose, probably always coaxed him: “Eat, moyshe, eat!”

But really it hid the fact that not only did Morrie have a world class intellect, and a will of iron, he also had a world class digestion. When we were kids, my dad would take us to Bertola’s, in Lafayette. And we would fight over the pepperoncinis. Later he would love to take us to Sizzler’s. He would swoon over Sizzler baked potatoes. No gourmet, my dad, but he would love to eat. He loved rotisserie chicken, and sashimi, and dim sum. And to suck the marrow out of the osso bucco bones. He could eat me away; he could eat me under the table.”

Randal’s touching and humorous tribute ended with these lines:

It was Kaiser, a man wiser than most men of Industry

With a dream to grow an HMO that took Morrie to Berkeley.

You see, a dream to grow an HMO took Morrie to Berkeley.

Where he could really eat. This urge he couldn’t suppress.

The average ravaging savage could not pass Morrie’s test.

Oh, yes, he loved to eat. Volumes he’d ingest.

A hungry bear, he didn’t care, at dining he was best.

Oh yes, at dining he was best.


Special thanks to DOR’s Janet Byron for helping with memorial documentation.

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Anthrax, the Ebola of 2001

posted on November 6, 2014

Lincoln Cushing, Heritage writer

FBI photo of anthrax-tainted letters sent to legislators and the media, 2001

With recent headlines about the Ebola situation the focus of the news, Kaiser Permanente takes seriously its responsibility to keep its employees, physicians and members safe and protected. Like other epidemics we’ve managed before, Ebola is still an emerging situation and people have real concerns about this virus.

It’s important for us as health care professionals to recall our history.

On October 15, 2001, soon after the September 11 attacks that killed more than 4,500 people in New York, Washington and Pennsylvania, letters containing anthrax spores were mailed to news media offices and two U.S. Senators. The pathogen infected 22 people and killed five.

The crisis instantly affected Kaiser Permanente health care practitioners in the Mid-Atlantic States service area (Maryland, Virginia, and D.C., with more than 530,000 members). Kaiser Permanente’s response to this act of bioterrorism was centralized in an Emergency Operations Center, which became fully operational on October 23 and was vital to successful and orderly response to the crisis.

Dr. Lee Jacobs, M.D., associate editor of The Permanente Journal, described the response:

Administrative people focused on the call center and appointment capacity to provide access for worried members, the frontline clinicians appropriately adjusted their clinical approach to these patients. The infectious disease specialists dealt with the diagnostic and therapeutic aspects of this rare disease along with the stressful public relations interactions while at the same time doing their regular jobs.

To supplement their staff during the high demand period, several physicians from other Permanente Medical Groups were brought in. To be able to rapidly deploy these physicians out to the medical offices, they fast-tracked licensure, computer encounter training, and other necessary preparation so the physicians could expeditiously be equipped to see patients.

Anthrax virus

Bacillus anthracis, photo courtesy CDC

In her testimony before the House Committee on Veteran’s Affairs, KP physician Dr. Susan Bersoff-Matcha, M.D. offered more details:

The process we had in place for the use of clinical protocols served us well. The information cascaded down from infectious disease specialists to everyone on the front lines: internists, family practitioners, advice nurses. Our organization’s ability and dedication to update and distribute them frequently enhanced the effectiveness of clinical protocols.

We shared information about our patients, and we shared our clinical protocols. Johns Hopkins University Hospital, Inova Fairfax Hospital, and others used our protocols as their guide for patient diagnosis and treatment.

Through our multiple information management systems, we could track data to help us respond to issues. For example, as soon as we understood that postal workers at Brentwood could be at risk, we identified all our members who work at the Brentwood post office by the telephone exchange they provided to us for their work number.

A cadre of nurses volunteered to contact all 237 Brentwood employees. Nurses asked our members if they had gone to D.C. General for testing, if they had received their medicine, were they taking it, and how did they feel.

Even in areas far away from the nation’s capital, measures were taken to safeguard public health. In California, Kaiser Permanente quickly sent its members “Anthrax Exposure Risk Assessment Guidelines” drawn from the California Department of Health Services.

After it was over, this extraordinary handling of the crisis was widely reported – and applauded – in both professional journals and the mass media. Lessons were learned, alliances built, and procedures honed. That is the legacy that Kaiser Permanente will draw upon in handling Ebola.


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