Special day meant to educate public
about medical trends and treatments
, Heritage writer
In 1921, U.S. President Warren G. Harding declared the first National Hospital Day. He picked May 12, Florence Nightingale’s birthday, to honor the famed nurse who set initial standards for hospital quality during the Crimean War of 1854.
President Harding declared the special day as an occasion to open hospitals across the United States and Canada to allow staff to educate visitors about medical examination and treatment and to distribute health care literature and information about nursing schools.
This publicity campaign was conceived by Matthew O. Foley, managing editor of the Chicago-based trade publication Hospital Management, in the wake of the 1918 Spanish flu pandemic.
The devastating epidemic killed an estimated 50 million people worldwide, including more than 675,000 Americans. Foley sought to rebuild trust in the city’s hospitals as well as to draw attention to broader crises facing health care. A May 1921 Canadian Medical Association Journal editorial outlined those problems:
“The time is past when support for the care of the sick poor can be obtained through funds raised from private philanthropy.
“Modern hospital methods are expensive beyond anything formerly conceived of . . . [while at the same time] the increase of poverty and unemployment and the influx of a new and inexperienced immigrant population as yet unestablished in homes create a greatly increased number of indigent sick demanding care.”
War influenced day’s focus
National Hospital Day 1945 addressed a different set of challenges – a country still reeling from the Great Depression and still at war with Japan; victory in Europe was declared May 8, 1945.
San Francisco Mayor Roger Lapham proclaimed National Hospital Day as a date to honor volunteer and professional workers for what the mayor called “the splendid record for health in San Francisco during our fourth year of war”.
Among those health care providers honored were those serving workers and their families in the Kaiser shipyards in Richmond, Calif. The shipyard magazine Fore ‘n’ Aft published this editorial:
“Hospital Day has never been one of this nation’s major anniversaries, but – indisputably – health is, and will remain, one of this nation’s major problems for a long time to come.
“For most citizens as well, medical and hospital bills have been one of the major problems in their family budget. That neither of these problems need loom so large and insoluble has been proved at the Richmond shipyards.
“Richmond workers can count themselves among the select – and unfortunately, small – group of American citizens who needn’t worry about running up doctors’ bills, yet they have by their side every protection modern medicine can offer.
“To the service that makes this possible – the Permanente Health Plan – we dedicate this issue of Fore ‘n’ Aft.”
Hospital Day becomes Hospital Week
In 1953, National Hospital Day was expanded to National Hospital Week to give hospitals more time for public education about medical care.
Currently sponsored by the American Hospital Association, this year’s National Hospital Week is Sunday, May 11, through Saturday, May 17.
The week is a time to celebrate hospitals and the men and women who, day in and day out, support the health of their communities through compassionate care, constant innovation and unwavering dedication.
Writing at a time when nursing was generally a woman’s profession, a Canadian editorial writer touted the occupation:
“[On] National Hospital Day efforts will be made to bring the value of a modern hospital before every member of the community, and also to impress young women standing on life’s threshold with idealism still dominant, and aspiring to a vocation as well as seeking a means of livelihood with the view that nursing is a profession and not a business, and that in its honour sacrifices must be rendered as well as privileges won.”
Short link to this article: http://ow.ly/wKF1m
The East Bay Economic Development Alliance will present its 2014 Legacy Award to Henry J. Kaiser today (Feb. 13) in a gala event at the Fox Theater in Oakland.
Kaiser is being remembered for the spirit of enterprise and economic development he nurtured during his lifetime in the East Bay community. He is well known for his work on Western dam projects, including the Hoover Dam in Nevada and the Bonneville and Grand Coulee dams built in Washington State in the 1930s.
But he is best known as co-founder with Sidney Garfield, MD, of the Kaiser Permanente Health Plan.
Barbara Crawford, Vice President, Quality & Regulatory Services in Northern California will accept the award on behalf of Kaiser Permanente.
Industrial giant of the mid-20th century
Henry Kaiser is one of America’s great business leaders of the 20th century. In name recognition he ranks among the likes of steel man Andrew Carnegie, oil magnate John D. Rockefeller and auto industry pioneer Henry Ford.
A man “greatly restless and restlessly great, one of America’s last real Horatio Algers,” the Oakland Tribune said of Kaiser in 1958.
In the 1940s, Kaiser was called the “patriot in pinstripes” for revolutionizing shipbuilding during World War II. His global enterprises included automobiles, steel, cement, aluminum, engineering and mining, to name a few.
Today, he’s remembered most for his socially responsible approach to business, better wages and pensions, a collegial approach to working with labor unions, one of the 20th century’s greatest experiments in workplace childcare, a devotion to honesty in business, and the health care delivery system that bears his name.
He was inducted into Modern Healthcare’s Health Care Hall of Fame in 2011.
“He was a powerful and complex man who charged full bore and seemingly without rest through the best part of the 20th century, generating big ideas, mastering big projects and projecting an endless supply of big dreams,” wrote Michael Dobrin, curator of a 2004 Oakland Museum of California exhibit on Kaiser’s life.
“Henry Kaiser was a pioneer in the new breed of responsible businessmen,” is how President Lyndon Johnson described him. “I was constantly startled at the adventure and compassion and the social consciousness and (his) willingness to extend a hand to the working man.”
Henry Kaiser’s health care legacy
Henry Kaiser was a champion of prepaid, group practice medicine at a time when innovation in health care delivery was frowned on by the American medical establishment.
With Dr. Sidney Garfield as the visionary of the Health Plan, the program was conceived to serve Kaiser’s workforce during the hardscrabble years of the Great Depression at the Grand Coulee Dam construction site in Washington State.
The Health Plan matured in Kaiser’s World War II shipyards and was converted to a public plan in 1945 with 27,000 members.
Today Kaiser Permanente has more than 9 million members and 17,000 physicians and operates in eight regions around the country.
Follow this link to view a video on the growth and development of Kaiser Permanente:
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, Heritage writer
In 1930s America, manual labor of all types– farming, construction, and manufacturing – was dangerous. In those depressed and troubled times, anxious workers were glad to have a job despite the risk of injury or death. Statistics of the decade told the story: workers were killed at an annual rate of 37 per 100,000 employees.
It was in this environment that Sidney R. Garfield began to offer industrial medical care for some of the 5,000 men working on the Colorado River Aqueduct Project in 1933. Garfield addressed the problem head-on by encouraging safe work habits and identifying and eliminating hazards. Garfield, bent on keeping the workers well, actively nurtured a culture of safety awareness and accident prevention.
Garfield’s vigilance to ensure a safe workplace – key to his early preventive care philosophy – remains a vital part of the Kaiser Permanente Health Plan he started with Henry Kaiser almost 70 years ago.
Garfield and Kaiser found synergy in providing health care for Kaiser’s 8,000 workers at the Grand Coulee Dam project in Washington state starting in 1938. That was practice for the real test they faced in maintaining the health of shipyard workers during World War II.
No time to plan for war industries
With almost no time for preparation or planning, Kaiser hired almost 200,000 new employees to toil nonstop to support American and Allied war efforts. Henry Kaiser ran seven West Coast shipyards and a steel mill in Fontana, Calif. His workforce was not composed of the usual sturdy males with experience in the trades – those men were serving in the military. Most shipyard workers were migrants from the South and Midwest, and about a third of them were women. Many were disabled. Few had held industrial jobs before.
The Kaiser Shipyards managers instituted several measures to reduce workplace risk.
One approach was to take care to assign people to the right job when they were first hired. In early 1944, the War Manpower Commission contracted with Permanente Foundation Hospitals to compile data about the physical requirements of each job in the shipyard. This study resulted in a 627-page reference guide called the Physical Demands and Capacities Analysis.
After workers were hired, they were not placed in a job until managers could fully understand their physical capabilities. The job placement guide helped avoid assigning someone to a job they couldn’t physically handle.
The “Plate Acetylene Burner” job description in the guide reads: “Climbs 6 steps to and from assembly platform twice daily, and walks within 500’ x 65’ area to stand, stoop, reach down, grasp, lift, and carry up to 35 pounds of “burning” equipment (women), and up to 75 pounds (men) to place where burning is to be done (25% of job).”
An article in the June 1, 1944, San Francisco Call Bulletin noted the study’s long-term importance. The manpower commission’s regional director told the paper: “The technique (methodology) on which (the research) is based will be invaluable in the postwar period when thousands of returning service men and women will have to be fitted into new jobs.”
Another strategy was to conduct ongoing worker education about occupational hazards. The weekly shipyard newsletters regularly featured cartoons, articles, contests, and photos about the right and wrong way to perform any task. The Richmond newsletter Fore ‘n’ Aft published a “Safety Boner Contest” cartoon created in the nearby Marinship yard (Sausalito) asking readers to identify hazards. Although 112 errors were intentionally drawn in, a zealous reader in a Vancouver (Washington) yard found 118.
Changes in law, technology curb hazards
Death and injury from industrial hazards such as coal dust, explosions, and asbestos have declined markedly in the past century, partly due to changing modes of production and partly due to progressive legislation.
One key step was the enactment of the Occupational Safety and Health Act in 1970, which helped accelerate an already improving work environment. In the 22-year period prior to OSHA’s existence, death rates dropped by 38 percent from the 1948 rate; in the first 22 years following its creation rates dropped by more than 61 percent.[i]
Hazards change. The most significant workplace health problem emerging in the late 20th century was the array of musculoskeletal disorders caused by repetitive stress. And today, in the health care field, other dangers lurk, such as needle sticks, exposure to contaminated human fluids, and getting injured while repositioning and lifting patients.
LMP works for reduction of KP workplace injuries
With the 1997 birth of Kaiser Permanente’s Labor Management Partnership, worker safety programs took a huge leap forward. The LMP’s Workplace Safety Initiative, launched June 21, 2001, was the most comprehensive and ambitious effort to date, with a goal of reducing the number of workplace-related illnesses and injuries by 50 percent over the next four years.
“Too many people in our organization are being hurt on the job today,” said Dick Pettingill, then-president of the Kaiser Foundation Hospitals and Health Plan in California. “This is unacceptable to me, and it should be unacceptable to all of us.”[ii]
The next year newly appointed KP Chairman and CEO George Halvorson and AFL-CIO President John Sweeney called on employees, managers, and physicians nationwide to make their workplaces safer. “There is no reason why we should accept an environment in which accidents are occurring,” Halvorson said. “We’re all going to work together, in Partnership teams, to improve the safety of our workplace.”[iii]
Hundreds of trained two-person teams from labor and management toured medical centers and regional operations facilities in “Broad Engagement Walk-throughs” sponsored by Southern California Region’s Workplace Safety group. The teams talked to unit staff who also responded to surveys to help identify workplace safety issues.[iv]
KP HealthConnect® joins safety campaign
New technologies also demanded workplace safety planning. In 2004, the Kaiser Permanente HealthConnect® workplace safety team partnered with stakeholders in Northern California to minimize any negative ergonomic consequences of the new national electronic health record system. Equipment at 34,000 workstations and hundreds of nursing stations and exam rooms had been modified or replaced, so the workplace safety team developed customized carts, wall mounts, and other adjustments to make sure that the upgrades were safe for physicians and staff.[v]
One way the LMP plays a valuable role is through the site-specific unit-based teams and other natural clusters of workers with similar jobs. In 2004 the Los Angeles Medical Center’s Lift Teams (specially trained staff members who help nurses and physicians lift and move patients safely) reduced the number of workplace injuries by nearly 45 percent over a three-month period.[vi]
By the end of 2005, the Southern California injury rate had declined 29 percent – short of the 50 percent reduction goal but still a significant achievement. Northern California met its goal of 50 percent reduction one year later.
Another major effort is the KP Workplace Safety Program, which seeks to reduce injury on the job for all employees of Kaiser Permanente, from office workers to nurses to couriers. Planning and implementation is coordinated by a national leadership team with regional representation.
In Northern California, the WPS Program serves all represented employees, including those in non-LMP unions such as the California Nurses Association, Stationary Engineers Local 39, and the Guild for Professional Pharmacists.
The challenge continues. In 2011 Northern California WPS Program Executive Director Helen Archer-Duste, RN, MS, reiterated KP’s goal: “Working in health care is dangerous. I want to make us the safest place in health care . . . Our ultimate goal is to have a workplace with no injuries. I believe that can happen.”[vii]
Thanks to Kathy Gerwig (vice president, KP Employee Safety), Helen Archer-Duste (executive director, KP Workplace Safety and Care Experience), Patricia Hansen (KP regional workplace safety practice leader), and Maureen Anderson (Coalition of Kaiser Permanente Unions) for contributing to this article.
[ii]California Wire, “Workplace Safety Initiative: KP and Labor Partners Put Safety First,” Aug. 6, 2001.
[iii] California Wire, “U.S. Labor Leader, KP CEO, Employees, and Managers Launch Programwide LMP Workplace Safety Plans,” Nov. 4, 2002
[iv] California Wire, “Labor Management Partnership Reaches Staff in Workplace Safety ‘Walk-throughs’,” Nov. 11, 2002.
[v] California Wire, “Safety Is Key in KP HealthConnect® Deployment,” July 19, 2004.
[vi] California Wire, “Los Angeles Lift Team Wins LMP Award,” July 26, 2004.
[vii] “Workplace Injuries Plummet,” Inside KP, Nov. 8, 2011.
By Steve Gilford
Senior consulting historian
In 1938, when Permanente founding physician Sidney Garfield recruited surgeon Cecil Cutting to join him at Grand Coulee Dam, Dr. Cutting persuaded nurse anesthetist Geraldine “Jerry” Searcy to come along.
Cutting had confidence in Searcy, having worked with her at San Francisco General Hospital after he completed his medical training at Stanford University in the mid-1930s. He knew she would be an asset to the medical care program set up for Henry Kaiser’s 5,000 construction workers.
Searcy remained with the program from 1938, through the Second World War, until her retirement from the Oakland Medical Center 34 years later. Jerry Searcy told me an anecdote about a personal experience that reflected Dr. Garfield’s managerial style. She liked the story because it helped her to explain why the medical staff was so fond of him.
Her story begins one evening in the Permanente Foundation Hospital in Oakland during the War. The normally busy hospital was unusually quiet that night with little for the staff to do. On that slow night, head physician Garfield just happened to drop by the ward where Searcy was working. His unexpected visit found the staff taking advantage of the quiet by playing a spirited game of poker.
For poker chips, the crew was using pink and white aspirin tablets they’d taken from the supply cupboard. Searcy recalled that Garfield was upset because this misuse of medication was a waste of hospital supplies. He asked them to stop and of course they did – immediately.
The next day the poker players waited somewhat anxiously to see what additional disciplinary measures they might have to face. Garfield surprised them, though. Instead of criticizing them further or meting out some sort of punishment, he donated a set of real poker chips to the hospital.
“From then on,” Searcy remembered: “staff members on call could play poker without disturbing hospital supplies.”
Garfield ‘not at all bossy’
Searcy, who died in 1993, was quoted in a February 1985 KP Reporter edition honoring Dr. Garfield following his death:
“I remember Sid as a very friendly, humble man, not at all bossy, although he did believe in hard work and discipline. Nothing was beneath him, nor beyond him. Once at Grand Coulee, Sid was walking around the hospital without his white coat, looking very youthful with his bright red hair and casual clothes.
“A patient saw him and shouted, ‘Boy! Would you take care of this?’ pointing to his bedpan. Sid wasn’t at all offended. He laughed and emptied the bedpan. Of course the patient had no idea who Sid was,” she said. She continued: “Dr. Garfield liked to sing ‘My Heart Belongs to Daddy’ while performing surgery at Grand Coulee.
“To me Sid was a colleague and a friend. He must have been a leader, though he never waved a flag or beat a drum.”
By Ginny McPartland
Millie Cutting was the wife of Kaiser Permanente’s pioneering chief surgeon Cecil Cutting, but her influence on the fledgling medical program during World War II contradicts any cliché prescribing the role of a doctor’s spouse. She was a vibrant, energetic force in her own right, a good woman behind a good man, but much, much more.
The Cuttings met in Northern California at Stanford University in the early 1930s. He was training to become a physician; she was a registered nurse with a degree from Stanford. They met on the tennis courts and married in 1935.
During her husband’s nonpaid internship, Millie Cutting worked two jobs – for a pediatrician during the day and an ophthalmologist in the evenings – to pay the bills. He was making $300 a month as a resident when Sidney Garfield, MD, contacted him about joining the medical care program for Henry Kaiser’s workers on the Grand Coulee Dam in Washington State.
Millie was at first reluctant to leave San Francisco to relocate in the desert. But when Cecil convinced her that he would have more opportunity as a surgeon with Garfield than in San Francisco, she was game. “Oh, she was willing to go along; she had a lot of spirit and enthusiasm,” Cecil Cutting said in his oral history.
“I think with a little reluctance, perhaps of the unknown,” he told interviewer Malca Chall of UC Berkeley’s Regional Oral History Office in 1985. “We didn’t have any money. She had worked during my residency as a nurse, to keep us in food.” Sidney Garfield was able to match the $300 Cutting was earning at Stanford to get him to Coulee.
A rough start at Grand Coulee
Unfortunately for Millie, things at Coulee didn’t start out too well. John Smillie, MD, writes: “Cecil and Millie Cutting resided in the company hotel. They were flat broke. The young couple had exhausted their resources getting to Washington. Neither of them thought of asking for an advance.”1
“My wife couldn’t take the heat very well,” Cutting told Smillie. “She would lay on the bed with a wet sheet over her; and we didn’t have enough money to eat, really. She would go to the cafeteria and see how far she could stretch a few pennies to eat. Of course, I ate well at the hospital and had air conditioning and everything.
“She finally learned to come over and sit in the waiting room on the very hottest days. Since then, Dr. Garfield laughed at us and said, ‘Why didn’t you ask me for money?’ We didn’t know enough to do that!”
“At the end of the first discomforting month, Cutting received his first paycheck for $350,” Smillie writes. “He and Millie moved into a remodeled schoolhouse, the largest home in the community, and it soon became the social center for the physicians and the Kaiser executives.”
Millie gets her groove back
During the rest of their time at Coulee, Millie not only got her energy back but she exhibited her strength as a staff nurse and as a community volunteer. Probably her most significant contribution was the development of a well-baby clinic in a community church. As a volunteer, she organized the clinic and went door to door soliciting funds for its operation. She had no qualms about knocking on the portals of the town’s brothels.
“The madams were very friendly,” Cecil Cutting told Smillie. “The community church provided the space, and the houses of ill repute the money – a very compatible community.”
Garfield’s right hand ‘man’ at wartime shipyards
The Grand Coulee Dam was completed in 1940, and the medical staff and their families scattered. The Cuttings settled briefly in Seattle where Dr. Cutting set up a surgery practice. But it wasn’t very long before World War II broke out and Dr. Garfield was called upon again to assembe the medical troops.
Cecil Cutting was the first physician to arrive in Richmond, California, where Henry Kaiser set up four wartime shipyards. Millie Cutting volunteered to work side by side with Sidney Garfield to get the medical care program up and running and to take charge of any job that needed to be done.
She recruited, interviewed and hired nurses, receptionists, clerks, and even an occasional doctor, to staff the health care program that was set up in a hurry in 1942. She smoothed the way for newcomers and helped them find homes in the impossible wartime housing market.
Thoroughly adaptable Millie drove a supply truck between the Oakland and Richmond hospitals and the first aid stations and served as the purchasing agent for a time. As she had done at Grand Coulee, Millie set up a well-baby clinic for shipyard workers’ families, and she opened her home in Oakland as a social center for the medical care staff.
Perturbing postwar perceptions
After the war, Millie and Bobbie Collen, wife of Morris Collen, MD, started a Permanente wives group in 1949. The association created a support system against an often hostile medical establishment that shunned prepaid group practice of medicine as “socialist.” The physicians were not allowed in the local medical society, and the women felt socially ostracized.
“They organized themselves as the Permanente Wives Association, which had a nickname, ‘Garfield’s Girls,’ ” Smillie wrote. “They had dances, parties, picnics and social outings several times a year that were really a lot of fun. The auxiliary. . .became famous for its rummage sales.”
The Cuttings became good friends with Sidney Garfield, and in fact, he spent periods of time living with them in their Orinda home in the 1940s and 1950s. Cecil Cutting credits Garfield with the couple’s decision in 1948 to adopt their two children, Sydney and Christopher. “He talked us into it,” Cutting said.
Garfield often went to them for advice about business matters, as well. “I think he talked over a lot of things with Dr. Cutting and Millie,” said Smillie in his oral history. “He had a great deal of confidence in their judgment. If they told him he was wrong, he was able to accept it.”
The Cuttings were the friends Garfield chose to share the happy moment of burning the mortgage papers once the renovated Fabiola Hospital (the first Kaiser Foundation Hospital in Oakland) note was paid off. The private celebration took place in the Cuttings’ home with just Garfield and Millie and Cecil present.
Dr. Cutting worked his way up to become the executive director of The Permanente Medical Group in 1957 and retired in 1976 after 35 years as a major figure in the organization. Millie Cutting continued to volunteer at the Oakland Kaiser Foundation Hospital all of her life. She had to quit in 1985 when she became too ill to leave her house. She died that year at the age of 73. Cecil Cutting received a flood of condolence notes from all the people whose lives Millie had touched.
One woman wrote: “When life seemed just too much, Millie’s unforgettable laughter would ring in my mind’s ear, and the will to tackle life again would be there like a gift from her. She didn’t just give. She was a gift.”
1 John Smillie, MD, Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group, McGraw-Hill Companies, New York, 1991
By Ginny McPartland
The Rosie the Riveter National Park, established in 2000 to commemorate American workers who toiled during World War II to build ships, aircraft, tanks and munitions for the Allied Forces, is now officially open for business.
You can learn just about anything you’d like to know about the World War II home front by taking a tour of the sparkling new Visitor Education Center located on the waterfront in Richmond, California.
The National Park Service (NPS) center is housed in the restored historic brick Oil House that once powered the humongous Ford Assembly Plant next door. At long last, the center brings cohesiveness to the park made up of sites around Richmond. The small city was forever transformed by the wartime activity of the Kaiser Richmond Shipyards.
Until now, the park has had no place to exhibit its rich compilation of stories and photos of the people of the American home front.
Inside the center, you’ll find many historical exhibits recalling the home front. For example, the Rosie the Riveter Trust has a display of “Rosie’s Girls,” a trust-funded program that encourages high school girls to find inspiration in the Rosies’ stories. Other exhibits highlight the origins of the Kaiser Permanente Medical Care program in Henry Kaiser’s wartime Richmond shipyards.
A gift shop operated by the Rosie the Riveter Trust offers World War II-related books, films and Rosie paraphernalia. Downstairs, the theater provides space for NPS ranger talks and the showing of films about local and national domestic efforts that supported the overseas battlefronts during WWII. An original film, made just for the Richmond visitors’ center, is the jewel of the collection.
The Visitors Education Center is open from 10 a.m. to 5 p.m. every day, except Christmas, New Year’s Day and Thanksgiving Day. A ranger program begins at 1:30 p.m. in the theater with the showing of an orientation film, followed by a 45-minute guided walk or indoor program.
The center is located at 1414 Harbour Way, South, which is in the area that was Shipyard No. 2 during the war.
Also at Shipyard No. 2 is the Ford Assembly Plant (now the Craneway Pavilion), whose workers assembled 49,000 jeeps during the war. “Its claim to fame,” according to the park service Web site, “was becoming one of only three tank depots in the entire United States. Every combat vehicle used in WWII was processed by one of these depots. Here (at the plant) the finishing touches were put on 91,000 tanks, half-tracks, armored cars and other military vehicles destined for combat.”
The National Park Service, the City of Richmond and Orton Development Inc. pooled resources to fund the restoration of the Oil House as a visitors’ center. Marcy Wong Donn Logan Architects created the restoration design, and Dalzell Corporation performed the restoration/construction work.
If you go to Richmond, you may also want to visit the SS Red Oak Victory, another feature of the Rosie park. The ship is located at Shipyard No. 3, which is accessed via Canal Boulevard from Interstate 580 West.
The cargo ship, built at Richmond during the war, has been restored as a museum and is operated by the Richmond Museum of History. The Red Oak volunteers offer tours and special events, including a World War II summer film festival.
The current festival, 7 p.m. Thursdays during June, July and August, features:
June 14 – “Confessions of a Nazi Spy”
June 28 – “All Through the Night”
July 12 – “Desperate Journey”
July 26 – “Watch on the Rhine”
Aug. 9 – “Thirty Seconds over Tokyo”
Aug. 23 – “The Clock”
Here’s a tidbit meant not only for military aficionados but also for gardeners:
On Memorial Day this year, the SS Red Oak Victory received a Blue Star Memorial in its new garden on the Victory Ship’s deck. The El Cerrito Garden Club, working with the Richmond Museum of History, dedicated the marker to honor the men and women who served in the American armed forces. The Red Oak’s marker is the first Blue Star to be installed in the city of Richmond.
What is a Blue Star? you may ask. National Garden Clubs, Inc., formerly the National Council of State Garden Clubs, started the program in 1945 after World War II. The blue star was used on service flags to denote a service member fighting in the war.
For more: SS Red Oak Victory.
By Wendy Edelstein
Third in a series
Getting regular exercise plays a key role in staying physically and mentally healthy. A given in 2012, the relationship between physical activity and good health has only been well understood for the past few decades.
While work once involved physical labor for a majority of Americans, early 20th century technological advances changed most jobs into something requiring much less exertion. Henry Ford introduced the assembly line into his Detroit factory to produce cars more rapidly, and mechanization spread to other industries, including farming.
Getting workers into ship-shape
The man behind California’s Richmond Kaiser Shipyards understood the value of good health. Industrialist Henry J. Kaiser knew that keeping workers and their families healthy and happy was vital for the success of his business. Competition among Kaiser teams to produce the most ships at the fastest pace was intense.
To keep workers fit, and to boost morale, the Kaiser Shipyard management provided many opportunities for employees to be active. Softball and basketball games were scheduled so that day, swing, and graveyard workers could participate. And bowling, skating, swimming, tennis and horseshoes were available any time.
Most able-bodied American men were away fighting on the war front, so women workers (who became collectively known as “Rosie the Riveter” and “Wendy the Welder”) took on jobs that in peaceful times would have been considered men’s work. The work was demanding – and early on women found their jobs requiring more strength and stamina than they could muster.
When shipyard gynecologist Hannah Peters recognized many of the women were resigning because the work was too hard, the yard began providing them with strength training. The women learned how to climb ladders, lift loads, and how to combine the two skills to climb with loads.
A mid-century check-up
By the early 1950s, the effect of industrialization began to show, and Americans were judged to be less physically fit than previous generations. “Muscular Fitness and Health,” a 1953 article published in the Journal of the American Association for Health, Physical Education, and Recreation, asserted that the sedentary 20th century American lifestyle had led to a loss of muscle tone in this country’s citizens.
Co-authors Hans Kraus, MD, and Bonnie Prudden cautioned that Americans needed to adopt physical fitness regimens to regain the level of fitness of earlier generations who used their feet to get around and sweated through their work day.
Kraus and Prudden’s message gained traction when mainstream publications such as Newsweek, U.S. News & World Report and Sports Illustrated picked up on a study Kraus had done that showed American youth to be significantly less fit than their European counterparts.
In the early 1950s Kraus studied students between the ages of 6 and 16 and measured their strength and flexibility as they performed sit-ups, leg lifts and toe touches.
A startling 56 percent of the 4,400 American students tested by Kraus and his colleague Sonja Weber, MD, failed at least one of the fitness components. In contrast, only 8 percent of the 3,000 European students (who hailed from Switzerland, Italy or Austria) failed even one part of the test.
Kraus blamed the American students’ poor showing on their pampered lifestyles: Their parents typically drove them to school, and they did only light chores and played within their own neighborhoods. Their European peers, on the other hand, typically walked miles to school, rode bicycles and performed strenuous chores such as chopping wood.
When President Dwight D. Eisenhower suffered a heart attack in 1954, America received a lesson in preventive care from Dr. Paul Dudley White, the president’s physician. Dr. White used television – 65 percent of Americans had a TV at home by 1955 – to tell Americans they could stave off heart attacks by exercising more, giving up cigarettes, and by eating healthier food, and less of it. President Eisenhower followed his doctor’s advice and went on to establish the President’s Council on Youth Fitness in 1956.
Sowing the seeds of a fitness revolution
In December 1960, then President-elect John F. Kennedy spearheaded a public awareness campaign promoting physical fitness. In “The Soft American,” an article he wrote that appeared in Sports Illustrated, Kennedy cited the results of the Kraus-Weber Test as well as an annual physical fitness exam at Yale University: 51% of the class passed in 1951, 43 percent passed in 1956 and 38 percent passed in 1960. http://sportsillustrated.cnn.com/vault/article/magazine/MAG1134750/index.htm
“Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity,” wrote Kennedy. “The relationship between the soundness of the body and the activities of the mind is subtle and complex. Much is not yet understood. But we do know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong; that hardy spirits and tough minds usually inhabit sound bodies.”
Once he took office, President Kennedy’s message reached an even wider audience via a public awareness campaign, President’s Council-sponsored pilot projects to test children’s fitness levels, clinics and educational films and booklets.
When Kaiser Permanente (KP) opened the doors of its Health Education Research Center in Oakland in 1969, its overarching educational theme was, “You have only one life to live – live it in good health.” The experimental center featured a patient health library and health exhibits. “Story of Life,” one of the most popular displays about human reproduction and family planning, used life-size, three-dimensional models and color slides.
Another area of the center presented information about health hazards: weight problems, smoking, venereal disease, cancer, and alcohol and drug abuse. The “Pathway to Positive Health” exhibit focused on how visitors could stay well by paying attention to nutrition, dental hygiene and the physical, mental, emotional and social aspects of good health.
The Health Education Research Center was an outgrowth of a pilot project that explored education’s role in increasing the effectiveness of preventive care. This was a new approach to prevention; it spread through the Kaiser Permanente system and beyond. By 1987, 85 percent of all U.S. hospitals offered health education programs.
From aerobics to yoga – 1970s ushered in fitness craze
Unofficial estimates in the early 1980s suggested that more than half of all Americans pursued some sort of recreational exercise, such as bicycling, swimming, tennis or running. This new dedication to physical activity signaled a change.
“Until recently, modern generations of Americans by and large failed to act on a compelling accumulation of knowledge linking individual lifestyle with individual health. As a nation, our eating habits violated accepted standards of nutrition. We shunned devoting our leisure time to regular physical exercise,” declared the writers of Kaiser Permanente’s 1984 annual report.
During the 1970s and 1980s many Americans got swept up in the fitness craze. Wearing leotards, neon spandex and leg warmers, they headed to health clubs and performed leg lifts and side bends and hoisted dumbbells to upbeat music. Or they popped Jane Fonda’s Workout in the video cassette recorder (VCR) and worked up a sweat at home. Others jogged their way to good health after reading Jim Fixx’s 1977 bestseller The Complete Book of Running.
Americans had different motivations to exercise, according to a 1978 Harris poll. Twenty-four percent of regular exercisers cited their reason was to strengthen their heart and/or lungs, 41 percent sought to lose weight, 24 percent wanted to become healthier, and 45 percent hoped to stay healthy.
A 1976 Centers for Disease Control and Prevention study of the 10 leading causes of death in the United States looked at the importance of four factors. Lifestyle, including exercise and diet, figured most prominently at 51 percent, followed by heredity (20 percent), environment (19 percent) and inadequate access to health care (10 percent).
Garfield’s Prescient Total Health Care Project
KP founding physician Sidney Garfield’s crowning achievement, the Total Health Care Project, came towards the end of his life in 1984. Among the Total Health Care Project’s goals was “to provide comprehensive primary care services for both wellness and illness and to provide incentives to professional staff to keep members well rather than just treating them when they are sick.”
An aggressive outreach plan to new members encouraged them to schedule a health evaluation appointment to review their current health and to develop a personalized Health Improvement Plan (HIP).
Members received a mailing with the instructions: “If you are feeling fine, we also want to see you to make sure you are in good health and assist you in preventing future problems. We really think the BEST time for you to get acquainted with us is when you’re feeling good, without the pressure of illness.”
Members who visited the Total Health Care Center for initial and periodic examinations assessed their own health via a questionnaire. They were asked about their eating habits, their lifestyle and how frequently and intensely they exercised. Part of the assessment was a treadmill endurance test to determine cardiovascular fitness.
Through the Total Health program, the center staff guided members in their quest for good health. Handouts offered tips such as how to select an activity that you will stick with as well as how to take your own pulse.
In the 1980s, popular health books included Pritikin Program for Diet & Exercise, Better Homes & Gardens’ Good Food & Fitness and Covert Bailey’s Fit or Fat? Fitness programs and initiatives began to take root throughout Kaiser Permanente’s regions. For instance, in 1984, the Ohio Region launched its “Annual Frost Belt Classic,” a series of five-, 10-, and 15-kilometer cross-country ski races. The race drew 500 skiers in 1987.
In the early 1980s, every KP region sponsored or supported a race or fun run. As part of its Dr. Wizardwise health education program, the Hawaii region sponsored a run for children.
Also in the 1980s, Kaiser Permanente’s Northern California Region established partnerships with about 15 local health clubs, enabling its members to join for a low or no initiation fee and a reduced monthly rate.
The current picture of health
Today medical assistants in Kaiser Permanente’s Southern California, Northern California, Colorado and Northwest regions ask patients about their exercise habits as a matter of course. Exercise as a Vital Sign was launched in Kaiser Permanente’s Southern California region first in 2009 to capture information about members’ physical activity.
Medical assistants routinely ask two questions: 1) On average, how many days a week do you engage in moderate or greater physical activity (like a brisk walk)? 2) On those days, how many minutes do you engage in activity at that level? Those answers are entered into the KP member’s computerized health record, and his or her physician can view that information along with the rest of the patient’s vital signs.
Kaiser Permanente also promotes healthy living through its Every Body Walk!, Thrive Across America, Healthy Eating Active Living and KP Healthworks programs and by sponsoring walks, runs and cycling events and offering an array of fitness classes at its medical centers.
With Exercise as a Vital sign in the exam room and a broad array of healthy living initiatives, Kaiser Permanente’s longtime fitness message endures: regular exercise is one of the cornerstones of preventive care and ultimate good health.
Kaiser Permanente is one of the sponsors of the Home Box Office (HBO) upcoming documentary series “Weight of the Nation,” which covers the issue of obesity in America. The four-part series will be aired May 14 and 15. For more information about KP’s involvement in the fight against obesity: http://bit.ly/kptwotn
by Ginny McPartland, Heritage writer
Second in a series
Established initially as an industrial health plan, Kaiser Permanente had grown and morphed into a community health plan with over one million members in six states by the mid-1960s. Meanwhile, Henry Kaiser’s ventures had spread across the globe and the basic concepts of industrial and preventive health care traveled with him.
This meant the idea of prepaid health care provided by doctors in group practice was getting a lot of exposure in places where it might be needed most.
The World Health Organization was busy helping African and other developing countries set down their “national health plans,” and industrial nations were taking a serious look at investments in these countries. Already with health care programs in Jamaica, Ghana, Argentina and Brazil, Kaiser Permanente seemed in a prime position to take the lead in other emerging nations.
“At first, we held the belief that since we managed a large, comprehensive and widely-accepted health care system in the United States, that we were in a favored position to cope with the health problems associated with industrial enterprises all over the world,” KP Health Plan President Clifford Keene told a group at Harvard University in 1969.
“This theory turned out to be true in a limited sense,” he continued. “We learned quickly that the medical care circumstances in rural India and in Jamaica are essentially different from those in California.”
Keene explained that developing nations, especially those with a national health plan, urgently needed primary health care workers, clean water, sanitation and disease control before they could even think about clinics and hospitals. Adjusting to local circumstances, Kaiser industrial health care leaders filled in the gaps where needs were most urgent – and bided their time.
KP establishes independent international agency
By 1964, Kaiser Permanente was getting requests from the U.S. and foreign governments to help plan and launch health care services in needy countries. Feeling the strain and drain on the Permanente Medical Care Program whose staff was responding to the calls, Keene and the board of directors established Kaiser Foundation International (KFI).
This not-for-profit entity, with an $55,000 initial grant from the Kaiser Foundation, was a separate self-sustaining agency established to fulfill government contracts to provide help setting up health care in foreign or domestic rural areas.
In its life between 1964 and 1975, KFI was involved in projects in more than 30 countries, including the U.S. where the agency helped set up programs in rural areas of California, West Virginia and Utah. Its workers took on projects in 13 countries on the African continent, as well as in India, Pakistan, Bahrain, Italy, Indonesia, Venezuela, Argentina, Brazil, Peru, Jamaica, the Bahamas, Canada, Okinawa, Taiwan and the Island of Curacao.
Nigerian civil war leaves damaged hospital in its wake
KFI was called upon in 1969 to bring back to life a Nigerian hospital that had been debilitated in the civil war that started in 1967. James Hughes, MD, Kaiser Industries vice president of Health Services at the time, explained:
“This project was completely unrelated to any commercial activities by Kaiser Companies in Nigeria. It was undertaken strictly in response to an urgent request by the government (U.S. Agency for International Development) for technical assistance in a matter of general medical care. Presumably, the request was based upon our prior experience in the organization and delivery of health care on other West African (Ghana, Ivory Coast, Togo, and Senegal) projects.”
The 250-bed hospital at Port Harcourt in the area of Biafra previously had been the referral center for the entire Rivers State of Nigeria with a population of one million. “The Port Harcourt situation looked particularly grim,” reported Keene.
“The war was still in progress 50 miles north of the city and the Biafran troops were making periodic sorties toward the airfield on the outskirts of Port Harcourt. KFI existed to handle tough overseas assignments, but we have never acted in a war zone,” Keene continued.
“When the physician (Carl Friedericks MD) arrived, he told us his first impulse was to turn around and come home. Medical care was critically needed by the remaining civilian population and by refugees streaming out of the jungle zone,” Keene reported.
KP team resuscitates Port Harcourt hospital
The initial team of five acquired a package disaster hospital (PDH)* from the U.S. Public Health Service. Electrical generators, emergency water equipment, and medical supplies and equipment were “scrounged from unbelievable sources,” Keene said. “A Nigerian staff was recruited and trained, on a counterpart system (that matched) native physicians, technologists and nurse volunteers to (our 20) personnel from the United States.”
In the first months at Port Harcourt, the hospital had a daily census of 80 to 100. Dr. Friedricks saw patients with familiar diseases such as diabetes, hypertension and pneumonia. But he also noted many patients with tuberculosis, parasitism, malnutrition and severe anemias.
“Tropical ulcers are common and yield to prolonged medical treatment and skin grafting. Malaria is the most common cause of fever . . . One young lad suffering from a heavy hookworm infestation came in with a hemoglobin of 2.0 grams, or about 13% of normal levels; blood transfusion and medication brought him up to 42% of normal hemoglobin to permit his discharge for home medication.”
They also dealt with issues such as having no dishes to feed the inpatients, getting fuel for the repaired coal stove and outfitting the makeshift operating room and exam rooms with light fixtures. Transportation was not a problem: the U.S. government supplied them with four Land Rovers and a Rambler station wagon. Nigerian Airways had regular flights between Port Harcourt and Lagos, the largest urban area in Nigeria.
San Francisco KP nurse goes to Nigeria
Frances Fuller, formerly assistant director of KP’s San Francisco Medical Center, arrived in Nigeria in September of 1969 as the KFI chief nurse. She went to work setting up nursing classes for 40 Nigerian students as well as developing a hospital procedure manual and a central supply and distribution system.
Fuller reported remodeling of a lecture theater for use as a temporary surgery. “When the room is ready, we will take the instruments and other supplies from the PDH (package disaster hospital) and start doing more surgery.” In the midst of her reporting on the status of the medical facilities, she interjected: “Grounds are being well kept. We even have flowers in the courtyard.”
In 1971, the KFI team departed Port Harcourt leaving a locally staffed, well-functioning and well-equipped community hospital.
Financial troubles doom international agency
Unfortunately, all of KFI’s ventures didn’t end happily. In Peru, a project to set up a hospital system for blue-collar workers was ended abruptly when the government was overthrown and all funds for health care projects withdrawn.
In 1968, politics killed another KFI project, this time in Libya. At the request of the U.S. state department, KFI sent a physician to discuss improved medical staffing of hospitals and clinics in Libya. When Libyan government officials learned that Kaiser assembled its Jeeps in Israel, they dropped the project, due to the Arab League boycott of companies doing business with Israel.
An ill-fated project to bring prepaid group practice to Saudia Arabia in 1974 ultimately brought down KFI, Permanente medicine’s first but not last international arm. Scott Fleming, KP senior vice president, said the project presented major cultural and legal problems that were costly to solve. In general, the KFI financial picture didn’t look promising at that time so the directors decided to discontinue its operation altogether in 1975.
Next time: Great press about Kaiser Permanente abroad fuels renewed initiative to teach eager foreign health officials about the KP care delivery model.