, Heritage writer
When the Pittsburg, Calif., Kaiser Permanente Medical Office opened in September, 1953, it was ground zero in the struggle between Kaiser’s comprehensive, prepaid, group practice model of medicine and the private practice medical establishment.
Wallace “Wally” Cook, one of the founding physicians in the Permanente Health Plan, recalled that epic confrontation in a 1986 oral history*:
When we were trying to grow rapidly, after Walnut Creek had started in 1952-53, Mr. Kaiser was putting a lot of pressure on the health plan. He built this beautiful facility–“he” in quotation marks–and by gosh, we needed members. We marketed the health plan in the steel workers’ union [United Steelworkers Local 1440] in Pittsburg, California… The steelworkers all went to their fee-for-service doctors up there, and here we were recruiting on their turf for members. This was in the summer of 1953. And there was going to be a vote by the steel workers. The fee-for-service doctors’ wives handed out leaflets, anti-Kaiser, anti-Permanente–very, very negative and, in many cases, untrue.
They hired a sound truck to go around the city of Pittsburg, announcing that Kaiser was trying to invade, and let’s keep them out, let’s preserve what you have with your fee-for-service physician. When the vote finally occurred, we got about 95% of the steel workers. So we immediately had an infusion of 10,000 members overnight, and they were going to be members within a month, or something like that.
Well, that put an even greater burden on the recruiting effort. We had to find some place to see these members. So we leased a building that was about to open as a motel in Pittsburg – a U-shaped, old-fashioned 1940s motel, with room, room, room around in a U-shape. And we converted that into an office. You came in the front, and you’d peel off for dermatology, or medicine, or whatever, each motel room complex being an office space. It wasn’t good, but it worked.
Cecil Cutting, MD, who was also from the original Permanente Health Plan cohort, shot these slides of the clinic in 1958. It was a far cry from the elegant “hospitals of the future” that Kaiser Permanente had built in Walnut Creek, San Francisco, and Los Angeles – but it valiantly served an important working-class community.
The KP Reporter laid out the situation in a 1962 article:
Sometimes the staff of our Medical Office in Pittsburg wonders if the rest of the Kaiser Foundation Medical Program knows they’re there.
Of course, relations with the Walnut Creek hospital are close and continuous, but Pittsburg is quite a distance from other facilities, and everyone there is so very busy – handling more than 3,100 patient visits a month with a staff of 4 doctors – they regard themselves as the “sheepherders” of our Program.
“When I came here in October, and this office opened,” says Dr. Bulgarelli, Physician in Charge, “each doctor saw about 800 patients a month. Our first purpose was to serve the steelworkers and their families.
“In four months patient visits went up to 1,200 per doctor. Of the original medical staff of five doctors, only Dr. Anna Grinbergs and myself remain. How we worked! And on Sundays, we walked. Or rather, Dr. Grinbergs walked, and still does. Myself, I could not keep up with her. She walks every day before breakfast- gets up at 4 a.m. She is younger today than when she took this job eight years ago.”
Membership continued to grow, and in 1954 Dr. F. W. Treubel was added to the staff, in 1955, Dr. B.B. Taylor. In 1956 Lenore Crane came from the Walnut Creek hospital to be clinic administrator. Patient load went over 3,800 a month while 6 doctors were on the staff, but has dropped to 3,200 now that there are only 4 physicians. The Medical Department at Walnut Creek sends a physician each afternoon to help see drop-in patients, who now comprise roughly 60 percent of the patient load at Pittsburg.
The humble motel-as-clinic closed in April 1964 when services were moved to Antioch. Dr. Bulgarelli, physician-in-chief at the new facility, noted the difference in a KP Reporter article January, 1964:
The opening of new Medical Offices in Antioch next month is awaited as eagerly by Health Plan members as by the clinic staff. We outgrew our quarters in Pittsburg where offices had to be scattered about several buildings. One was in the same building with a bar where a juke box kept the customers happy all day long, but was not so pleasing to our patients.
The new building at 3400 Delta Fair Blvd. is a tremendous improvement. It is more centrally located for all the Health Plan members in our area. It is an attractive, modern building, spacious and air-conditioned, where all our services can be united under one roof. And, in addition to those practical advantages, it is surrounded by 5-1/2 acres, and commands a fine view across green fields to the river and the hills beyond.
Color images are scans from Kodachrome slides shot March, 1958 by Dr. Cecil Cutting.
* Wallace H. Cook, M.D., “History of the Kaiser Permanente Medical Care Program,” an oral history conducted in 1986 by Sally Smith Hughes, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1987.
Short link to this article: http://k-p.li/29JhxH0
, Heritage writer
Previous part: “Injured on the job! The history of Kaiser Workers’ Compensation care“
Beginning with Dr. Sidney Garfield’s pioneering developments in occupational medicine in the 1930s, and Henry J. Kaiser’s expansion of that care for thousands of workers in his seven West Coast shipyards and Fontana steel mill, further advances in programs for handling worker health care evolved as did labor in America.
After the end of World War II, the composition of the national workforce bagan to shift from blue-collar to white-collar occupations, and the percentage of the Kaiser Permanente Health Plan devoted to industrial care waned. Still, in 1967 over a fifth of the Permanente Medical Group’s (the entity of the KP Health Plan that represents doctors) income was derived from industrial medicine.[i]
Yet a prejudice about this sphere of medicine had grown where many doctors had become cynical about both employee and employer versions of injury. As PMG Director Dr. Cecil Cutting ruefully commented, “…we practice Industrial Medicine in a manner which ranges from half-hearted to reluctant, reserving our active interest and most attentive effort for the care of Health Plan patients.”
Kaiser Permanente developed a bad reputation among insurers as being uncooperative in processing the admittedly large amount of paperwork required for industrial claims. Dr. Cutting found this unacceptable, and sought to overhaul and invigorate its industrial medicine practice. He hired the respected and experienced Dr. Walter Hook to oversee the creation of Departments of Industrial Medicine at all major medical centers, each headed by a Chief.
The efforts paid off, and in less than two years the number of industrial patients grew from 21,257 to approximately 33,892.[ii] These departments were not clinical services, but handled the reporting and billing functions required to process workers’ compensation claims.
During the 1980s California employers saw dramatic workers’ compensation cost increases. The workers’ compensation system quadrupled in size between 1983 and 1993, from $2.5 billion to $11 billion, and efforts were made to contain costs and streamline services.
Kaiser Permanente responded with a program called “Kaiser On-the-Job” (now called Kaiser Permanente On-the-Job, or KPOJ), first started in the Northwest Region in 1991. The program was implemented with the goals of meeting employer needs to decrease employee time lost from work and to help reduce health costs related to workplace injuries. KOJ now covers more than 300,000 workers in the NW Region’s service area.
To achieve optimal patient outcomes, it incorporated prevention, case management, clinical protocols, and return to work programs with impressive results. Between 1990 and 1994, the NW Region reduced average loss time per claim by more than two days and achieved a cost savings of $666 in average cost per claim.
The program was so successful that it received the Northwest Region’s 1996 James A. Vohs Award for Quality.[iii] Soon afterward, the Hawaii Region started opening KOJ clinics on the islands of Oahu, Maui and Hawaii.
This approach was soon adopted in other KP settings. Dr. Doug Benner, Coordinator of Regional Occupational Health Services at the time, remarked: “We had a system that just wasn’t working for employers, and wasn’t working for our physicians and staff either…This model goes a long way toward fulfilling our members’ expectations for access and service.”[iv]
KOJ later expanded to California in 1993 when Northern California started building dedicated occupational health centers integrated with our KP program, eventually opening 30 KOJ centers.
In January, 1993 the first of the new KP “one-stop” occupational health clinics opened at the Bayhill Medical Offices in San Bruno. A network of occupational health clinics were fully equipped and staffed with physicians, nurses, and physical therapists specialized in treating work-related injuries. Whereas injured workers frequently used KP’s regional emergency rooms as a first resort, they are now directed by their employers to seek care at the Occupational Health Centers.
Kaiser On-the-Job occupational clinics in the Northwest region were featured in KP’s Perspectives video magazine, promoting the innovative provision of “comprehensive array of services for the workplace.”
Four KP Divisions (Northwest, Northern California, Southern California, and Hawaii) now operate KOJ programs that share many of the same clinical guidelines, care philosophies and processes, and – most important – the same commitment to integrated managed care.[v]
Work will always pose hazards. But the treatment of injuries on the job, which was the spark that in 1933 led to the eventual formation of Kaiser Permanente, continues to be one of the many ways that this health care organization serves this nation’s working people.
Short link to this story: http://bit.ly/1i7dUup
Special thanks to Dr. Doug Benner, Coordinator of Regional Occupational Medicine Services (1993 to 2011) and Connie Chiulli (Director of Operations, Occupational Health Service Line, Regional Occupational Health, TPMG) for help with this article.
[i] Newsletter from the desk of the Executive PMG Director, June, 1967.
[ii] Newsletter from the desk of the Executive PMG Director, March 1970.
[iv] “Designated Occupational Medicine Services: New Model of Care for Injured Workers, Opening Soon Everywhere,” Contact, 12/1993.
by Lincoln Cushing, Heritage writer
This piece is a Thanksgiving offering, a display of our deep appreciation for all the health care professionals who keep us well.
Kaiser Permanente Heritage Resources recently digitized some silent film footage of the Mason City (Washington) Hospital circa 1938. It shows doctors and nurses who were proud to serve at America’s largest Depression-era construction project, living under hardship conditions in a remote town with blistering heat and freezing cold.
This facility was the birthplace of the Kaiser Permanente health plan, where Dr. Sidney Garfield was brought up to care for the workers and families at Henry J. Kaiser’s massive Grand Coulee Dam project.
The original hospital at the site had fallen into disrepair and the unions claimed it was insufficient for their members’ health care. In 1938 Kaiser Industries won the contract to finish the dam, and Henry J. Kaiser and his son Edgar (General Manager of the project) spared no expense on a remodel. Among the many modern amenities installed was air conditioning.
In this clip Kaiser Permanente founding physician Dr. Sidney Garfield is seen exiting the recently-renovated facility to a gathering of doctors and nurses which includes Dr. Cecil Cutting (center of this frame, with a ball in his hand), Dr. Wallace Neighbor, nurse anaesthetist Geraldine “Jerry” Searcy, and RN’s Winifred Wetherill and Evie Sanger. The footage is short clip from recently digitized from Dr. Neighbor’s home movies, which also includes doctors on horseback, the local rodeo, scenes of Mason City, and dam construction.
See them thrive. Then go thrive yourself, and help build thriving communities.
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by Lincoln Cushing, Heritage writer
Henry J. Kaiser was an industrialist, health plan founder…and lifesaver.
On July 3, 1951, at 69 years of age, Henry J. Kaiser sped off in a speedboat to rescue his wife Alyce “Ale” Kaiser and founding Permanente physicians Dr. Sidney Garfield and Dr. Cecil Cutting when their catamaran capsized in the frigid waters of Lake Tahoe.
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