, Heritage writer
If you can’t easily get patients to a clinic, what do you do?
Take the clinic to the patients.
This year, a Kaiser Permanente grant to the Healthy Smiles Mobile Dental Foundation in Fresno, California, paid for a brand-new recreational vehicle that’s been transformed into a dental clinic on wheels, complete with exam space, X-ray machines, and dental equipment. Several hygienists and dentists work inside the clinic, cleaning children’s teeth, and filling cavities.
It’s a model that’s been researched in the medical literature — and, because of long history in mobile medicine, we know that it works.
Early innovations in mobile medicine
In the early 1970s, Kaiser Permanente undertook several projects to test the feasibility of mobile health vans to serve underrepresented communities. One was rural, one was urban.
The rural example was “STARPAHC” — short for Space Technology Applied to Rural Papago Advanced Health Care. Kaiser Permanente and NASA partnered with Arizona’s Papago Indian Reservation to test the practicality of the emerging field of telemedicine. The project used the real needs of a remote earth-bound population to see how technology and routines could work when providing health care for astronauts in outer space.
And in very urban Oakland, California, Kaiser Foundation School of Nursing student members of Kaiser Black Student Nurses’ Association served on a mobile Foot Health Clinic in 1972.
Our medical care keeps moving
In 1988, Kaiser Permanente launched a Mobile Health Education and Screening Program in the Kansas City area. The 25-foot mobile van traveled to Kaiser Permanente medical offices as well as community organizations, local businesses, and public health fairs, where staff checked blood pressure and cholesterol levels, gave lifestyle assessment quizzes, and provided educational materials on a variety of health topics.
In Southern California, Kaiser Permanente had a similar program that operated out of a 38-foot Wellness Care-A-Van. It traveled as far north as Bakersfield and as far south as San Diego, reaching out to people in their communities, testing blood pressure and body fat. Frayne Rosenfield, Member Health Education administrator and Worksite Wellness Program coordinator, was enthusiastic about the service: “The van has been very well received. We see approximately 120 people a day, and the van is out 5 to 7 days a week.”
Kaiser Permanente also used the mobile van model for immunization drives in the 1990s.
Kaiser Permanente’s 2001 Annual Report profiled a mobile bone-scan van used in the Mid-Atlantic states (complete with custom Maryland license plate “KPBONES”) to help members prevent and treat osteoporosis. It was staffed by Stephen Moki, radiology technologist and health educator, and Pat Brown, clinical assistant.
The Scan Van rotated among several Kaiser Permanente medical centers, spending 1 to 3 weeks at each facility before moving on. It proved to be a valuable outreach tool, and community organizations frequently called to request a visit from the van. Michael J. Moriarty, MD, vice president and associate medical director of Quality and Health Management, said, “I think that it helps to affirm our image as an innovator and a quality health care provider.”
Mobile health vans are in our future
In 2009, Kaiser Permanente in Hawaii celebrated the arrival of a mobile health vehicle. The 500-square-foot, 10-wheeled rolling clinic was fully wired, equipped with our electronic health record system, a digital mammography unit, and video telemedicine capability.
The vehicle was designed to roam the Big Island, providing glucose and cholesterol screenings, mammograms, urinalysis, testing for sexually transmitted diseases, and vaccinations for the flu and pneumonia.
Billy Kenoi, the mayor of Hawaii County, praised the service when it was formally blessed July 2.
“I come from a 48,028 square mile island with incredible geographical and infrastructure challenges,” Kenoi said, “and the delivery of this Mobile Health Vehicle will improve not only the health care available on the island of Hawaii, but ultimately, the quality of life for our island residents.”
The use of mobile health vans is now integrated into our health plan, visiting urban worksites and rural communities and saving members time and travel for many of their medical needs.
As Frayne Rosenfield said in 1988, “The van is out 5 to 7 days a week.”
That’s about as accessible as health care can get.
Also see: “Driver as Receptionist? Kern County union and management leaders work out innovative solution” to optimize mobile health van driver workload.
Short link to this article: https://k-p.li/2DcTiQG
, Heritage writer
The nation is at war. A desolate stretch of waterfront is rapidly turned into a state-of-the-art shipyard, producing vessels for national defense. The huge demand for labor runs deep, and, for the first time ever, women are hired to perform electric welding on ships for the Navy.
The Kaiser Richmond shipyards, 1942? No.
Hog Island, just outside of Philadelphia, 1918.
Although the powerful role of women on the World War II U.S. home front is well-known now as the story of “Rosie the Riveter,” the pioneering role of women 24 years earlier is all but forgotten.
Sarah A. Erwin was the first woman in the United States to be engaged in industrial ship construction. She applied for a job at the Hog Island shipyard in September 1918.
The managers put her in the electric welding department as a test of women’s abilities in this craft, where she did so well that the jobs were opened to 30 more women. The shipyard provided paid training, and the women fixed bad welds in the plate and angle shop. Erwin was followed by Anna Kenneste (or Aina Kannisto) and Mary Dunn. The women had to be between the ages of 24 and 35 and be “healthy and robust.”
The thousand-acre Hog Island yards were under the jurisdiction of the United States Shipping Board Emergency Fleet Corporation, had 50 shipways, and employed as many as 35,000 men and nearly 700 women.
Although only a handful of women worked as welders, other non-clerical positions included such jobs as drivers of “high power touring cars.” The newspaper want ads noted that, despite requiring the ability to change tires and perform engine cranking, “Women of poise and character only wanted.”
Like the World War II “Rosie the Riveter” and “Wendy the Welder” pioneers, the women welders at Hog Island were proud of their accomplishments. A November 30, 1918, article in the Pittsburgh Press quoted Kannisto as saying, “I would rather do electric welding than sell ribbons behind a counter or work in an office. The pay is better, and you have more independence. This war has driven out of the heads of many women the mistaken idea that they are only fit to look pretty and flatter their husbands.”
Alas, a generation later, on the other side of the country in the Kaiser shipyards, women would again have to blaze the same path. Yet Erwin’s contribution to the advancement of women in the workforce should not be forgotten.
Special thanks to History of Total Health reader Frank Trezza who pointed out this lost history.
Short link to this article: https://k-p.li/2FL9P2h
, Heritage writer
During World War II, Henry J. Kaiser’s job wasn’t just getting ships built. It also included providing the services all those workers needed — such as child care, housing, health care, and transportation. Fast forward through history, and a $20 million commuter ferry terminal is opening right next to the Rosie the Riveter World War II Home Front National Historical Park in Richmond, California, where thousands of Kaiser shipyard workers on the home front produced cargo vessels.
Those workers had ferry service, too — a few hundred yards from the new terminal, across the Richmond Inner Harbor Channel.
A news item in the shipyard newspaper Fore ‘n’ Aft on September 17, 1942, noted, “After untiring efforts by Labor-Management committees in all three yards, the trial run of the San Francisco ferries to the shipyards took place Wednesday of last week.”
The hour-long trips went from the Ferry Building in San Francisco to the slip at the parking lot along the estuary at Yard Three. Ferries arrived 15 minutes before shifts started and left 30 minutes after shifts ended. The fare was 10 cents each way, and passengers could buy food onboard.
The service was sponsored by the U.S. Maritime Commission and run by the Wilmington Transportation Company, which operated the Los Angeles-Catalina Island ships. Pressed into duty were craft from the Key System, the enormous public transportation service of San Francisco’s East Bay, and included relics such as the side wheeler Yerba Buena. Some of the ferries carried automobiles.
The Commission proposed four ferries run between Richmond, San Francisco, and Sausalito, with almost continuous service to accommodate the staggered shifts at the Kaiser Richmond and Bechtel’s Marinship (Sausalito) yards.
The wartime ferries weren’t the first to come to Richmond; regular service between Richmond and San Rafael had operated since 1915.
By 1943, the ferry service was overwhelmed, and thousands of workers threatened to quit because it wasn’t running on time and was making them late to work. Under Maritime Commission rules, worker pay was docked if they were 15 minutes late. Faster ferries were put in service.
Some of the transits were quite eventful. The Klamath rammed a surfaced submarine in the middle of San Francisco Bay on July 1, 1944, (minor damage, no injuries) and almost collided with an anchored — but loaded — ammunition ship in the foggy morning of September 5, 1945.
A new auto ferry pier was one of the first infrastructure projects authorized after the war ended. Construction at Castro Point, at the terminal of Standard Oil (now Chevron), commenced in early 1946, and service began March 1947. By 1951, plans were being drawn up for a Richmond-San Rafael toll bridge. When it opened in 1956, the bridge was the last across San Francisco Bay to replace a ferry service.
It’s unlikely the new generation of Richmond ferry passengers will risk hitting a submarine or an ammunition ship, but they can travel with pride knowing that commuters to the Kaiser shipyards over 70 years ago were part of a bold social experiment in child care, housing — and health care.
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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
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, 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
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, 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.
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