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
What does one do with a decommissioned hospital? When Portland’s beloved Bess Kaiser hospital was closed down (to become the American headquarters of the Adidas sporting gear company) several 40-foot shipping containers of recycled components – doors, fixtures, cabinets, even the proverbial kitchen sink – were salvaged and crated up.
Community volunteers and hospital staff worked with the Portland Rebuilding Project and Mercy Corps to ship these still-usable items to far-flung health care facilities in Central America, the Balkans, and Central Asia.
Short link to this item: ow.ly/onT5u
By Lincoln Cushing, Heritage writer
Dr. Charles Grossman, one of the 12 original partners of what was originally called the Northern Permanente Group (Oregon and Washington), passed away July 16, 2013, at age 98.
Dr. Grossman came to Vancouver, Wash., in October 1944 to join the 45 physicians of the Northern Permanente Foundation hospital. It was here that the wartime health plan covering 60,000 Kaiser shipyard workers in Oregon and Washington was in full swing. This was the formative crucible of what would later become the public Permanente Health Plan. Grossman, having just completed his medical residency at Yale, at which he took part in the first U.S. clinical trial with penicillin, joined the pioneering medical group “…induced he said, by the annual salary of $8,400—considerably more than Yale had offered.”[i]
Northwest physician and historian Dr. Ian MacMillan recounts a story of those early years: Dr. George Bookatz, a talented surgeon with a flair for humor, once admitted “a male with chest abscess” for a drainage procedure. The patient was Grossman’s dog, an adoptee from the local animal shelter. Its vigorous protests prompted another patient awaiting treatment to remark with alarm that the suffering patient in the adjoining cubicle had begun to bark like a dog.[ii] While treating the men and women in the shipyards Dr. Grossman looked into the prevalence of pneumonia, where the incidence was 18.5 per 1,000 employees, a figure much higher than among the workers’ families and almost twice that that Dr. Morris Collen was finding in the Richmond, Calif., shipyards. Dr. Grossman concluded that certain workplace conditions played a role, with painters and chippers appearing to be at highest risk. [iii] But the samplings were too small and the time period too short to arrive at any definitive conclusions.
When the war ended and the shipyards closed, the Northwest group suffered the same attrition as did the Oakland hospital. Dr. Grossman noted that within six weeks after V-J Day (August 14, 1945), about 35 of the 45 medical staff quit Permanente to return to private practice.[iv] Besides Grossman, that left Wallace Neighbor, brothers Morris and Barney Malbin, Ernest Saward, Walter Noehren, Norbert Fell, Ernest Spitzer, Katherine Van Leeuwen, pediatrician Margaret Ingram, and two only identified in a recent interview by Dr. Grossman as “Knos (Bookatz?) and Haeber.”
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… With all the Kaiser shipyards on the West Coast closing, we had no patients or income. In addition, we were faced with opposition from the leaders of both Oregon and Washington medical societies to “socialized medicine” as they considered Permanente to be.
In public, they argued on a less ideological level that with the war over and the shipyards closed, the emergency that persuaded them to tolerate Northern Permanente was over. Their opposition was so fierce that Permanente doctors were barred from membership in the local medical societies and we therefore had no admitting privileges at area hospitals. [v]
In November 1945 Dr. Grossman began a year of absence from Northern Permanente to fill an internist position in the Southern California Permanente Medical Group at the Kaiser steel mill in Fontana, Calif. He rejoined the Northwest Permanente Medical Group in October 1946. Although the practice acquired the Vanport, Ore., hospital in 1947 to expand its service area, a 1948 flood wiped out both the town and the hospital. Dr. Grossman himself waded in to salvage a 50-pound EKG machine.
During the late 1940s the Permanente plans and hospitals experienced the fractious Cold War dynamics wracking the country at that time. Dr. Grossman’s political leanings were seen by management and some other physicians as negatively affecting the medical group’s relationship with the community. A series of struggles eventually resulted in his departure in 1950.[vi]
Dr. Grossman continued private medical practice in the Portland area, and his political activism continued throughout his life. In 1990 he was arrested during a peaceful demonstration organized by Physicians for Social Responsibility, challenging the presence of a battleship capable of carrying nuclear arms 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.”
Dr. Grossman was one of the brave and committed physicians who stood by the Permanente practice during its most desperate times. He will be missed. Short link to this article: http://ow.ly/nZNOf
By Lincoln Cushing, Heritage Writer
Basic civil rights for members and workers at Kaiser Permanente has been part of the culture for a long time. Here Kaiser Permanente nurse Sue Caulfield accepts the 2004 Fair Workplace Project Award from the Education Fund of Basic Rights Oregon for KP’s work in promoting a progressive environment for gay, lesbian, bisexual and transgender employees. The award noted that the 7,000 workers in the Northwest region enjoyed policies such as equal benefits for same-sex partners and a program of culturally competent medical care.