Permanente Medical Group historian
History is often a treasured story passed down through generations. The history of The Southeast Permanente Medical Group, opened in 1985 to serve the Georgia area, is one such story: It begins with a group of doctors who had a vision of building a community focused and patient-centered culture.
Georgia native J. Harper Gaston, MD, was one leader who graduated with his medical degree from Emory University and worked as an internist at Grady Hospital. After Kaiser Permanente hired Dr. Gaston in 1961, he moved to California and worked at hospitals in the cities of San Leandro and Hayward. As HMOs expanded throughout the 1970s, Kaiser Permanente saw the opportunity to develop medical group practices in other geographical regions. After much research and discussion, Atlanta was one of two selected areas for expansion during the early 1980s.
News of Dr. Gaston’s success in hospital administration, combined with his re-election as physician-in-chief at Kaiser Foundation Hospital in Hayward, convinced Kaiser Permanente leaders to approach him with plans to establish a medical group practice in Georgia. Atlanta was a growing urban capital, attracting the attention of major corporations and leaders around the world. However, the city’s lack of familiarity with HMOs before 1980 presented a challenge for Kaiser Permanente’s geographical expansion.
Dr. Gaston and Edgar T. Carlson, MD, a colleague from Kaiser Permanente’s Ohio Region, went off to open the new region. Georgia. When they arrived in Atlanta in 1984, State Insurance Commissioner Jimmy Caldwell revealed that previous agreements with existing HMOs prevented Kaiser Permanente from receiving the certificate needed to establish an HMO in Georgia for a year. Dr. Gaston turned the unexpected situation into an opportunity by spending the next year meeting with physicians and community organizations.
The bonds formed between Dr. Gaston and the Georgia community became lasting partnerships when Kaiser Permanente finally received the certificate during the summer of 1985. After opening their first medical office, Dr. Gaston and a team of physicians volunteered at the Downtown Day Labor Service Center and conducted medical exams for the homeless on Friday nights. When the annual school budget ran out, they volunteered to continue hearing and vision screenings for elementary schools through the Adopt-A-School program.
Since the first Kaiser Permanente medical office opened in Atlanta more than 30 years ago, Kaiser Permanente in Georgia has grown to more than 25 offices around Atlanta and one in Athens. And the momentum continues. A recent agreement with Emory Healthcare provides Kaiser Permanente members with a fully integrated health care experience, and in the process, advances patient- and family-centered care in metro Atlanta and beyond.
Short link to this article: https://k-p.li/2SyWlsw
, Heritage writer
What was left?
Big buses. Really big buses.
“The bus of the future” was announced in the Oakland Tribune on August 1, 1946. Unveiled to the public for the first time in Oakland and San Francisco, this marvel of mass transportation was custom built of lightweight magnesium and aluminum. It carried 63 passengers (or 40 passengers, depending on the account) in two articulated sections totaling 60 feet in length. It was operated by a driver and a “co-operator,” in charge of collecting tickets, passenger comfort, announcements, and dispensing refreshments. Each section had a toilet, and the seats could swivel, allowing passengers to “play cards or converse.”
The ride was promoted by would-be Don Drapers as being “like a cloud,” suspended on “torsilastic springs” manufactured by B.F. Goodrich. It was powered by a 275-horsepower supercharged Cummins diesel engine, a precursor to the powerplant Kaiser used in the 1952 Indianapolis 500.
The bus was prepared for Santa Fe Trailways (later Continental Trailways, part of National Trailways Bus System) at the Kaiser Permanente Metals Corporation plant near Los Altos as a prototype. Eventual production options included fabrication at the recently closed Kaiser Richmond shipyard number 3. These were intended for longer routes between train stations, not urban transportation.
In 1947 the bus was featured leaving Oakland for Los Angeles with members of the cast of the Southern California Sportsmen’s Show. News accounts noted that the bus, “approximately twice the length of the standard bus and equipped with many luxury features, will be open for public inspection.”
Alas, the fleet of super buses never materialized, although this prototype entered regular service between Los Angeles and San Francisco through 1951. At the time, Henry J. Kaiser was busy with his Kaiser-Frazer automobile company, and the “bus of the future” was one project that never gained traction.
In early 1966, the Alameda County (California) Transit Authority announced plans to roll out a new, 77-passenger articulated bus dubbed the “Freeway Train,” described as the first in the nation to be used for public transportation.
Well, the first after Henry Kaiser’s.
Short link to this article: https://k-p.li/2KJv0kS
, Heritage writer
When we think of Army veterans, we usually think of infantry soldiers who fought on the front lines. But the armed forces also include health care professionals whose medical service exemplifies the highest levels of sacrifice and bravery. Dan Golenternek, MD endured World War II in just such a manner that serves as a shining example.
The first reveal of his sacrifice emerged when we learned he was a prisoner of war in a short report from the Oakland (Kaiser) Permanente Foundation Hospital in the December 1945 issue of the Alameda-Contra Costa Medical Association Bulletin:
Coffee consumption in the staff dining room rose sharply in October with a daily contingent of colleagues back from the wars to tell their stories and catch up on gossip from the home front. Major Dan Golenternek has gained back 90 pounds of the somewhat more which he lost during three and a half years in Japanese prison camps …
Such weight loss is alarming. What happened?
Dr. Golenternek, who’d been training at L.A. County Hospital before enlisting in the Army, was captured by the Japanese Army in April 1942 and imprisoned in the Philippines soon after he’d gone to the South Pacific. Later he was one of two U.S. Medical Corps physicians at the Sendai #6-B prisoner-of-war slave labor camp working at the Mitsubishi Mining Company copper mine in Hanawa, Japan. At liberation, it held 546 POWs: 495 Americans, 50 British, and 1 Australian. The other physician was John Lamy, with a rank of First Lieutenant.
The Sendai camp was established on September 8, 1944 and liberated a year later. It was filled with prisoners (including survivors of the infamous Bataan Death March) shipped from the Philippines to Japan on the “hell ship” Noto Maru. The Noto Maru sailed from Manila on August 27, 1944, transporting 1,035 American POWs to Port Moji, Japan. Dr. Golenternek was one of them.
Army Air Corps Technical Sergeant James T. Murphy, who survived the Sendai camp, recounted the horrific conditions and Dr. Golenternek’s role:
Dr. Golenternek was not given any medicines or medical facilities in his required job of keeping the slave-laborers — the American POWs — fit enough to walk the two miles to and from the mine daily, in their inadequate clothing and shoes, and to perform their 12-hour shifts … By hook and by crook, by sheer innovation … he managed to keep the sickest POWs from going to the mine. He created medical facilities and methods to treat wounds where there were none. He even convinced the Japanese to increase our food rations. All his methods had curative effects, and during that year of 1944-1945, only eight POWs were lost.
In Bilibid, Dr. Golenternek was called to care for the Japanese commander, who had an indolent ulcer on his leg that didn’t heal despite three surgical attempts by Japanese doctors. The commander told Dr. Golenternek to operate and cure the ulcer or he would be executed. At first, Golenternek was reluctant to aid the enemy, but reconsidered after realizing his own death was imminent. The ulcer did heal. A reward of extra food, antibiotics and vitamins was secretly provided for the POWs, because the appearance of unyielding brutality had to be maintained by commander.
After the war and brief service at the Permanente Hospital in Oakland, Dr. Golenternek returned to Los Angeles to complete his training in obstetrics and gynecology. He never spoke about his wartime experiences and died in 2004.
Photos courtesy National Archives and Records Administration
Short link to this article: https://k-p.li/2POS4nd
, Heritage writer
For many years, Kaiser Permanente members signed up through “groups” — organizations such as unions or employers who provide health plan benefits to their employees. However, when the Affordable Care Act became law in 2010 and the first open enrollment began 2014, Kaiser Permanente saw a large demand for “individual member plans” — plans families and individuals purchase themselves — and created options accordingly.
That wasn’t the first time. In 1995, an exciting new Kaiser Permanente individual plan was opened to the public.
When founding physician Sidney Garfield, MD, started his practice for the workers on the Colorado River Aqueduct project in 1933, they were covered under an industrial health plan. Non-work-related health care was paid as fee-for-service, but Garfield soon covered that under a low-cost prepaid plan. Dr. Garfield next cared for the workers at the Grand Coulee Dam project in Washington, where there was a community of wives and children. When the unions insisted, a prepaid health plan was extended to families. During World War II, Dr. Garfield’s medical coverage of the workers in the West Coast shipyards added families, first in the Northwest in September of 1943 and then in California in April 1945.
After the war ended, the Permanente health plans faced a serious challenge with the loss of almost 200,000 Kaiser workers. But because of Henry J. Kaiser’s positive relations with organized labor, unions became the first group members of the public plan. Soon, corporations, government agencies and nonprofit organizations were signing up their employees, and for many years, group membership was the primary point of entry for health plan members. Group membership in 1959 was 80 percent; within 20 years that would grow to approximately 90 percent. The few individuals were “conversion members” who were no longer covered under a group.
In late 1995, Kaiser Permanente in Northern California sought to increase membership by launching its first non-group health plan for individuals and families who weren’t covered by their employers or a family member. It was called Personal Advantage. In 1996, the employee magazine Contact described the development:
Rates for this plan are based on age and are highly competitive, with special rates available for people living in certain geographic areas. … Personal Advantage members have access to the same comprehensive quality care provided by Kaiser Permanente’s [“conversion member”] individual plan, including a prescription plan and optional dental coverage.
Personal Advantage was marketed through television and newspaper advertising, and was promoted at events that attracted young adults, such as sports events and concerts.
“Growth has been nearly 100 percent higher than expected,” said Jill Feldon, advertising manager. “Consumers like the low price, and they appreciate the value of receiving comprehensive health care coverage, access to specialists, and the high-quality care that Kaiser Permanente provides.”
In 2002, Personal Advantage Plan members were able to take advantage of the then-new phenomenon of online enrollment. The initiative marked one of the first examples of an insurer offering online enrollment through its own website, and it reduced processing time by eliminating paperwork. By 2005, the Kaiser Permanente Personal Advantage Plan was joined with a similar effort called the Kaiser Permanente Individual Plan and became Kaiser Permanente for Individuals and Families.
Group or individual, Kaiser Permanente strives to accommodate the health care needs of all.
Short link to this article: https://k-p.li/2PhJQDP
, Heritage writer
Quick — what’s the symbol commonly used to depict medical practice?
If you said two serpents wrapped around a winged staff, you would be right — and wrong.
The story of the symbol representing medical care is one of mistaken identity. In the United States, we usually think of the caduceus, two snakes twisted around a winged staff. Its origins go back to antiquity, where it was carried by the Greek god Hermes and represented commerce and negotiation. It was later appropriated by the Roman god Mercury. The caduceus never referred to medicine (or at least the essence of healing), but it looks very much like the Greek Rod of Asclepius (composed of a single snake and staff, no wings), which does. What happened?
It appears that when the U.S. Army Medical Corps developed their branch logo in 1902 they picked the wrong symbol, and it has permeated American medical graphics ever since.
Here are examples of these images from the Kaiser Permanente archives. Some are from our own organization, some are external, and some display various combinations of the two logos. Click on one to engage slideshow.
, Heritage writer
Did you know that Kaiser Permanente’s founding physician, Sidney Garfield, MD, was an innovator in prepaid health care, hospital design and … hospital food service?
In 1955, along with E. R. Park, coordinator of the Kaiser Permanente Dietary Departments, Dr. Garfield worked out the plans for introducing microwave ovens into Kaiser Foundation hospitals. Dr. Garfield was extremely proud of this experiment, claiming they would bring more flexibility to serving patients warm meals. In 1956, he wrote an unpublished article titled “Just a Second! Becomes a Truism With Microwave Ovens.”
In this age where “fresh and local” is synonymous with good, healthy food, it’s easy to smirk at the benefits of microwave ovens in food preparation. But, like the advent of refrigeration, this technological advance had its advantages in the preparation of hospital food. The microwave’s primary purpose was warming previously cooked meals when the patient was ready to eat.
The earliest microwave ovens were the size of a refrigerator, required water for cooling, and consumed massive amounts of electricity, thus limiting their usefulness. The Raytheon Corporation’s first commercial model, the 1161 “Radarange,” was introduced in 1954. It would be another 10 years before Raytheon produced a microwave model that was user-friendly and inexpensive enough to become a universal kitchen accessory. Between 1965 and 1997, Raytheon’s consumer products were produced under the Amana name.
Dr. Garfield was an early adopter, bringing 1161s into Permanente’s new California hospitals at Harbor City, San Francisco, and Walnut Creek.
By the mid-1960s, the ovens had gotten small enough that they could be moved out of the kitchen and placed in nursing stations, closer to patient rooms. These were accompanied by refrigerators and hot water/coffee dispensers, creating kitchenettes throughout the facility.
In 1965, Kaiser Permanente’s Santa Clara Medical Center became the first in the organization to provide built-in microwave ovens on the nursing floors. The Bellflower Medical Center followed suit when it opened in 1965.
An article in the June 1967 issue of the trade publication “The Modern Hospital” examined how the Kaiser Foundation hospitals were embracing microwave ovens, a key part of what was called the “total convenience food system.” At that point, most of the 18 Kaiser Foundation hospitals in the Western states and Honolulu had converted or built into their new facilities a food service system using microwave ovens and prepared foods.
Kaiser Permanente food service consultant Marie Marinkovich said: “The difference between other hospitals’ failure … and our success lies in the quality of the food being served … [our suppliers] cooperated with us fully in developing entrees, both for regular and special diets, that met our needs.”
Microwave ovens continue to serve as part of the toolkit for providing healthy and appetizing hospital food. Jan Villarante, director of Kaiser Permanente’s National Nutrition Services, calls microwave ovens “workhorses“ and notes that every food service operation within the organization uses microwaves today.
See article on Kaiser Permanente’s current efforts to develop sustainable food practices.
National Healthcare Food Service Week is October 8-14, 2018. Honor food service workers.
Pacemaker hazard warning graphic by Delmar Snider, MD, 1934-2017
Short link to this article: https://k-p.li/2NpH8XK
, Heritage writer
Falls Prevention Awareness Week starts September 22. This 1942 cartoon from the Kaiser Richmond shipyard newspaper Fore ’n’ Aft illustrated remarks from Secretary of the Navy Frank Knox about industrial accidents on the World War II home front. “We have no time to train replacement workers… We cannot afford to permit accidents to encroach upon that bare minimum of time.”
Falls were among the largest contributors to shipyard accidents, which overall accounted for approximately 5 percent of employee absenteeism. But campaigns around safety education and rule enforcement made a difference – the frequency and severity of accidental injuries dropped 50% from 1941 to 1942, an improvement unsurpassed by any major industry in the United States.
These days, Kaiser Permanente still seeks to reduce fall-related injuries, for both employees and patients.
An injury-free workplace is an essential ingredient of high-quality, affordable patient care. Kaiser Permanente has set the goal of eliminating all causes of work-related injuries and illnesses. “Slip, trip, and fall” prevention is part of a comprehensive workplace safety strategy, designed to keep employees safe and create a workplace free from harm.
A focus on patient safety comes from the “No One Walks Alone” program – pioneered at the San Diego Medical Center and adopted at the Moanalua Medical Center in Hawaii – where the number of patient falls was reduced by more than half. And last year, the Kaiser Permanente Washington Health Research Institute contributed an editorial accompanying the latest JAMA study about preventing falls among seniors.
For 10 tips on preventing falls, see this infographic.
Short link to this article: https://k-p.li/2QKLYlj
, Heritage writer
During World War II, American industrialist Henry J. Kaiser’s job was building ships to win the war. Everything else — the housing and transportation infrastructure required to accommodate the influx of workers, even the incredible health care program that is his greatest surviving legacy — was a secondary, but necessary, part of the deal. And it was accomplished with a remarkable level of respect and cooperation between labor and management.
In an article titled “Class Bitterness Most Serious Problem for Labor, Management” in the Oakland Tribune September 9, 1943, Kaiser said “There is no such thing as labor relations. There are only human relations. You are dealing with people, not impersonal problems of finance or electronics. There are three sides to every argument — your side, my side, and the right side.”
Cooperation was pragmatic. Since Kaiser’s approach to building ships — like products in an assembly line — was new and evolving, there was an urgent need for innovation and shop-floor creativity. Workers were always coming up with more effective and efficient approaches, and rewards ranged from War Bonds to the right to christen a ship.
This cooperation was the task of Labor-Management Committees, established in early 1942 at the behest of the War Production Board. When the committees were first set up, some saw it as a plan by industry to throttle unions, but the WPB directive stated “The plan is not to further any special interests of any group nor to promote company unions or to interfere with bargaining machinery.”
Since production improvement involved many things besides mere mechanics, the committees also concerned themselves with many other matters, such as housing, food, transportation and morale. Valuable suggestions were shared with other shipyards, and by the end of 1944 over 3,000 ideas had come forward that saved an estimated $45 million and 31 million labor-hours.
Today’s health care worksite may not be the war-driven frenzy of the Kaiser shipyards, but it still relies on worker wisdom to serve Kaiser Permanente members through its unit-based teams. These are groups of frontline employees, managers, physicians and dentists whose work brings them together naturally and who collaborate with one another to improve member and patient care. The Kaiser Permanente Labor Management Partnership’s UBTs continue the tradition of healthy competition and innovation to achieve results.
Recent examples of successes include a UBT at Kaiser Permanente’s Capitol Hill Medical Center in Washington, D.C., that adjusted to a big jump in Kaiser Permanente member enrollment and improved patient care at the same time; a team at Colorado’s Ridgeline Behavioral Health which reduced the number of unnecessary Emergency Department visits while still ensuring patient care; and a Sacramento pharmacy that helped members reduce wait times.
Henry J. Kaiser’s vision of labor-management cooperation was channeled by Harry Caulfield, MD, a previous Executive Director of The Permanente Medical Group, when Dr. Caulfield described the first National Partnership Agreement signed in 1997: “When we work together, then we’re able to progress together. But without each other, neither one of us will be able to accomplish anything near what we could accomplish together.”
Top photo courtesy of the National Park Service, Rosie the Riveter/WWII Home Front NHP, RORI 5049_Box 4-02
Short link to this article: https://k-p.li/2wCB3kt
, Heritage writer
The space was christened “Garfield’s Café” to honor our founding physician and Kaiser Permanente’s long-standing commitment to nutrition as a component of good health. The menu features a wide variety of healthy options, ranging from oatmeal to daily paninis, veggie bowls and salads. The architects of this new café hope patrons will also sink their teeth in history of Kaiser Permanente and the Northwest region.
The space is near a display mounted in 2015 that includes key moments in Kaiser Permanente history in the Northwest. Oversize panels on the café wall highlight Dr. Garfield and the programs in the Portland area during World War II to feed the home-front workforce. These include photos of “Victory Gardens” in the worker-housing projects and employees dining at the huge Kaiser Oregonship cafeteria at St. Johns in 1942.
A large photograph of Dr. Garfield at Contractors General Hospital in the remote Mojave Desert is captioned with a quote from a 1980 letter to the 12,000 members who were part of his Total Health Care Program:
“Remember, good health is a way to get more out of your life — more energy, more enjoyment, more potential, more purpose, more life.”
Also, perhaps another cup of coffee and tasty bowl of oatmeal!
Short link to this article: https://k-p.li/2Oxlkue
, Heritage writer
The eyes didn’t have it.
In 1967, artist Emmy Lou Packard created a stunning mural, “Peaceable Kingdom, the Garden Before the Fall of Man,” for the Kaiser Industries’ flagship Oakland headquarters. A prankster, she slyly swapped out the glass eyes of the lion and the lamb, but got into trouble.
“Taxidermy eyes removed because patrons were uncomfortable with the eyes watching them over the bar,” she lamented on one of her sketches.
For 38 years, that bas-relief mural has rested in storage, but this spring it was briefly displayed in its full glory. The work of art is a reminder of Henry J. Kaiser’s support for the arts, a focus that lives on in Kaiser Permanente hospitals and facilities.
“Peaceable Kingdom” was 6 feet tall and 26 feet long, composed of 16 panels cast in basaltic concrete and carved before fully set, and portions were sandblasted for texture.Packard, an activist as well as artist, had worked for Henry J. Kaiser before — in 1944 and 1945 she’d been an illustrator for the weekly Kaiser Richmond shipyard newspaper Fore ‘n’ Aft, injecting messages of feminism and tolerance in the medium read by a new and unconventional workforce. With this mural commission for an unconventional industrialist, she continued making powerful artwork advocating for a better world.
The 28-story Kaiser Center was built in 1960 on the site of the former Holy Names College on the shore of Lake Merritt as the world headquarters for Kaiser Industries and affiliated companies. This conglomerate produced over 300 products, including steel, aluminum, Jeep vehicles — everything from gravel to guided missile components. It had a combined $1.5 billion in assets, employing 76,000 people in 17 states and 5 foreign countries. The gently curved Kaiser Center was a modern classic, designed by Welton Becket and Associates showcasing Kaiser’s many building materials.
In 1967 — the same year Henry J. Kaiser died — the elegant Mirabeau Restaurant opened on the 3rd floor, looking over the stunning 3-acre rooftop garden. The interior was designed by noted local architect Henrik Bull, who commissioned Packard to create the mural for the cocktail lounge’s back wall.
Packard prepared a colorful description explaining her mural’s message:
The lion lies protectively shielding the lamb, but the lamb has tiger eyes to preserve the balance of nature in the Garden …
The cat and dog and mouse, traditional enemies, live peacefully together, and the cat eats grapes while protecting the mouse in the curve of its tail …
A horned creature somewhat like the triceratops and the stegosaurus combined lurks under the giant fern … he is called militasaurus, and will flourish for a while after the Fall, but like others of the Mesozoic era, will become extinct because he is over-armed …
In 1980, the Kaiser Center underwent a major remodel, and the mural panels were taken down and gifted to the Oakland Museum of California. The Mirabeau continued operation until 1984. Also in the Kaiser Center, on the 28th floor with a sweeping view of Lake Merritt, was the Kaiser Executive Dining Room which opened in 1960.
When Kaiser Industries imploded, the dining room was replaced by the members-only Lakeview Club in 1984. But as business lunching evolved from martinis to kale salads, membership dropped, and it closed in 2000.
In June 2018, Packard’s son Don Cairns and other family members inspected the mural in storage at OMCA. Cairns had watched his mother make it years ago, and remembers seeing it when dining at the Mirabeau. Thanks to the able stewardship of OMCA, the panels are as clear and strong as the day they were taken down. And Packard’s family could once again see the dream of the cat, and the dog, and the mouse, living together in peace.
Short link for this article: https://k-p.li/2N1D2oZ
Credit for all OMCA images: A80.35 Emmy Lou Packard, Untitled (Fauna & Flora Mural), 1967. Concrete with embedded glass. Collection of the Oakland Museum of California. Gift of Kaiser Aluminum & Chemical Corp.