Posts Tagged ‘Los Angeles Medical Center’

60 years ago: Kaiser Permanente’s first LA medical center opens

posted on June 21, 2013

KP Sunset Hospital in Los Angeles, built in 1953, was one of Dr. Garfield’s “dream” hospitals.

By Lincoln Cushing, Heritage writer

Garfield’s design of ‘dream hospital’ features unconventional and efficient layout

1953 was a big year for expansion in Kaiser Permanente. The fledgling Health plan opened state-of-the-art hospitals in three communities – Los Angeles and Fontana in Southern California and Walnut Creek in Northern California.

The Los Angeles Medical Center (on Sunset Boulevard) was the first to open, on June 16, 1953. The dream hospital design was inspired by Kaiser Permanente founding physician Sidney Garfield who worked with architect of record George M. Wolff.

The new hospitals debuted the concept of separate corridors for visitors and staff. Visitors could enter a patient room from an outside walkway, staying out of the way of busy medical staff moving along the interior corridor.

Garfield’s design called for decentralized nursing stations with one for every four rooms (one nurse per eight patients) instead of one per floor. Patient rooms had an individual lavatory with hot, cold, and iced water.

The futuristic concept of the “baby in a drawer” – a sliding bassinet that let a tired mom pass her newborn through for care in the nursery – was also introduced in the 1953 dream hospitals.

LA Times touted new medical center

The Los Angeles Times gushed about the $3 million facility, describing it as “sorely needed.” It also noted: “The Kaiser Hospital, operated by the non-profit Foundation, is open to the public, a fact not generally known. In addition to Health Plan patients, it also accepts private patients and charity patients referred by social welfare agencies.”

But that public aspect did not sit well with the Southern California medical establishment whose members resisted the arrival of prepaid, group practice medicine. The next month the Los Angeles County Medical Association sent out a questionnaire to its members with the header caption “This is the most important notice ever sent to you by the LACMA.”

Medical association resisted group practice

The cover page made clear the medical association’s concerns:

“Points have been raised as to whether this (Kaiser Permanente) is really a corporation practicing medicine, whether the ‘captive’ patients of the plan forced to join by their union is good for the welfare of the people, whether the patients receive adequate medical care, whether it is proper for a layman to control physicians, etc.”

Opposition reached a fever pitch in August 1953 when Paul Foster, MD, president of the medical association, condemned the Kaiser Permanente program as “unethical.”

These were difficult times for the fledgling Permanente group. The successful practice of high-quality medicine in gleaming new facilities like Sunset eventually wore down the opposition.  By 1960, the local medical society attacks on the program had come to an end.






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Southern California Kaiser Permanente doctors nurture academic culture

posted on February 13, 2013

By M. Rudolph Brody MD and Sam Sapin MD Kaiser Permanente Southern California

Rudy Brody, MD, second from left, takes residents on rounds at Los Angeles Medical Center.

First of Two Parts 

Permanente’s pioneering physicians started out in the 1940s with the idea of developing an academic environment in which to practice medicine. Accustomed to the university-based hospitals in which they got their training, these not-so-traditional doctors relished the idea of keeping their strong connection to academia. Group practice, which allowed for convenient consultation with colleagues, was the perfect vehicle.

In the late 1940s, Southern California Permanente Medical Group physicians presented interesting and challenging cases for their peers twice per week at the medical centers. More in-depth discussions took place at half-day departmental educational activities that included organized rounds at various hospitals, teaching and research.  Often the medical group hosted visiting professors who presented and led discussions.

Rudy Brody, MD, is the retired director of the Center for Medical Education at the KP Los Angeles Medical Center.

In Northern California, The Permanente Medical Group physicians were taking a similar route. Doctors were given a half day a week to pursue academic opportunities, including teaching, learning and research. By 1969, San Francisco and Oakland medical centers had graduate medical education programs, and each facility had a chief of staff for education.

Beginning in 1955, SCPMG invited medical experts renown in their fields to lead specialty symposia and share new clinical information. Research, mainly on clinical topics, flourished. Without knowing it, SCPMG physicians were practicing in an environment that met the definition of an academic medical center.

Cross-pollinating medicine and academia

What is an academic medical center? Let us take you back one hundred years in American medicine to explain:

In 1910 the Carnegie Foundation asked educator Abraham Flexner to review the quality of the 155 medical schools then operating in the United States and Canada. Flexner visited each one of the schools and prepared a voluminous report that would result in all but five of the schools being declared deficient and forced to close.

Sam Sapin, MD, in 1979. Sapin was SCPMG’s first director of Education and Research, taking on that position in 1972. In this capacity, he oversaw the development of residency and other educational programs.

The Flexner Report spurred a revolution in medical education, and the academic standards set at the time of its release are still pertinent today. In his investigations, Flexner identified Johns Hopkins University School of Medicine as the model for all institutions qualified to train new physicians.

The Johns Hopkins model set down three must-haves for an institution qualified as an academic medical center: 1) a clinical setting where new physicians can gain experience treating patients, 2) high quality teaching and 3) a research program.

Academic bent attracted like-minded colleagues

Starting out a few decades after the Flexner Report’s release, Kaiser Permanente pioneers understood the value of high-quality physician education.  Our early physician leaders created educational opportunities at the medical centers and encouraged all doctors to participate. Many physicians taught at local medical schools. With this academic mindset, SCPMG attracted many new physicians who had recently finished their post-graduate residency and/or fellowship training.

With a large clinical practice and excellent continuity of care, Kaiser Permanente medical centers also began to attract medical students looking for a clinical rotation. Next, residents from local university residency programs came to Kaiser Permanente for an elective experience. This led to residents affiliated with medical schools rotating through the Fontana and Los Angeles Kaiser Permanente medical centers.

In the mid-1950s, SCPMG physicians began to ask themselves: Why not develop our own independent residency programs? The three assets that Johns Hopkins University saw as vital to an academic medical center – opportunities for clinical experience, education, and research – all existed within Kaiser Permanente Southern California.

First SCPMG residency program launched

Led by OB-GYN physicians T. Hart Baker and Jack Halett, the first independent residency program was begun in 1955 at Kaiser Permanente Los Angeles. Dr. Baker, who later became the Southern California regional medical director, had a strong academic background and proven administrative abilities. He teamed up beautifully with Dr. Halett, who had an upbeat personality and a passion for research.

During the early years, a number of the graduates of our OB/GYN Residency Program stayed on after their residencies and devoted their professional careers to SCPMG. These included Ruth Nicoloff, MD, Fred Miyazaki, MD, Harry Richards, MD, and Doug Taguchi, MD.

T. Hart Baker, MD, retired OB-GYN physician, was instrumental in launching the KP Southern California OB-GYN residency program in 1955.

Started in 1971, the pediatrics program initially had one resident, Richard Mittleman, MD, then added Daisy Dolorfino, MD, Jim Heywood, MD, Mary Ellen Friedman, MD, and Phil Mattson, MD. All but one of these pioneer pediatric residents continued their careers at what later became the Baldwin Park Medical Center. Dr. Mattson continued his career at SCPMG in San Diego.

Graduate physician education expands

In the ensuing years, residency programs were started in several other KP medical centers: family medicine at Fontana; internal medicine, general surgery, pathology, urology and pediatrics at Los Angeles; internal medicine at West Los Angeles; and family medicine programs in Orange County, Riverside and Woodland Hills.

Vince Roger, MD, was key to the development of the Family Medicine Residency in Fontana. Dr. Roger also oversaw the launch of the Sports Medicine Fellowship in Fontana, which Aaron Rubin, MD, and Bob Sallis, MD, have directed since 1990.  Our sports medicine program was among the first 20 that were accredited in the United States in 1993.

Today, SCPMG trains more than 300 residents and fellows in 27 independent residency and fellowship programs in six of Kaiser Permanente’s Southern California medical centers.  About 150 residents at various GME programs in Southern California, including UCLA, University of Southern California, UC Irvine and Loma Linda Universities, rotate through our medical centers for a portion of their training. We can afford to be highly selective because we receive more than 7,500 applications each year for 100 available positions.

Bob Sallis, MD, a champion of KP’s “Every Body Walk!” campaign, and Aaron Rubin, MD, co-direct the Southern California Permanente Medical Group’s Sports Medicine residency program, launched in 1990.

Many people have contributed over the decades to the success of our residency programs. Our list includes our longtime Los Angeles residency program directors:  Jack Braunwald, MD, Steve Woods, MD, Ted O’Connell, MD, Thomas Tom, MD, Jimmy Hara, MD, Aroor Rao, MD, Craig Collins, MD, and Scott Rasgon, MD.

Also deserving recognition are: Tim Munzing, MD, program director, Orange County; Walter Morgan, MD, program director, Riverside; Dennis Kim, MD, physician director of the Center for Medical Education; and A. Robert Kagan, MD, an internationally known radiation oncologist.

The growth and prestige of our educational programs result from the work and support of many professionals. We have mentioned some of them in this article, but we realize that many more deserve credit and praise for their contributions.

Next time: Southern California Kaiser Permanente residents take their care to the community.

M. Rudolph Brody, MD, is the retired director of the Center for Medical Education at the KP Los Angeles Medical Center. A pediatrician, he helped create and develop SCPMG’s Pediatric Residency Program and was the first pediatric residency program director (1970-1990). He was the regional coordinator for all the Southern California Residency Programs from 1983-1992.

Sam Sapin, MD, a retired pediatric cardiologist, was SCPMG’s associate medical director for Clinical Services from 1982 to 1990 and consultant for Clinical Services until 1994. Sapin was SCPMG’s first director of Education and Research, taking on that position in 1972. Sapin was also a major influence in the development of quality assurance methods.

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