, Heritage writer
Although newspapers and popular magazines covered the remarkable feat of providing industrial health care for World War II home-front Kaiser shipyard workers, a review in the prestigious trade publication Architect and Engineer was endorsement on a different level.
A&E was considered one of the “most important professionally oriented architectural magazines” in California’s history. Their May 1945 article, with cover photo, gushed about the aesthetic and practical features of this hospital that was handling 1,500 patients a day.
While Kaiser Permanente founding physician Sidney R. Garfield helped plan many early Permanente Foundation hospitals and clinics, the huge expansion to the preexisting Fabiola Hospital in Oakland was designed by Palo Alto–based architect Birge Malcolm Clark. The A&E review comments:
If, as he has stated, Dr. Garfield’s first thought is to prevent illness and keep people well, he has admirably adapted the atmosphere of this institution to that purpose, for on first inspection there is little that is “hospitalish” about the place. The familiar odors that we associate with hospitals are absent.
However, it’s clear that Dr. Garfield had a hand in shaping this facility — the review notes one of his trademark features:
The surgeries were built, schematically, in a circle around a central work and sterilizing area, which permits the patients to enter through exterior corridors, thus avoiding cross traffic. This plan was thoroughly tried out at the Kaiser Hospital in Vancouver and improved in this plant.
The healing features of the design were also noted:
The halls are wide, clean and open to outside air and light; the reception rooms are furnished in good taste in a restrained domestic style; the patients’ rooms are simple, comfortable and attractive; there are outside, lawn covered courts of ample dimensions where convalescents may rest in wheel chairs; and there are sun decks.
This review was published months before the Permanente Health Plan was opened to the public, and the magazine saw the potential for this novel and effective program:
When that day comes thousands will thank providence that the men who built the Permanente Foundation Hospital worked so faithfully.
These buildings were demolished in early 2018, their long service to affordable health care fulfilled. Kaiser Permanente’s new facilities receive professional accolades for LEED environmental compliance as well as aesthetics and community engagement, but it all started with recognition for what’s “not hospitalish.”
Special thanks to librarian David Eifler from the UC Berkeley’s Environmental Design Library for his help in accessing this publication.
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Kaiser Permanente Panorama City Hospital, California
Built 1962, decommissioned 2008, demolished 2016
Designed by Clarence Mayhew with partner Hal “H.L.” Thiederman, Dr. Sidney R. Garfield as medical consultant.
Saint Joseph Hospital, Denver, Colorado
Built 1964, demolished 2016
Designed by Robert Irwin.
When I was touring Denver’s Kaiser Permanente facilities in late 2016, my host pointed out a hospital that was being demolished. It was the venerable Saint Joseph Hospital, and what I noticed immediately was that it had two paired cylindrical (or “radial”) towers, just like our former Panorama City hospital, a design universally described as “binoculars.” But taller.
Even though the Kaiser Permanente Health Plan has been operating in Colorado since 1969, and has built numerous state-of-the-art medical office buildings, it has always contracted with local facilities for hospital space. Saint Joseph is one of them.
Although there’s no firm evidence that the Saint Joseph design was influenced by Panorama City, it’s surely not a coincidence. The workflow logic was identical, and the main differences were the stairwell, lobby placement, and lack of an external balcony. It looked more like an overhead view of the Starship Enterprise than a pair of binoculars.
“Building started at Saint Joseph,” Rocky Mountain News, Oct. 26, 1961:
Groundbreaking rites were held Wednesday for the new $8,771,560 addition to Saint Joseph Hospital. The new building, to replace most of the north hall of the hospital, will consist of a pair of 11-story circular towers. Each will a have nurses’ stations at the center, and no station will be more than 20 feet from any room.
The new circular towers will be the heart of the 88-year-old hospital. Saint Joseph will be the nation’s largest example of the new hospital design, according to Robert Irwin, architect. The circular concept means patients’ rooms and wards will radiate from the nurses’ stations in the center.Kaiser Permanente’s original Panorama City Medical Center was featured as The Modern Hospital’s “modern hospital of the month” in November 1962. In the seven-page article “Good Nursing is Core of Panorama Plan,” Sidney Garfield, MD, explained the “circles of service” design concept:
It saves steps for the nurses [in this case, patients are within 20 feet of the nursing station]; it reduces the number of special duty nurses; it keeps the nurses to a central area outside the patients’ door, and it is particularly useful for keeping patients under observation at night with a reduced nursing staff.
Saint Joseph Hospital Communications Manager Colleen Magorian added these details:
The Saint Joseph Hospital “twin towers” were dedicated in 1964, so they were just more than 50 years old when our new hospital opened. The towers were part of an ever-expanding hospital that had been on the same site since 1898 and were inspired, in part, by the towers of the preexisting structure.
Predecessors to this design were a never-built Kaiser Permanente geodesic-dome-based facility from 1957, followed by the “Atomedic Hospital,” which originated in the early 1960s. But these facilities were never meant to be more than one or two stories tall.
Hospital architecture scholars Stephen Verderber and David J. Fine have noted that there are a few other examples of multistory “radial” layouts in the United States, all built in 1964-1965. These include the Lorain Community Hospital (Lorain, Ohio), the Scott & White Memorial Hospital (Temple, Texas), and the Central Kansas Medical Center (Great Bend, Kansas). The Prentice Women’s Hospital and Maternity Center in Chicago, which opened in 1975, was a unique version of this style with four radial towers. It was vacated in 2011 and was the subject of intense preservation efforts to avoid demolition. It was eventually torn down in 2014.
Prentice was designed by Bertrand Goldberg, who drew on learnings from anthropology and the field of “proxemics” (“the study of our use of space and how various differences in that use can make us feel more relaxed or anxious.”) It was praised for its innovative design and engineering prowess. However, many of the design weaknesses of the wedge-shaped rooms were noted as well. Architect and critic Jain Malkin pointed out that the most heavily trafficked side of the room was the narrowest, and in the case of Prentice, that the rounded exterior wall reflected and amplified sounds in a space that’s supposed to be quiet.
Of all of these architects, it was Dr. Garfield and his Panorama City vision that pioneered this bold experiment in improved workflow and patient care. And, as I saw in Denver that cold October morning, the circles of history closed in on the “circles of service.”
Special thanks to Stephen Verderber, and Colleen Magorian and Tiffany Anderson of Saint Joseph Hospital, for their help with this article.
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