Posts Tagged ‘working-class health care’

Harbor City Hospital – Beachhead for Labor Health Care

posted on September 29, 2017

Lincoln Cushing
Heritage writer


Painting of proposed Harbor City hospital, circa 1955

When the Permanente Health Plan was made available to West Coast members of the International Longshore and Warehouse Union in 1950, it was a classic example of “be careful what you wish for.”

The Permanente plan, robustly serving workers and families for Henry J. Kaiser’s home front industries, expanded to the public on July 21, 1945, less than a month before the end of World War II. It was a heady and challenging period, and labor unions were to become major group members of the postwar Permanente. Why? Because, for the first time, unions could negotiate health coverage.

The key legal ruling was the 1948 decision by the Seventh Circuit United States Court of Appeals in the case of Inland Steel Company vs the National Labor Relations Board. This precedent affirmed the legal obligation of employers in unionized companies to include health and welfare benefits as part of labor negotiations.

Harbor City Hospital under construction, 1959

In 1950 The International Longshoremen and Warehouse Union and the Pacific Maritime Association requested the Permanente Health Plan provide care for all 22,500 of their workers up and down the West Coast; The ILWU became the first major group enrolled in the Health Plan.

At the insistence of ILWU leader Harry Bridges, Permanente was the only choice for the union members. This exclusivity violated Permanente policy that membership should be voluntary, which understandably caused some dissatisfaction with ILWU members. It wasn’t until 1954 that ILWU members were offered a choice of a second plan after Permanente consultant and economist Avram Yedidia convinced Bridges of the importance of dual choice; only 10 percent would leave Permanente.

But there was a problem with capacity. Bridges brought in thousands of new members to a plan that was recovering from a postwar slump and had limited facilities.

For the major ports of Oakland and San Francisco, where the Permanente hospital and clinics were already established, that wasn’t a problem. Looking north, ILWU members in Seattle got care through an agreement with the Group Health Cooperative of Puget Sound and other providers while Portland-Vancouver union members were served by Northern Permanente. Southern California would involve an estimated membership of more than 11,000 longshoremen, but the only Permanente hospital was at the Fontana Steel Mill, 60 miles from the ocean. Not exactly longshore territory.

First LA South Bay clinic, 599 W. Ninth St. (and Grand Ave.).

Bridges wanted a Permanente facility in the San Pedro harbor area where there was a high concentration of members. His promise convinced Permanente that this is the time and the place to expand. Enter the Harbor City Hospital, proud pioneer of the Los Angeles South Bay service area.

Temporary facilities began immediately. A history compiled for the 60th anniversary of the South Bay area described the first San Pedro clinic:

Dr. Ray Kay (founder of the Southern California Permanente Medical Group) and Medical Director Dr. Ira “Buck” Wallin found a working clinic at 599 W. Ninth St. (and Grand Avenue) already occupied by doctors who were, at first, willing to share space. They even agreed to help take care of the longshoremen after hours. That arrangement was short-lived, however. Spooked by the economic threat posed by group practice, the doctors in the community gave the cold shoulder to Wallin’s staff and anyone who associated with them professionally or socially. The three fee-for-service doctors with offices in the shared clinic buckled under the pressure and vacated the premises.

Permanente promised the ILWU that they would build a new hospital in the Wilmington-San Pedro area, but progress was slow. The new Kaiser Foundation Hospital in downtown Los Angeles broke ground in late 1951, and drew institutional resources away from the Harbor City facility.

Aerial photo with lot boundary marked, Harbor City Medical Center, 1100 West Pacific Coast Highway, circa 1957

Things came to a head when 5,000 cannery workers in the San Pedro area signed up with the Permanente plan at the end of 1953. The workers’ employers had wanted them to sign up with the California Physicians’ Service, a competing prepaid plan offered through the California Medical Association. This was during the period where the medical establishment disapproved of Permanente physicians, who were barred from facilities such as San Pedro Community Hospital. The ILWU had been waiting more than two years for their promised hospital, and were getting cranky.

1953 was also the year the scrappy Permanente clinic in Pittsburg, Calif., opened to serve the labor unions and local community.

By early 1955 a site had been purchased, a complex deal involving three parcels, each held by different owners. Clarence Mayhew, the most prominent architect of Kaiser Foundation hospitals, drew up plans for a bold and innovative 66-bed hospital. It featured “vast amounts of glass,” separate corridors for staff and the public, and the famous “baby-in-a-drawer.” The groundbreaking ceremony November 4, 1955, included elected officials, leaders of the ILWU, and the PMA.

On January 14, 1957, the Kaiser Foundation Hospital in Harbor City at 1100 West Pacific Coast Highway, opened. It was hectic. At a 30-year celebration, Medical Administrator Pat Crowe reminisced “The day before we opened, carpenters were still making last-minute changes and final clean-up was not yet complete. Eighteen patients were admitted that afternoon and evening.” One of them was about to deliver her second child. At 1:54 a.m. on January 15 she gave birth to a healthy baby girl.

Aerial photo, Harbor City Medical Center, 1100 West Pacific Coast Highway, expansion construction, circa 1975

The ILWU Dispatcher newspaper of February 15 added this under “Local 13 Man Launches New Harbor Hospital”: First patient in the new $1,000,000 Kaiser Foundation Harbor Hospital was ILWU Local 13 member Oscar Roberts, covered through the ILWU-PMA Welfare Program.

As with all the Permanente facilities, demand always pushed capacity. Sixteen beds were added in late 1958, and a two-story clinic at 1050 West Pacific Coast Highway was built in 1959. Additional expansion happened in 1964, bringing bed capacity up to 121. 1969 saw further clinic expansion. A serious fire destroyed a section of the adjacent Parkview Medical Office Building in 1973.

Harbor City Hospital, ER nurses’s station, 1966

Harry Shragg, MD, served at Harbor City from 1957 until 1968 as a surgeon, chief of the Department of Surgery, administrator of a community health care program for indigents, and medical director. In his oral history he recounted an epiphanic moment about Permanente medicine:

I was on call in the hospital one evening, and a black girl from Compton ─ which is a lower socio-economic level area ─ came into the emergency room with abdominal pain. I think she was sixteen years old. And she was seen by a board-certified pediatrician, examined by a board-certified gynecologist, and examined by me, a board-certified surgeon. We took her to the operating room ─ she had appendicitis ─ and we operated on her. And the whole sequence of that one episode, to my mind, crystalized the merits, and the value, and the philosophy of this kind of practice, where the issue of whether one could afford it or not never arose… She was just a sick person who came in and needed help, and we just gave her what I thought was outstanding quality care… That was, to me, a very dramatic and very memorable occurrence, and I think that’s what it’s all about.


Service to working communities. Yes, that’s what it’s all about.


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Kaiser Permanente Pittsburg Medical Office – unsung soldier in the postwar health plan battles

posted on July 18, 2016

Lincoln Cushing
Heritage writer


Kaiser Foundation medical offices, 242 Diane Ave., Pittsburg, Calif., 1958-03. Scans from Kodachrome slides shot by Dr. Cecil Cutting. Car is 1957 Dodge Custom Royal.

Kaiser Foundation medical offices, 242 Diane Ave., Pittsburg, Calif., 1958. Dodge Custom Royal at right.

When the Pittsburg, Calif., Kaiser Permanente Medical Office opened in September, 1953, it was ground zero in the struggle between Kaiser’s comprehensive, prepaid, group practice model of medicine and the private practice medical establishment.

Wallace “Wally” Cook, one of the founding physicians in the Permanente Health Plan, recalled that epic confrontation in a 1986 oral history*:

When we were trying to grow rapidly, after Walnut Creek had started in 1952-53, Mr. Kaiser was putting a lot of pressure on the health plan. He built this beautiful facility–“he” in quotation marks–and by gosh, we needed members. We marketed the health plan in the steel workers’ union [United Steelworkers Local 1440] in Pittsburg, California… The steelworkers all went to their fee-for-service doctors up there, and here we were recruiting on their turf for members. This was in the summer of 1953. And there was going to be a vote by the steel workers. The fee-for-service doctors’ wives handed out leaflets, anti-Kaiser, anti-Permanente–very, very negative and, in many cases, untrue.

Doctor ad in Pittsburg Post-Dispatch 1953-07-22 [TMPG P1514]

Private practice ad in Pittsburg Post-Dispatch 7/22/1953.

They hired a sound truck to go around the city of Pittsburg, announcing that Kaiser was trying to invade, and let’s keep them out, let’s preserve what you have with your fee-for-service physician. When the vote finally occurred, we got about 95% of the steel workers. So we immediately had an infusion of 10,000 members overnight, and they were going to be members within a month, or something like that.

Well, that put an even greater burden on the recruiting effort. We had to find some place to see these members. So we leased a building that was about to open as a motel in Pittsburg – a U-shaped, old-fashioned 1940s motel, with room, room, room around in a U-shape. And we converted that into an office. You came in the front, and you’d peel off for dermatology, or medicine, or whatever, each motel room complex being an office space. It wasn’t good, but it worked.

Cecil Cutting, MD, who was also from the original Permanente Health Plan cohort, shot these slides of the clinic in 1958. It was a far cry from the elegant “hospitals of the future” that Kaiser Permanente had built in Walnut Creek, San Francisco, and Los Angeles – but it valiantly served an important working-class community.

The KP Reporter laid out the situation in a 1962 article:

Shirley Nelson, at Central Desk in the Pittsburg clinic, has a word with Kenneth, 4, while Kathie Mendoza makes an appointment for his Ma - Mrs. A. N. Franklin. KP Reporter, 1962

“Shirley Nelson, at Central Desk in the Pittsburg clinic, has a word with Kenneth, 4, while Kathie Mendoza makes an appointment for his Ma – Mrs. A. N. Franklin.” KP Reporter, 1962

Sometimes the staff of our Medical Office in Pittsburg wonders if the rest of the Kaiser Foundation Medical Program knows they’re there.

Of course, relations with the Walnut Creek hospital are close and continuous, but Pittsburg is quite a distance from other facilities, and everyone there is so very busy – handling more than 3,100 patient visits a month with a staff of 4 doctors – they regard themselves as the “sheepherders” of our Program.

“When I came here in October, and this office opened,” says Dr. Bulgarelli, Physician in Charge, “each doctor saw about 800 patients a month. Our first purpose was to serve the steelworkers and their families.

“In four months patient visits went up to 1,200 per doctor. Of the original medical staff of five doctors, only Dr. Anna Grinbergs and myself remain. How we worked! And on Sundays, we walked. Or rather, Dr. Grinbergs walked, and still does. Myself, I could not keep up with her. She walks every day before breakfast- gets up at 4 a.m. She is younger today than when she took this job eight years ago.”

Kaiser Foundation medical offices, 242 Diane Ave., Pittsburg, Calif., 1958-03. Scans from Kodachrome slides shot by Dr. Cecil Cutting.

Kaiser Foundation medical offices, 242 Diane Ave., Pittsburg, Calif., 1958.

Membership continued to grow, and in 1954 Dr. F. W. Treubel was added to the staff, in 1955, Dr. B.B. Taylor. In 1956 Lenore Crane came from the Walnut Creek hospital to be clinic administrator. Patient load went over 3,800 a month while 6 doctors were on the staff, but has dropped to 3,200 now that there are only 4 physicians. The Medical Department at Walnut Creek sends a physician each afternoon to help see drop-in patients, who now comprise roughly 60 percent of the patient load at Pittsburg.

The humble motel-as-clinic closed in April 1964 when services were moved to Antioch. Dr. Bulgarelli, physician-in-chief at the new facility, noted the difference in a KP Reporter article January, 1964:

Dr. Rino Bulgarelli, physician-in-charge at Pittsburg, has a warm working alliance with Lenore Crane, clinic administrator. KP Reporter, 1962

“Dr. Rino Bulgarelli, physician-in-charge at Pittsburg, has a warm working alliance with Lenore Crane, clinic administrator.” KP Reporter, 1962

The opening of new Medical Offices in Antioch next month is awaited as eagerly by Health Plan members as by the clinic staff. We outgrew our quarters in Pittsburg where offices had to be scattered about several buildings. One was in the same building with a bar where a juke box kept the customers happy all day long, but was not so pleasing to our patients.

The new building at 3400 Delta Fair Blvd. is a tremendous improvement. It is more centrally located for all the Health Plan members in our area. It is an attractive, modern building, spacious and air-conditioned, where all our services can be united under one roof. And, in addition to those practical advantages, it is surrounded by 5-1/2 acres, and commands a fine view across green fields to the river and the hills beyond.


Kaiser Foundation medical offices, 242 Diane Ave., Pittsburg, Calif., 1958-03. Scans from Kodachrome slides shot by Dr. Cecil Cutting. Physicians listed: P.M. Weber, Anna Grinbergs, Rino Bulgarelli, Bill B. Taylor, F.W. Treubel, J.R. Heiman.

Roster, Pittsburg medical offices, 1958. Physicians listed: P.M. Weber, Anna Grinbergs, Rino Bulgarelli, Bill B. Taylor, F.W. Treubel, J.R. Heiman.

Color images are scans from Kodachrome slides shot March, 1958 by Dr. Cecil Cutting.

* Wallace H. Cook, M.D., “History of the Kaiser Permanente Medical Care Program,” an oral history conducted in 1986 by Sally Smith Hughes, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1987.

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