By Lincoln Cushing, Heritage writer
Part of a series about our regional origins
When Henry J. Kaiser’s shipyards closed at the end of World War II, the Permanente doctors lost almost all of their patients. Roughly 200,000 members had been employed in the seven West Coast shipyards and most were covered by the Health Plan.
To survive in the postwar era, Kaiser Permanente needed to gain a large number of new members in a competitive market.
A handful of Permanente physicians in the Pacific Northwest had caught group practice fever and were inspired to stay on despite the uneven odds against their success. Six or seven (nobody recalls for sure how many) out of 45 wanted to give it a go.
Charles Grossman, MD, one of those who hung on, recalled:
“All of us were firmly committed to the prepaid, group health concept, and we decided to rebuild Northern Permanente rather than allowing it to close down,” Grossman told Portland historian Michael Munk. The Permanente physicians judged their wartime hospital to be in good enough shape to withstand a few more years of service.
A cool reception from traditional medicine
Not only were the doctors at first without patients or income, they were given the cold shoulder by the leaders of both the Oregon and Washington medical societies, the states in which Permanente hoped to offer care.
The traditional fee-for-service physicians, unaccustomed to the concept of salaried physicians practicing as a group, branded Kaiser Permanente as “socialized medicine.”[i] The Health Plan and its doctors in all regions faced this type of criticism for decades in the 20th century. The Multnomah County Medical Association of Oregon didn’t accept Permanente physicians until 1963.
Meanwhile, Northern Permanente opened its first clinic in 1947 on Broadway in Portland, Ore. In 1959, the Health Plan opened the Bess Kaiser Hospital in Portland to its 25,000 members; membership doubled to 50,000 in the next two years. In 1975, Kaiser Permanente Sunnyside Medical Center was completed in Clackamas County, southeast of Portland.
Today, the Kaiser Permanente Northwest Region has about 470,000 members. Its newest hospital, green-award-winning Westside Medical Center, opened Aug. 6 in Hillsboro, Ore., on the west side of the Portland Metro Area.
Innovation a hallmark for Northwest
Over the years, the Kaiser Permanente Northwest Region has been at the forefront of innovative and successful health care practices. Below are some examples of the region’s innovations.
- Dental coverage – Head Start children residing in the Model Cities area of Portland were eligible for dental care through an Office of Equal Opportunity pilot program offered in the Northwest Region in 1970. The program was so successful that dental coverage has continued to be offered as an optional benefit to all group members in the region.
Study of health care delivery for the poor and elderly – Kaiser Permanente Northwest took part in a Medicare and Medicaid demonstration started in 1984 to identify the best ways to integrate acute and long-term care for patients covered by prepaid, per-person, per-month (capitation) financing arrangements.
- Testing of an occupational health model — With the goal of decreasing injured employee lost work time and reducing medical costs related to workplace injuries, the region started Kaiser-on-the-Job in 1991. Between 1990 and 1994, the region reduced average lost time per claim by more than two days and achieved a cost savings of $666 in average cost per claim. The occupational medicine program, separate from the Health Plan, covers more than 300,000 workers through their employers in the Northwest Region.
- Sunday Parkways – Recognizing not everyone can succeed in challenging athletic pursuits, Kaiser Permanente’s Northwest Region helped launch a special, less taxing mobility event with the city of Portland in June 2008. Six miles of local streets were closed to traffic from 8 a.m. to 2 p.m. In 2009, up to 25,000 Portland area residents walked, biked, jogged and skated in three summer Sunday events.
- Sustainable use of resources – The Kaiser Permanente Westside Medical Center, new this year, has already received Leadership in Energy and Environmental Design Gold certification from the U.S. Green Building Council. Westside is the second Portland-area hospital to receive the LEED Gold designation and one of just 36 hospitals nationally to earn the honor.
Short link to this story http://ow.ly/pD11u
[i] “Present at the Creation: The Birth of Northwest Kaiser Permanente,” unpublished interview edited by Portland historian Michael Munk, 2013.
By Lincoln Cushing
Permanente in the Northwest fills a large gap in the history of Kaiser Permanente – the unique contribution made by the Northwest region, especially in the early years. Author and retired Northwest internist Ian C. MacMillan, who served 14 years as chief of medicine at Kaiser Permanente Sunnyside Medical Center, demonstrates an insider’s insight and enviable access to details that thoroughly enrich this account.
Before there was a Kaiser Permanente, there was Permanente Metals, the division of Henry J. Kaiser’s construction consortium that built ships during World War II. The medical services offered to those civilian workers was the kernel of what would eventually grow to become one of the nation’s largest not-for-profit health plans, and with two vibrant shipyards in Portland, Oregon, and Vancouver, Washington, the Northwest was a key participant.
The prologue provides a history of the medical care options in the area before 1941 as well as the story of how Sidney Garfield, MD, and industrialist Henry J. Kaiser came to collaborate on their successful model of prepaid industrial medical care. This is followed by a detailed account of the wartime boom – shipyards, housing, and health care rolled into one.
Wartime shipyards in Oregon and Washington
Notable events include the then-new practice of treating civilian tuberculosis patients with streptomycin, the model day care program for workers’ children endorsed by Eleanor Roosevelt, and a rich art community.
The demand for medical facilities soon outstripped the capacity of the first aid stations in the yards, and the first Northern Permanente Foundation (NPF) Hospital was built in Vancouver, Washington, in 1942, followed by a second one across the Columbia River in Vanport, Oregon, a temporary community built for shipyard workers, the following year.
That hospital was kept out of the nearby metropolis of Portland through stiff resistance by the local medical establishment, an example of a contentious relationship that would last many years.
As happened in California, the exodus of shipyard workers after the war forced the Northwest medical care program to expand to the broader community. Ernest Saward, MD, who had administered the wartime health care plan for DuPont plutonium workers at Hanford, Washington, became the medical director of the physician group and the Northwest health plan in 1947.
Changes after World War II
Dr. MacMillan explores some of the fractious cold-war dynamics of the medical partnership at that time, including debates about how KP internist Charles Grossman’s political activism was affecting the medical group’s relationship with the community.* (See note below.)
By 1950 relationships had deteriorated to the point that Edgar Kaiser (Henry J. Kaiser’s son) fired them all and formed a new partnership. Dr. MacMillan details other challenges to the Northwest region, including its struggle for legitimacy with the American Medical Association and ostracism by private practitioners.
The first major postwar facility in the Northwest was the Bess Kaiser Hospital in Portland, completed July 7, 1959. (There would not be another until the 1975 Garfield-designed Sunnyside Medical Center at Clackamas, Oregon). Named for Henry Kaiser’s first wife, the state-of-the-art facility featured air conditioning, telephones and televisions in every room, pneumatic medical records delivery, and a drawer bassinet allowing newborns to slide through the wall between mother’s room and the nursery.
Tumultuous times for KP Northwest medical group
The Kaiser Permanente health plan expanded into Hawaii in 1958, and the Northwest physicians played a significant role in helping that region survive a rocky start. Dr. Saward was called out to apply his management skills when friction within the physicians group exploded. Dr. MacMillan explains some of the complex background that led to the struggle, and he chronicles the eventual maturation of the region.
A large portion of the book is devoted to the history of various medical specialties of the Northwest medical group, detailing medical arcana more likely to be of interest to practitioners than a lay audience. The last three chapters trace significant chronological events in the region from the 1970s to the present.
Among these topics are the challenges of recruiting and retaining good doctors (he outlines the need for robust medical infrastructure, clear work policies, and adequate pay), the deep impact of the 1988 nurses’ strike, and the erratic steps taken by KP to institutionalize an effective electronic medical record system.
In all, this is a much-needed historical survey of a major region in the Kaiser Permanente constellation. Dr. MacMillan does not shy away from exploring awkward and complicated events in the Northwest Permanente history, and he writes with an insider’s viewpoint that enriches the accounts.
Permanente in the Northwest should be of interest to anyone interested in modern American health care policy, health practice, and the broader history of medicine.
Permanente in the Northwest
Ian C. MacMillan, MD, The Permanente Press, 2010
313 pp, with illustrations, bibliography, and index
To order the book, go to permanentejournal.com
KP Northwest historical materials brought to Oakland
Preservation of the rich history of Kaiser Permanente’s Northwest Region (KPNW) got a boost at the end of 2011 when staff of the national Heritage Resources department in Oakland packed up over 100 cartons of Northwest photographs, clippings, newsletters, and files to fold into the KP archives. These materials will be selectively processed over time and added to the existing collection, greatly enhancing our research capacity. The photographs accompanying this review were drawn from that collection.
Special thanks to KPNW Community Benefit and External Affairs staff Jim Gersbach and Mary Ann Schell for their help.
*After leaving Permanente in 1950 Dr. Grossman continued to practice medicine privately, and his political activism continued throughout his life (a path respectfully footnoted in MacMillan’s book in his Afterword titled “What Happened to the Pioneers?”). He was arrested in 1990 during a peaceful demonstration organized by Physicians for Social Responsibility, challenging the presence of a nuclear-armed battleship berthed near the Portland Rose Festival. His court testimony describes the scene:
“I was standing silently with several other doctors and a few others with a sign in my hand saying ‘Rose Festival is a fun time, we don’t need nuclear weapons.’ About 2:30 p.m. three or four policemen approached and asked us to leave. I asked why and was told that we have no right to stand in a city park carrying a sign. . . I put my sign down and said ‘O.K. I am not carrying a sign.’ His response was that if I did not leave within 30 seconds I would be forcibly removed. I said we were creating no disturbance and again asked why such a confrontation was necessary. While I was writing [down his badge and name] my two arms were forcibly seized, forced behind my back and handcuffs were applied.”