Lincoln Cushing, Heritage writer
Mark Wellman fell from a cliff and broke his spine in 1982 at the age of 22. A well-known mountain climber, Wellman went on to scale Yosemite’s El Capitan seven years later despite his injuries, and was the first person to climb the 3,000-foot cliff using only his arms. Two years later, he summited Half Dome, and later became the first person with paraplegia to sit-ski across the Sierra Nevada.
Wellman received physical therapy and rehabilitation treatment at the Kaiser-Kabat Institute in Vallejo, Calif. (also called the Kabat-Kaiser Institute of Neuromuscular Rehabilitation), now the Kaiser Foundation Rehabilitation Center and Hospital which is still in operation. The work in Vallejo built upon the distinctive and important physical rehabilitation work done under the direction of Herman Kabat, MD, at the Kabat-Kaiser Institute in Santa Monica, which operated from 1947 to 1962.
Henry J. Kaiser had purchased the Vallejo Community Hospital in March 1947 from the
Federal Works Agency to serve the growing Permanente health plan membership in that corner of the San Francisco Bay Area. The innovative facility had been designed by noted architect Douglas Dacre Stone (1897-1969), who’d also designed Children’s Hospital Oakland and Peralta Hospital. The facility was larger than needed, and in June part of the campus was allocated to the new Kabat-Kaiser rehabilitation program. There was also a Kabat-Kaiser clinic at the Permanente Foundation Hospital in Oakland, but after living quarters were built in Vallejo in late 1947 the Oakland clinic only served outpatients.
A key impetus behind Kaiser’s involvement in physical rehabilitation was in response to his youngest son Henry Junior (1917-1961) contracting multiple sclerosis in 1944 and being successfully cared for by program director Dr. Kabat. The first Kabat-Kaiser Vallejo administrator was Felix Day, and the medical director of the physical therapy school was physiatrist Ora Leonard Huddleston, MD.
The center in Santa Monica primarily treated patients with polio and multiple sclerosis, but Vallejo handled a much wider population of patients with disabling conditions including stroke and spinal cord injury. A 1954 brochure for the Kaiser Foundation Health Plan specifically noted “Members are entitled to rehabilitation and treatment for polio after the acute and contagious state, provided they have had continuous membership since the condition arose, and it originated after April 1, 1954.”
Interestingly, this last group included coal miners from rural mining communities in the Midwest and East. In 1947 legendary United Mine Workers of America leader John L. Lewis and the UMWA Welfare and Retirement Fund partnered with Henry J. Kaiser and the Kabat-Kaiser Institute to provide top-quality medical care and rehabilitation for injured miners. They came across the country on the Southern Pacific’s elegant “Gold Coast Limited,” and when they arrived some had to be handed out through windows because they could not be lifted from their berths onto gurneys.
One of the mine workers to benefit from rehabilitation at Vallejo was Harold Willson, who arrived in 1948 with a crushed spine. There he met his nurse and future wife, regained mobility, and went on to work for the Kaiser Foundation Health Plan. Willson became a staunch advocate for making the then-new Bay Area Rapid Transit more accessible with elevators, ramps, chair-high water fountains, accessible bathrooms, lowered hand railings, and “kneeling” buses.
It was in these early years that great strides were being made in the use of physical therapies to treat neuromuscular disabilities. Dr. Kabat received national publicity in the early 1950s for his work at the Vallejo facility, including a major spread in the popular magazine Collier’s Weekly. The institutes, under the direction of Dr. Kabat and physical therapist Margaret “Maggie” Knott, pioneered the therapy called “proprioceptive neuromuscular facilitation.” Maggie Knott and another physical therapist, Dorothy Voss, published the first textbook on PNF in 1956. PNF has become internationally recognized as one of the most widely used and effective treatments for certain injuries and illnesses.
It was also during these years that some in the medical establishment attacked the Permanente Health Plan as “socialized medicine.” Left-sympathetic Dr. Kabat became a casualty, and he resigned from KKI in 1954 to pursue private practice and engage in research. (Also targeted but never harmed was Rene Cailliet, MD, certified in physical medicine and rehabilitation and chief of Kabat-Kaiser Santa Monica). Sedgwick Mead, MD, from Harvard University, was appointed medical director of the Vallejo KKI facility and it was renamed the California Rehabilitation Center.
KKI programs included a range of occupational training such as shoe and watch repair. One of their more popular recreational programs was wheelchair square dancing. And a local sports page on March 16, 1950, noted that the Fifth Annual Hayward Area Open Basketball Tournament would host the “First civilian wheelchair basketball team in the world” the “Wheeling Warriors” from KKI, where they would tangle with the National Guard 49ers.
Because the PNF method works so well, the program at the Kaiser Foundation Rehabilitation Center in Vallejo continues to draw graduate students from all over Europe, South America, and Asia. Just as in the early years, all productive approaches are welcome in physical and emotional therapy. A recent article highlighted several patients whose recovery was greatly enhanced by the healing power of visual art.
Kabat-Kaiser Vallejo – mending bodies and minds since 1947.
Short link to this article: http://k-p.li/2tS1jbn
Third in a series on Kaiser Permanente’s 70th anniversary
At the end of World War II the huge challenge of civilian social services was being reviewed at the highest levels of government. When Harry S. Truman took office in 1945, following the death of President Roosevelt, he did so as a supporter of national health insurance. President Truman made this plea in a speech to Congress on May 19, 1945:
Healthy citizens constitute our greatest national resource. In time of peace, as in time of war, our ultimate strength stems from the vigor of our people. The welfare and security of our nation demand that the opportunity for good health be made available to all, regardless of residence, race or economic status.
At no time can we afford to lose the productive energies and capacities of millions of our citizens. Nor can we permit our children to grow up without a fair chance of survival and a fair chance for a healthy life. We must not permit our rural families to suffer for lack of physicians, dentists, nurses and hospitals. We must not reserve a chance for good health and a long productive life to the well-to-do alone. A great and free nation should bring good health care within the reach of all its people.
Such sentiments were not only echoed by Henry J. Kaiser, he believed that he could contribute to the dialogue. The World War II Permanente Health Plan was so efficient and effective that Kaiser proposed it as a model for national health care. His “Proposal for a Nation-Wide Pre-Paid Medical Plan Based on Experience of the Permanente Foundation Hospitals” dated March 3, 1945, began with this bold statement:
It is maintained that the greatest service that can be done for the American people is to provide a nation-wide prepaid health plan that will guard these people against the tragedy of unpredictable and disastrous hospital and medical bills, and that will, in consequence, emphasize preventive instead of curative medicine, thereby improving the state of the nation’s health.
The San Francisco Chronicle reported on July 20, 1945 that a Senate subcommittee was considering Kaiser’s plan for a volunteer health insurance system to be created through government financing, permitting establishment of voluntary systems for national prepaid medical care through facilities of the Federal Housing Agency. Legislation legalizing the plan was prepared by Kaiser for introduction in Congress by Senator Claude Pepper (D., Fla.).
The bill was an outgrowth of Kaiser’s experience in providing group health insurance to 125,000 employees monthly through the Kaiser Permanente Foundation. Sen. Pepper’s legislation and support for what would become the National Health Insurance Act of 1949 (Senate Bill 1679) was strongly supported by President Truman.
However, Truman’s proposal was immediately attacked by conservative groups, including the American Medical Association. The JAMA editorial on May 7, 1949 put forward their position:
Obviously the propaganda agencies that are devoted to the cause of compulsory sickness insurance provided the thought, if not the language, for President Truman’s address. Here are many of the same old misrepresentations that have characterized their previous statements on this subject. Lacking only is reference to the “socialization of medicine;” apparently the proponents of nationalized political medical care have learned that the American people are exceedingly distrustful of socialism. No doubt the most important objection to medicine socialized by nationalization of its control is the well-established fact that the taking over of medicine is but the first step toward nationalization of every interest and activity of the nation.
Truman’s plan failed to win enough support to pass, and Kaiser withdrew from the national health debate. It would not, however, be the last time that Kaiser Permanente would be part of the national dialogue around best practices in health care.
Short link to this article: http://k-p.li/1TQqHC5
Who was Kaiser Permanente’s first black physician? Given our enduring commitment to member and care provider diversity, such a question is important. Medical practice after World War II was still overwhelmingly white. It was also private – physicians hung up a shingle and arranged for privileges with local hospitals. Group practices, as run by the Permanente Foundation Health Plan, were rare. Once each group grew beyond the original medical partners, new physicians were hired to be part of a team. Physicians hired physicians.
In 1954, the racially diverse International Longshore and Warehouse Union (more commonly known by its initials, ILWU) expressed a desire for the Southern California Permanente Medical Group to hire black physicians. Although the physician leaders didn’t like being told whom to hire, they wanted to serve the medical needs of their large union membership. They hired radiologist Raleigh C. Bledsoe, MD (1919-1996), who had already achieved a distinguished career in the U.S. Army while completing his medical education and training. Even within the relatively progressive setting of the SCPMG, Bledsoe’s acceptance as a partner was controversial. But he was brought in, and stayed more than 30 years. In 1965 he transferred to the newly opened West Los Angeles Medical Center and served as chief of Radiology until his retirement in 1986, becoming the longest serving chief in Kaiser Permanente’s history at the time.
Five years later, in 1959, the Northern California Permanente Medical Group would hire its first black physician, Dr. Eugene Hickman.
Eugene A. Hickman was born in 1921 in Alton, Ill. He served as a trumpeter in the U.S. Navy band stationed in Hampton Institute, Virginia, and graduated from Nashville’s Meharry Medical School (the second oldest medical school for African Americans in the nation) in 1949, specializing in radiology. Looking for opportunity, he moved west to California. There he practiced in Los Angeles, first briefly in a traditional partnership, then with the Los Angeles City Health Department, Mt. Sinai Clinic (now Cedars-Sinai Medical Center), and the Veterans Administration hospital.
Dr. Hickman wrote an unpublished memoir of his life that describes his experience of choosing to move to Northern California and work for the Kaiser Permanente Hospital in Oakland:
I was hired by Dr. James Davis at the Veterans’ Hospital on Sawtelle, near UCLA. I became the chief of Radiology at the branch for the mentally impaired. This hospital had an excellent staff. Again I was treated with cordiality and respect. Seldom was the work really interesting, so I spent a lot of time reading.
It occurred to me that I would lose the skills I had acquired and that this would be a dead end. My wife Eunice encouraged me to move on and asked me if I didn’t think I was worth more than I was being paid. I had a major problem. Hospital radiology departments were, and still are, staffed by a group of radiologists, invariably white. It would not have been a good decision, from a financial point of view, for them to hire me.
I found a copy of the annual Journal of the American Medical Association in which was listed medical facilities throughout the U.S. and names of persons to contact when searching for employment. So again I wrote a few letters.
One was to Dr. Irving Lomhoff, who was then the chief radiologist at Kaiser Hospital, Oakland, Calif. I had seen a Life magazine article about the showcase Kaiser Hospital, Walnut Creek, Calif. Otherwise I knew absolutely nothing about the Kaiser Permanente system. Dr. Lomhoff responded to my inquiry and suggested I come to Oakland for an interview. I was still living in Los Angeles. I had received so many rejections, I found it difficult to take Lomhoff’s invitation seriously. Eunice very strongly suggested I forget the past and go for it. I needed that push.
I arrived [by train] in Oakland on a Monday morning, midsummer 1959 at about 8:00 a.m… [and] called Dr. Lomhoff. Of course he told me to take a bus up Broadway and get off at MacArthur. I did just that, then started walking because I didn’t see anything resembling the hospital I had envisioned. I entered the MacArthur- Broadway Bldg. and called Lomhoff again. He told me he was a big stout red haired Jew and would stand on the front porch to greet me on my arrival.
Well, he was across the street and came out and stood on the porch of a building that I had not recognized as a hospital. In fact, I believe if I had seen a picture of this hospital beforehand, I probably would not have made the trip. Lomhoff greeted me very cordially and took me for coffee and pastry. Then we went to his office for a fairly long interview.
At that time there was not, nor had there been, a black physician on the hospital staff, but this was not to be a factor in the interview or its outcome. He gave me a tour of the facility and introduced me to many of the staff members. He warned me that I would probably encounter difficulty finding a place to live. How correct he was…
Dr. Hickman’s reception by fellow Kaiser Permanente physicians was not without struggle. He described experiencing hostility and condescension from some doctors, and even ugly rumors that members might leave the plan due to his hiring. But Dr. Lomhoff stood by him and things settled down. Dr. Hickman had a long career at Kaiser Permanente, becoming president of the hospital staff and later chief of the department of radiology. He ended his 30-year tenure in 1989.
Dr. Hickman also experienced discrimination of a different type, one entirely unrelated to his skin color:
Before I started working at Kaiser Permanente, I didn’t know anything about the organization, nor about the attitude of the local medical society vis-a-vis Kaiser, but I soon found out. I had been a member of the L.A. County Medical Association for several years. I wanted to transfer my membership to the Alameda Contra Costa Medical Association. I was informed that I would have to be interviewed by one or several members of the ACCMA. At the interview at an office on “Pill Hill” I was strongly advised against affiliating with Kaiser. I was assured Kaiser Permanente was a front for socialized medicine, if not in fact a communist cabal. ACCMA was not accepting physicians allied with the Kaiser organization. I was not enlightened as to the basis for this charge.
Because of the history of racial discrimination/segregation in this country there were also medical associations for black doctors, the one in Oakland named Sinkler-Miller in honor of two outstanding black physicians. [The Sinkler Miller Medical Association was formed in 1969 by physicians located in Alameda and Contra Costa Counties] This group accepted me for membership, but insisted on characterizing me as some sort of traitor to the black physician community. I didn’t let that be a problem for me.
Years later, ACCMA changed its policy and in fact had a member of Kaiser-Permanente as president. There were members of ACCMA who were not in accord with the Association policy regarding Kaiser and with whom we had good relationships, educationally and socially.
Dr. Hickman passed away in 2013 after a short illness, survived by his wife of 64 years and two sons. We honor his courage and persistence in helping Kaiser Permanente provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.
Thanks to those who helped with this story, including retired Kaiser Permanente physicians who remembered Dr. Hickman. A special thanks to Dr. Hickman’s son John, for generously sharing his father’s legacy.
Short link to this story: http://k-p.li/1QC88RD
By Ginny McPartland
Kaiser Permanente’s post-World War II public health plan was but an embryo in 1950 when famed labor leader Harry Bridges asked Dr. Sidney Garfield to provide medical care for West Coast longshoremen. The International Longshore and Warehouse Union (ILWU) had just adopted a health and welfare plan for its members, and Permanente’s prepaid health coverage fit Bridges’ vision.
The health plan, then called Permanente, already had services in the San Francisco Bay area, so covering the six or seven thousand Northern California dock workers was no problem. But Permanente’s only presence in Southern California was at the Fontana Steel Plant, 70 miles inland from the Los Angeles harbor area where the roughly 3,000 longshoremen lived.
Garfield didn’t have to ponder Bridges’ offer for long. The struggling health plan needed members – desperately. After saying “yes!” to Bridges, Garfield flew into action. He hired a physician to run the longshoremen clinic, found a suitable building in the Port of Los Angeles town of San Pedro and opened for business in about two weeks.
Today, Kaiser Permanente’s South Bay service area, boasts about 190,000 members, a 255-bed medical center, and medical offices in Long Beach, Torrance, Harbor City, Lomita, Carson, and Gardena. The KP South Bay community is celebrating its 60 years of history on Wednesday, June 23, in Harbor City.
It’s been a rough ride
The Harbor area health plan’s six decades of existence can be characterized as a roller coaster ride with its ups, downs, and unexpected turns. The years have brought growth, at times unmanageable, stopgap solutions to facility needs, the San Pedro murder of a popular doctor, and a fire that disrupted operations for a year – not all roses and sunshine.
In the beginning, and for many years, the doctors made house calls and took turns sleeping overnight in a blood draw room in the clinic. They were at the beck and call of the longshoremen and their families. Over the first five years, the ILWU became steadily more impatient with the health plan for delaying construction of a sorely needed Harbor area medical center.
Meanwhile, the group had expanded to Long Beach – first to an old house and then to the old posh Kennebec Hotel across from the Pike, a popular amusement park in Long Beach. The health plan also opened a Los Angeles clinic and then a hospital on Sunset Boulevard. From 1953 when the Sunset Hospital opened until the Harbor City hospital was built in 1957, patients were shuttled to Los Angeles for hospital care.
After a tussle with the ILWU that threatened the loss of the group, Sidney Garfield and Buck Wallin got the funding to build the Harbor City medical center. The first medical office building, called Parkview, was opened adjacent to the hospital in 1958.
South Bay no stranger to innovation
The South Bay/Harbor City movers and shakers contributed more than their share of innovative ideas over the years. Some examples:
- In 1964, Harry Shragg, who later became area medical director, was the first in Southern California Kaiser Permanente to perform outpatient surgery, a practice that would become prevalent for its economy and medical soundness.
- In 1964-65, Buck Wallin and Chief of Medicine William Fawell pursued the idea of discharging patients sooner and providing follow-up medical care in their homes. When Medicare came along in 1965, suddenly (home health care) became one of the ‘in’ things to do.
- In the early 1970s, Harry Shragg, Internist Jay Belsky, and Medical Group Administrator Ed Bunting worked together to develop a new exam room layout that would leave more room for the patient and the examination table. “It was such a big success that it was adopted and became standard for all of Southern California, Bunting said.
The good, the bad and the ugly
- In 1967, Dr. Shragg saw the opportunity to help disadvantaged Harbor City people through a local program funded by the federal Office of Economic Opportunity. Kaiser Permanente used its community service funds to provide medical care for 100 participant families.
- In 1960, Leon Quattlebaum, a well-liked and respected 36-year-old Harbor City OB-GYN, was killed in San Pedro by a local tough who, unprovoked, punched “Q” in the jaw, knocking him to the cement floor and fracturing his skull. The prosecutor at the murder trial said the only reason for the killing was the murderer’s “malignancy of heart.”
- In November of 1973, a night fire of unknown origin collapsed the three-story Parkview engineering tower and threatened to destroy Harbor City’s medical records and appointments data. The medical offices and appointment center were up and running again in about a week, said MGA Ed Bunting. But it took about a year to rebuild the burned out section at the center and make the complex whole again.
Tags: group practice, Harbor City, Harry Bridges, health plan, ILWU, innovation, Ira Wallin, kaiser permanente, Long Beach, longshoremen, Los Angeles harbor, MD, prepaid health care, Red Scare, San Pedro, Sidney Garfield, socialized medicine, South Bay, West Coast, World War II