Heritage writer

Permanente in the Northwest fills a large gap in the history of Kaiser Permanente – the unique contribution made by the Northwest region, especially in the early years.  Author and retired Northwest internist Ian C. MacMillan, who served 14 years as chief of medicine at Kaiser Permanente Sunnyside Medical Center, demonstrates an insider’s insight and enviable access to details that thoroughly enrich this account.

Before there was a Kaiser Permanente, there was Permanente Metals, the division of Henry J. Kaiser’s construction consortium that built ships during World War II. The medical services offered to those civilian workers was the kernel of what would eventually grow to become one of the nation’s largest not-for-profit health plans, and with two vibrant shipyards in Portland, Oregon, and Vancouver, Washington, the Northwest was a key participant.

The prologue provides a history of the medical care options in the area before 1941 as well as the story of how Sidney Garfield, MD, and industrialist Henry J. Kaiser came to collaborate on their successful model of prepaid industrial medical care. This is followed by a detailed account of the wartime boom – shipyards, housing, and health care rolled into one.

Wartime shipyards in Oregon and Washington

Notable events include the then-new practice of treating civilian tuberculosis patients with streptomycin, the model day care program for workers’ children endorsed by Eleanor Roosevelt, and a rich art community.

Clipping about the completion of Bess Kaiser Hospital, July 1959, Oregon Journal

The demand for medical facilities soon outstripped the capacity of the first aid stations in the yards, and the first Northern Permanente Foundation (NPF) Hospital was built in Vancouver, Washington, in 1942, followed by a second one across the Columbia River in Vanport, Oregon, a temporary community built for shipyard workers, the following year.

That hospital was kept out of the nearby metropolis of Portland through stiff resistance by the local medical establishment, an example of a contentious relationship that would last many years.

As happened in California, the exodus of shipyard workers after the war forced the Northwest medical care program to expand to the broader community. Ernest Saward, MD, who had administered the wartime health care plan for DuPont plutonium workers at Hanford, Washington, became the medical director of the physician group and the Northwest health plan in 1947.

Changes after World War II

Dr. MacMillan explores some of the fractious cold-war dynamics of the medical partnership at that time, including debates about how KP internist Charles Grossman’s political activism was affecting the medical group’s relationship with the community.* (See note below.)

Beaverton (Oregon) medical office building groundbreaking, June 1968

By 1950 relationships had deteriorated to the point that Edgar Kaiser (Henry J. Kaiser’s son) fired them all and formed a new partnership. Dr. MacMillan details other challenges to the Northwest region, including its struggle for legitimacy with the American Medical Association and ostracism by private practitioners.

The first major postwar facility in the Northwest was the Bess Kaiser Hospital in Portland, completed July 7, 1959. (There would not be another until the 1975 Garfield-designed Sunnyside Medical Center at Clackamas, Oregon). Named for Henry Kaiser’s first wife, the state-of-the-art facility featured air conditioning, telephones and televisions in every room, pneumatic medical records delivery, and a drawer bassinet allowing newborns to slide through the wall between mother’s room and the nursery.

Tumultuous times for KP Northwest medical group

The Kaiser Permanente health plan expanded into Hawaii in 1958, and the Northwest physicians played a significant role in helping that region survive a rocky start. Dr. Saward was called out to apply his management skills when friction within the physicians group exploded. Dr. MacMillan explains some of the complex background that led to the struggle, and he chronicles the eventual maturation of the region.

Frank Stewart, administrator; George Wolff, architect, Dr. Wallace Neighbor (pointing); Northern Permanente Foundation Hospital, circa 1942.

A large portion of the book is devoted to the history of various medical specialties of the Northwest medical group, detailing medical arcana more likely to be of interest to practitioners than a lay audience.  The last three chapters trace significant chronological events in the region from the 1970s to the present.

Among these topics are the challenges of recruiting and retaining good doctors (he outlines the need for robust medical infrastructure, clear work policies, and adequate pay), the deep impact of the 1988 nurses’ strike, and the erratic steps taken by KP to institutionalize an effective electronic medical record system.

In all, this is a much-needed historical survey of a major region in the Kaiser Permanente constellation. Dr. MacMillan does not shy away from exploring awkward and complicated events in the Northwest Permanente history, and he writes with an insider’s viewpoint that enriches the accounts.

Permanente in the Northwest should be of interest to anyone interested in modern American health care policy, health practice, and the broader history of medicine.

Permanente in the Northwest
Ian C. MacMillan, MD, The Permanente Press, 2010
313 pp, with illustrations, bibliography, and index
To order the book, go to permanentejournal.com

KP Northwest historical materials brought to Oakland

Preservation of the rich history of Kaiser Permanente’s Northwest Region (KPNW) got a boost at the end of 2011 when staff of the national Heritage Resources department in Oakland packed up over 100 cartons of Northwest photographs, clippings, newsletters, and files to fold into the KP archives. These materials will be selectively processed over time and added to the existing collection, greatly enhancing our research capacity. The photographs accompanying this review were drawn from that collection.

Special thanks to KPNW Community Benefit and External Affairs staff Jim Gersbach and Mary Ann Schell for their help.

*After leaving Permanente in 1950 Dr. Grossman continued to practice medicine privately, and his political activism continued throughout his life (a path respectfully footnoted in MacMillan’s book in his Afterword titled “What Happened to the Pioneers?”). He was arrested in 1990 during a peaceful demonstration organized by Physicians for Social Responsibility, challenging the presence of a nuclear-armed battleship 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.”

Sara Beadle, Fresno's first outpatient in 1986, with Larry Coble, MD.

By Ginny McPartland

Heritage writer

It’s been a quarter of a century since Kaiser Permanente (KP) established a prepaid medical care outpost in Fresno, then unbroken territory for the health plan. Since its opening in 1986, KP Fresno has grown from 400 initial area members to over 100,000 today.  Its facilities have expanded from a remodeled space in a shopping center to several large clinics and a hospital the Fresno Bee newspaper labeled KP’s local “crown jewel” when it opened in 1995.

“It’s big, bright and modern and epitomizes health care competition in Fresno,” the Bee writer effused.

KP officials began to ponder a move into Fresno in 1985 when large statewide employers began to expand into the burgeoning Central Valley. The health plan already had a clinic in Stockton, which is north of Fresno and south of Sacramento.

Fresno's outpatient facility opened July 1, 1986.

It made sense to go to Fresno since KP health plan members were moving there and getting their care at other KP facilities, the closest of which was three hours away. Also, employees of big companies, such as Bank of America, Pacific Gas & Electric Company and Pac Bell were retiring and settling in Fresno and other communities in the Central Valley.

“These employers wanted the advantages of having similar benefits for their employees in multiple sites, and the employees wanted access to the same quality of care and service they had grown to appreciate in the Bay Area and Southern California,” explained Larry Coble, MD, retired Fresno pediatrician and physician-in-chief. Dr. Coble wrote a history of the first 13 years of KP Fresno when he retired in 1999.

Behind the scenes, high level KP leaders had been debating about where the boundary should be between Northern California region, with a facility in Stockton, and Southern California region, which was developing a presence in Bakersfield. The argument was settled when Northern California entered Fresno and thus staked its claim in the Central Valley.

To launch a KP facility in Fresno, whose isolation made it different from most other expansion areas, KP leaders had to start at square one. No existing facility could take Fresno under its wing as a satellite.

Checking out Fresno’s potential

In 1984, TPMG executive director Bruce Sams, MD, tapped Albert Kahane, MD, associate executive director and former Sacramento Medical Center’s physician-in- chief, to work with the regional medical group to assess the potential for KP’s entry into Fresno. By early 1985, the decision to go to Fresno was made.

As the medical group facilities planning liaison, Dr. Kahane was called on to spearhead the acquisition and conversion of clinic space where the Fresno medical care program would be launched. He was also responsible for contracting for community hospital beds for KP’s patients.

Fresno's nursing staff June 30, 1986, the day before the outpatient facility opened on First Street.

In the fall of 1985, The Permanente Medical Group (TPMG) and health plan leaders began to assemble a team to make Fresno a reality. They set the opening date for July 1, 1986, and leased a four-story building at First and Shaw streets in the former Fashion Fair Plaza. Remodeling of space for the primary care areas began right away.

The start-up team, affectionately called the A-team, was selected from the Sacramento service area. Led by Dr. Coble, the team members were: John Bowden, medical facility administrator; Shirley Edmons, RN, nursing director; Toni Hays, Support Services manager; and Edie Yoder as secretary.

Selling Kaiser Permanente

In the spring of 1986, Dr. Coble began his quest for willing professionals to make up the KP core team of primary care staff physicians, contracted specialists and laboratory and x-ray professionals. “(I was) literally going from door to door meeting with physicians, optometrists, podiatrists, laboratory supervisors, etc. At times I felt like a salesman, handing out my card wherever I went. . .that’s exactly what I was doing, selling Kaiser Permanente.”

The first patient was 19-month-old Sara Beadle, who was brought in by her mother (Debra Shriver-Sprinkel) at 8:40 a.m. on the first day. She grew up to be a healthy young woman and distinguished herself on Fresno State University’s equestrian team in the 2003-2004 season. She studied philosophy and business in the Fresno pre-law program.

Most local residents and employers welcome KP

Dr. Coble says the people of Fresno, especially the major employers, for the most part welcomed Kaiser Permanente to the Fresno community. It took the Fresno City Council five minutes to approve a zoning change for 38 acres at Fresno Street and Alluvial Avenue to allow KP to build a 200-bed hospital and medical offices for 180 physicians. At the time, the health plan had no immediate plans to build a hospital, but opened a huge outpatient facility at the site in 1991 and added an outpatient surgery center in 1992.

There was, however, initial resistance from the Fresno area fee-for-service physicians who objected to KP’s prepaid group practice. Dr. Coble recalls: “One very ugly situation occurred in which someone obtained a copy of our contracted physician list and posted it on (a local) hospital’s physician lounge bulletin board.”  The list of specialists taking referrals from KP doctors was circled with black crepe, the symbolic “black ball” meant to intimidate physicians from supporting KP.

Fresno's medical center opened in 1995.

Dr. Kahane says he also encountered resistance when he negotiated with local hospital administrators for KP’s use of hospital beds. He says favorable contracts were elusive because hospital leaders believed KP would eventually build its own hospital in Fresno. He told local hospital officials: “Whether it costs us less (to operate our own hospital) or not is your decision.” He explained that if the community hospitals charged prohibitive fees for contracted beds, KP would be forced to build its own Fresno hospital. “And that is exactly what happened,” he said in a recent interview.

Fresno KP gets its own medical center

In the early 1990s, with rapidly growing membership and medical staff, KP Fresno leaders started making plans for a hospital of their own. Construction began in 1993 on the site at Fresno Street north of Herndon Avenue. In 1994, Ed Glavis was appointed as administrator of the new hospital; Maura Hopkins, RN, as nursing director; and Davidson Neukom as facilities manager.

When the new hospital opened in February 1995, the Fresno Bee said: “The Kaiser Permanente Hospital is the crown jewel in a $100 million Kaiser building project in Fresno, including the $30 million ancillary building which opened in late 1992.”

“I’m terribly excited,” Dr. Coble told the Fresno Bee. “It’s going to be easier because our physicians now will be able to literally walk down the hall to see their (hospitalized) patients. . . In addition, he said, all the ancillary services, such as laboratory, x-ray and pharmacies are close at hand . . . It’s professionally a very satisfying way to provide health care.”

Opening just in time for laboring mom

The rest of the hospital complex was opened in October of 1995. Having received “full accreditation with commendation,” Dr. Coble reported in his memoir: “We were a full-scale, high-quality medical group and hospital!”

Continued growth and success

From its early milestones, KP Fresno has continued to grow and prosper. The Fresno KP community has been honored recently for its commitment to reduce waste and prevent pollution in its facilities. The staff has also been recognized for its excellence in employee wellness efforts and for its work to overcome obesity in the community.

KP’s Fresno Medical Center, which stopped accepting free baby formula years ago, is close to being designated as Baby-Friendly* with 75.8% of new mothers exclusively breastfeeding their newborns, the highest rate in Fresno County in 2009. The center’s maternity staff places an emphasis on breastfeeding and discourages formula supplementation for infants whose mothers intend to breastfeed exclusively.

KP’s presence in the rest of the Central Valley has continued to expand as well. In 2008, the health plan opened another exquisitely designed hospital to serve the area. The new Modesto Medical Center** follows the current version of the evolving KP hospital design template, which incorporates functionality, as well as sustainability, patient comfort, optimal use of natural light, staff efficiency and accommodation of the latest medical technology.

*Baby-Friendly USA is a national campaign to encourage breastfeeding. Fourteen of Kaiser Permanente’s facilities have received the designation, and KP leaders have vowed to have all 29 medical centers called out as “baby friendly” by Jan. 1, 2013. Already designated are: Los Angeles, San Diego, Fontana, Downey, Riverside, Anaheim, Panorama City, Irvine, Baldwin Park, and Woodland Hills in Southern California; Hayward and South Sacramento in Northern California; Honolulu, HI, and Clackamas, OR.

**For more about the KP facility template, click here.

Artist Jonathon Nix took real life as his inspiration. This 1984 poster depicts Nix's wife and children (and friends) following the birth of his son. Click on image for larger view.

By Ginny McPartland

Heritage writer

Thanks to Sue Odneal, a Kaiser Permanente information security employee, I recently was turned on to a series of holiday posters from the 1980s that are amazing gems from KP’s past. Sue, who has worked for KP for 36 years in Vallejo, Oakland and Walnut Creek, found three of the posters among her things and wanted to donate them to the Heritage archives.

I was thrilled to hear from Sue, and I emailed her right back and said: “Please send them!” Once I saw three of the full-size posters,
published from 1982 to 1988 in the KP Reporter, I wanted to find the rest of the six-poster series.

Looking through our archived KP Reporters, Heritage writer Laura Thomas and I found the rest of the six and were completely charmed.  Next, knowing that Molly (Prescott) Porter, director of KP International today, was the employee publication’s editor in the 1980s, I contacted her to jog her memory.

“It’s so funny to be reminded of these things,” Molly wrote. “Yes, I remember; and I hired Jonathon Nix, a talented illustrator. I guess we (Molly and Gretchen Gundrum) made a decision to publish and insert these into the internal magazine as a holiday present to (30,000) Northern California employees and physicians – perhaps to put up in their cubes or take home.”

Sue Odneal was one of those employees: “We really enjoyed having these as part of our office holiday decorations,” she recalled.

The 1986 holiday poster urged automobile safety. Note seat belts and child's car seat. Click on image for larger view.

Poster artist reminisces about holiday project

Artist Jonathon Nix was not hard to find. I got his email address from his Web site and jogged his memory too.  “Yes Virginia, there really is an illustrator,” he wrote back. “Um, sorry about that. Couldn’t resist.” (Apropos since my email name is Virginia.) He continued: “Yes, I am the illustrator of those posters . . . I’m tickled to hear that you’re thinking of writing about
them. . . To be honest, I don’t remember every one of them, so it will be fun to see them when you send them.”

My colleague Lincoln Cushing scanned the posters and we sent the PDFs to Jonathon. A few days later I had the chance to talk to the artist, who now lives on the East Coast. “I was fairly surprised to see there were six of these,” Jonathon told me.  “Before you
got in touch I would have said that I did, maybe three. It was really fun to see these images again and be reminded of the project. . . .Molly used a very light hand in directing these,” Jonathon recalled.  The artwork was meant to feature children and each poster to promote one very simple idea.

As it happened, the years during which Jonathon designed the KP holiday posters made up a crucial period of his life. Living in San Francisco with every intention of moving back to his hometown of Tucson, Jonathon was sidetracked when he met and married his wife, Andrea, in the late 1970s.  The couple had their first child, Olivia, while living in the Bay Area.

Dolls and teddy bears need to exercise too. Click on image for larger view.

Illustrator finds inspiration in real life

Looking at the rediscovered posters, Jonathon felt the memories of his young family flowing back. “What comes back the strongest is that the little Japanese doll character, which appears in all of them, was modeled on my daughter Olivia who is now 31 and is a mom,” Jonathon told me. “She was definitely that character although we never put up her hair like that, thank goodness. I always considered her a pivotal character in all of the posters.”

Jonathon made illustrations for the Kaiser Permanente publication for several years before deciding in 1983 to move to western Massachusetts. The poster created immediately after the move reflects the inspiration Jonathon felt from Norman Rockwell who had lived and worked in the Berkshires where the Nix family settled. “We actually knew someone who had been a model for Rockwell when she was a kid,” he said.

That poster shows a hospital scene where a red-headed girl with long braids, in a wheelchair and her leg in a cast, leads a parade of toys down the corridor. A startled nurse resembling a Rockwell character looks on in horror.  “(From the nurse’s point of view, things like that) “are not supposed to happen in a hospital and she’s expressing that,” Jonathon said with a laugh.

Norman Rockwell's work influenced artist Jonathon Nix in his creation of this comical hospital scene. Click on image for larger view.

The red-haired girl, inspired by Jonathon’s niece Sarah, creates a jovial holiday atmosphere in an often cheerless place – a hospital ward. “We were thinking about children’s wards and creating something that would reach out to families who had children hospitalized at that time of year, which is always a very poignant thing,” he said.

In 1984, Jonathon got his inspiration for the holiday poster from the birth of his son, Edward. The artwork shows Andrea, his wife, his newborn son nestled in her arms and Olivia sitting at her mother’s side on the hospital bed. Peering over the bedrail are Olivia’s teddy bear, another recurring character in the series, and an amiable Pinocchio.

At the foot of the bed is Pierrette, the female Pierrot character that originated in Commedia dell’arte or Italian Comedy.  Dressed in flowing diamond-patterned trousers and a layered harlequin collar, Pierrette also appears in many of the posters. Young Olivia had a Pierrette doll among her toys, and Jonathon found the chic yet sweet and cute character added a little sophistication to his creations.

This 1982 poster suffered at the hands of someone who punched holes in it for filing. Click on image for larger view.

Healthy lifestyle themes illustrated

In posters presented to KP employees during the holidays from 1985 to 1988, healthy lifestyle messages were integrated into Jonathon’s whimsical scenes. In 1985, it was all about exercise; in 1986 and 1987, the message was automobile safety; and in 1988, it was about healthy eating.

Jonathon says the 1986 poster with the car on the checkerboard road was influenced somewhat by a 1951 Plymouth that he drove in Massachusetts at the time. The obvious yellow seatbelts everyone was wearing and the “healthy and safe” message illustrate Henry Kaiser’s early interest in the 1950s in highway safety.

“It was such a happy collaboration with Molly (Prescott Porter). I really enjoyed working with her, and I think her boss (Gretchen Gundrum, director of communications) was also influential in providing direction on these.”

Jonathon said the posters were meant to represent KP’s diversity and to avoid references to any particular faith. However, reflecting on the imagery of the 1980s posters, he sees how some of the symbols, such as Santa Claus driving a car and the wreaths and pieces of holly sprinkled throughout, would not be considered strictly secular in today’s world.

Eating healthy is not a new idea, as shown in this 1988 KP holiday poster. Click image for larger view.

Although Jonathon didn’t remember all the posters, he didn’t forget his first. “The watercolor artwork for the earliest one, with the Peace on Earth theme, was framed and hung in Olivia’s room the whole time she was growing up. That room is a guest room now, and the illustration’s still in there,” Jonathon reported.

So what has Jonathon been up to for the past 30 years?  He has had his own graphic design business in Massachusetts and continues to paint and sculpt on the side. He’s won many awards and participated in many exhibitions. Currently, Jonathon designs full time for the Met Life insurance company in Boston. You can learn more about Jonathon Nix on his Web site: http://www.jonnix.net

This illustration of a KP physician with an AIDS patient was originally published with a 1988 article about AIDS and medical ethics in KP's publication, Spectrum.

By Lincoln Cushing

Heritage writer

The epidemic appears

AIDS was first reported in the summer of 1981. The next year, when Kaiser Permanente San Francisco Medical Center (KP San Francisco) began treating its first patients, diagnosis and treatment protocols were in their infancy. Doctors, nurses, administrators, and other caregivers struggled to know what to do.

Sometimes standard procedures worked fine, other times they were inadequate. One early conflict erupted in 1983 when two nurses at a Santa Clara (CA) hospital (not a KP facility) resigned over a dispute regarding caregiver safeguards in that facility’s first AIDS case. “I think most nurses would agree. . . There really isn’t anyone who wants to go in the room,” one nurse said.

At KP San Francisco, Infection Control nurse Barbara Lamberto described Kaiser Permanente’s response:

“We called a department head meeting immediately [and] we talked about our personnel policies and our posture about that kind of situation, and I think in the long run it made a difference because everybody knew [that] this is how we felt. We are a health care organization. We are here to care for patients.” ²

Michael Allerton, Operations and Policy Practice Leader for The Permanente Medical Group, describes the situation as he saw it: “Here was a disease that was invariably fatal, in a horrible way, and nobody knew where it came from, how it was transmitted. . . and in this incredible environment of fear and anxiety, our doctors walked in those rooms. Our nurses walked in those rooms. Our engineers went in to fix TVs. We had people who really rose to the occasion.” ³

The lack of solid data compounded treatment of “the mysterious disease” in unexpected ways. In a 1985 interview, KP San Francisco RN Grace Rico-Peña explained the challenge in the early years:

“This is very different than any other illness we’ve needed to educate about. We’re trying to dispel myths and rumors. When news media reports stories about AIDS they have a certain bias — they want to make things seem a little more dramatic, a little more exciting, and so they highlight certain parts of the story and get everybody all charged up about it.

“There are a lot of people with crazy ideas about AIDS. I remember one story about a bus driver who didn’t want to take money when he was in the “gay areas,” people who don’t want to wait on people. That’s part of our getting sensitized and taking care of these patients. AIDS patients frequently become social lepers.” ⁴

She describes how Kaiser Permanente responded with reason and balance:

“Our philosophy in our educational approach, which has been dictated by our top level administration here in Epidemiology, has been to not let ourselves get carried off into emotion, or political controversies, but to educate very solidly along the lines of the information that’s known. We’ve done educational programming always on the facts. [We ask] “What are our patients’ needs, how are we going to meet those needs?”

Tom Waddell, MD, Olympic decathlete, SF physician, AIDS patient, and activist for better medical care for people with AIDS, 1987.

Patients get involved in care

And, as is true with all quality care, part of the solution came from the patients themselves. Tom Waddell, Olympic decathlete and a physician at San Francisco General Hospital’s emergency department, was diagnosed with AIDS in 1986.

Initially publicly critical of the treatment of AIDS patients at KP San Francisco, he fought for better care. “I made a lot of noise,” he said. Other patients did so as well. On June 8, 1988, the Kaiser Patient Advocacy Union (with the suitably explosive sounding acronym “K-PAU”) was formed, demanding a voice in a range of issues. This was a life-and-death issue, and emotions flared.

But, as Dr. Waddell later admitted, “Much to Kaiser’s credit they responded.  I think they may now have a model program for treating AIDS patients.” ⁵ It was clear that motivated, informed patients needed to be part of the solution.

An HIV Support Group Program was established in 1988 at KP San Francisco, and the next year a system-wide KP HIV Member Advisory Panel was formed. In 1998, KP hired the top San Francisco HIV specialist, Dr. Stephen Follansbee.

Documentary highlights KP’s central role

In the year 2000, Critical Condition, an independent three-hour documentary about the politics of managed care, observed this high-stakes match between institution and critics. One segment included footage of AIDS activists picketing KP, angry that it moved slowly and would not prescribe medication other than standard and approved drugs. ⁶

Tensions were high and tempers flared, but the strategic choice of Kaiser as a target was revealing:

“We only picketed Kaiser — not because it was the worst but because you knew where Kaiser was.  It’s like the big kid on the block.  If you can bring that kid to his knees, the others are going to get in line also.” ⁷

Another protestor reflected on the choice: “Do I think those protests were effective?  Absolutely.  I think it slapped Kaiser in the face and I think Kaiser stood up to it and said, ‘Okay.  What can we do here?’ ”

A third activist agreed: “The fact is we still have to acknowledge that Kaiser is the only HMO that I know of that’s ever allowed the members to come in and be part of the process.” ⁸

The strength of many

The San Francisco Bay Area quickly became one of the national centers confronting the epidemic. By 1989 two cities (San Francisco and Oakland) accounted for 67% of the region’s cases.  But other KP regions were affected as well and mounted their own responses.

In 1989 Kaiser Permanente Colorado created an AIDS-specific social services program to help patients manage their own care, led by Barry Glass.  Glass’ holistic model proved so effective that it was extended into other areas, including care of the elderly and those with catastrophic illness. Broader health care lessons were being learned.

Some answers were found through the strength of massed medical resources. In 1987 KP established a multidisciplinary Interregional AIDS Task Force, expanding to an Interregional AIDS Committee the following year.

James Vohs, KP health plan and hospital president and CEO in the 1980s, reflected on that process: “One of the best interregional committees that we established was in response to the AIDS epidemic. It was an excellent way to educate our other regions on the basis of the experience that we had in Northern California, especially because we had so many AIDS cases.

“Kaiser covered something like 2 percent of the population of the United States when I was there, but we had about 5 percent of the AIDS cases. . . Having the Interregional AIDS Committee was very, very helpful in providing a good knowledge base of what was working, what wasn’t working, and how to organize services. It was extremely successful.” ⁹

KP continues to lead

KP Educational Theater actors rehearse scene from 1989 Bay Area production of "Secrets," a play about HIV/AIDS.

At the 30-year anniversary of the first diagnosis of the mysterious disease, KP continues to be a leader in AIDS treatment and research, and in partnering with community-based efforts. KP Southern California has provided grants totaling over $4 million to nonprofit organizations for a variety of services for people living with HIV and AIDS, including dental care, youth education and screening programs.

The nature of the epidemic has changed, but the work remains, and Kaiser Permanente has demonstrated its commitment to applying the full weight of its health care resources to finding solutions.

Learn more about KP’s response to the AIDS epidemic at the Center for Total Health.

Heritage correspondent

Greg Millett, White House advisor, speaks at KP diversity conference in San Francisco.

Kaiser Permanente’s 34^th Annual National Diversity Conference, held recently in San Francisco, culminated in the presentation of the HIV/AIDS Diversity Awards, along with White House policy advisor Greg Millett’s battlefront assessment of the 30-year war against the disease in the U.S.

Millett noted the year-by-year drop since the 1990s of new HIV cases and a decrease in the public’s alarm over the disease. He contrasted that success with the continuing problem of delivering adequate care for the poor and minorities in urban areas where the prevalence of HIV is still high.

Bringing care to these victims is crucial, he said, because many studies show that beginning to treat an infected person in the early stages of HIV reduces the risk of transferring it to another by 90 percent or more.

“The road to treatment in the U.S. is fraught with difficulties,” he told the audience. “This is nothing new to any of us.” Millett, who is also a researcher at the Centers for Disease Control, lauded the Kaiser Permanente study published in 2009 that showed the risk of dying from AIDS didn’t differ between ethnic groups when there was equal access to care.

“You don’t see that nationally,” he said. “Kaiser Permanente is doing a very good job of suppressing HIV. This is exactly what we would like to see happen nationally.”

KP’s HIV leader shares Millett’s visions

Michael Horberg, MD

Millett’s words were well-received by Dr. Michael Horberg, Kaiser Permanente’s national director for HIV/AIDS, who announced the Diversity Award winners and was on stage with Millett and Diane Gage-Lofgren, senior vice president for KP Brand Strategy, Communications and Public Relations (BSCPR).

Appointed to Obama’s Presidential Advisory Council on HIV/AIDS (PACHA) in 2010, Horberg hopes to make Kaiser Permanente’s best practices a part of national policy. Practicing at Michael Reese and Northwestern Memorial hospitals in the Chicago area for 10 years before coming to California, he has spent most of his medical career in the fight against the disease.

He is one of those lucky people whose life both on and off the job is fueled by a strong sense of purpose. In the early 1980s, as the first patients infected by the HIV virus were being treated at Boston City Hospital where he was in his third year of medical school, he already knew he was gay, but it was still a little too early for him to declare himself.

“It was the fear of rejection, the fear of being ostracized, even in the medical community, of not being able to attract any patients,” he recalled.

AIDS outbreak spurs Horberg to action

Ironically, the onset of the AIDS crisis is what finally helped to liberate him. As patients with HIV symptoms, including some of his close friends, began coming to him in private practice, he realized stepping out of the closet would help them get the care they needed and allow him to be a more powerful advocate for specialized care.

The timing was good.

“There was no hiding any more. I was true to the world and it was true to me,” he wrote in California Medicine in 1997. “And it paid off in a number of ways. For one thing, because I was a gay doctor with a large gay and lesbian patient population, Northwestern Community Medical Group (affiliated with Northwestern Memorial Hospital) invited me to merge my practice with theirs.  And because I had a high patient satisfaction rating, managed care companies came courting as well.”

KP's Michael Horberg (fifth from right in front row) serves on Obama’s Presidential Advisory Council on HIV/AIDS (PACHA).

Dr. Horberg began specializing in HIV care in Chicago where he grew up. Early on, he knew he wanted to be a doctor. Both the science and the humanism involved appealed to him, and both values were part of his family heritage. His uncle was a physician and a great-aunt had attended medical school and practiced in the 19^th century in Estonia and the Ukraine.

Being able to help his gay and lesbian brothers and sisters has fulfilled that early desire to meld technical skill with compassion. Especially early in the crisis “when there was a limit for what we could do for patients, really caring, really showing love was critical,” he said.

Research key to improving care

Both the science and the compassion have continued to motivate Dr. Horberg in his work: He was an early proponent of experimental drug trials and has devoted much of his research to improving the delivery of care as well as exploring the source of the disease.

Horberg was recruited by Kaiser Permanente for his work with HIV and was happy to leave the muggy hot summers of Chicago in 1996 for the Bay Area’s temperate climate. He worked briefly at South San Francisco before taking charge of the HIV/AIDS program at KP Santa Clara where he handled patients, began his work as a scientist in Kaiser Permanente’s Division of Research while studying for a master’s degree in research (MAS) at the University of California at San Francisco.

He has since worked on numerous studies using data from the records of 50,000 HIV patients who have been treated by Kaiser Permanente since 1981. His studies have focused on many aspects of caring for HIV patients, from the management of antiretroviral drug therapy and allied infections to issues of ensuring quality of care and equal access to care.

Dr. Horberg collaborated on the study that sought to determine whether equal access to care would result in a similar outcome for HIV patients of different races. The study – lauded by Millett in his remarks to the Diversity Conference – was the first to break out statistics for Hispanics and it found no disparity in the clinical outcomes between white, black and Hispanic KP patients, with Hispanics having a slightly lower mortality rate.

Leading the charge for best HIV/AIDS care

During his years in California, he was a tireless advocate for HIV patients in his roles as physician, researcher and leader of initiatives to improve and standardize care. Horberg chaired the central research committee for the Northern California region, and led the HIV Interregional Initiative.

Last year, working with the National Committee on Quality Assurance (NCQA) and other interested groups, the HIV Initiative developed 17 measures for quality HIV care – including patient retention, screening and prevention for infections, immunization, and initiation and monitoring of antiretroviral therapy – that are intended for nationwide implementation.

“We really have done a very good job,” he says of Kaiser Permanente.  “We can do better. We are not going to rest on our laurels. We know where there is room for improvement. . . We are willing to analyze our care. We are the first managed care organization to develop a set of care metrics. And from that we asked our other research questions that have led to policy changes. We have really compassionate care. We give a damn.”

Early this year, Dr. Horberg moved to Maryland to become executive director of research for the Mid-Atlantic States Permanente Medical Group. Dr. Horberg had to let go of seeing patients when he made his move to the east and that was hard to give up, but leading research, his other love, is also about people, he says. “The science we do at KP is the science of caring for patients and how to do that in the most effective way is really what we study.”

Fortunately, he left with his true love, husband Chip Brian Horberg, whom he married in 2008 while gay marriage was legal in California. The couple, whose birthdays are July 10 (Chip) and July 12 (Michael), were married July 11 under a traditional Jewish huppah on the rooftop of their condominium in San Francisco, surrounded by family and friends, including a large contingent of Kaiser Permanente colleagues.

This is the first of two articles about Kaiser Permanente’s response to the HIV/AIDS crisis. There’s more about KP’s history of taking care of HIV/AIDS patients at the Center for Total Health.

Next time: Kaiser Permanente’s early struggle to stand up to AIDS.

Shipyard No. 3 fire truck towed to the dock from Spanish Fork, Utah

SS Red Oak Victory coming back into Richmond Shipyard No. 3 dock

By Ginny McPartland

Heritage writer

Plenty has been happening lately at the site of the World War II Kaiser Richmond Shipyards where the decade-old Rosie the Riveter national park is taking shape. Maybe the most exciting event for the community and history buffs was the recent return and the ceremonial relaunch of the SS Red Oak Victory ship.

Red Oak Victory edges up to the Richmond dock after its facelift.

The ship, built in 1944 in the Richmond shipyards, was greeted by a small enthusiastic crowd when it returned from BAE Systems dry dock in San Francisco where it got a major facelift. The Red Oak was towed back across the bay on Oct. 14, just one day before the annual Home Front Festival, an event celebrated both on the ship and at the Craneway Pavilion just across the channel.

The Home Front festival honors workers who helped build ships in Henry Kaiser’s WWII Richmond shipyards. The shipyard’s medical care program for workers and their families was the genesis of today’s Kaiser Permanente Health Plan.

Old recovered shipyard fire truck part of the fun

Arriving almost simultaneously on the Red Oak dock was a newly recovered shipyard wartime fire truck found by chance in Spanish Fork, Utah. The Richmond Museum of History, savior of the Red Oak from the Mothball Fleet 13 years ago, is also sponsoring the restoration of the long-lost Ford fire truck, which the museum purchased and volunteer Anthony D’Ambrosio of Potenza Transport towed back to Richmond.

1940s era Ford insignia on shipyard fire truck to be restored.

Headlight on the old fire truck

The fire truck still sports the original, yet time-worn, shipyard designation: “Kaiser Co. Inc., Richmond Shipyard No.3, but the interior, engine and other moving parts are in pretty bad shape. Lois Boyle, president of the Richmond Museum Association, estimates the relic can be restored for about $5,000, funds the association hopes to collect from donors.

Marian Sauer, matron of honor, cracked the champagne bottle across the replica bow of the Red Oak Victory.

The community excitement over the Red Oak’s restored grandiosity gave rise to its Veterans’ Day rechristening attended by an audience of about two hundred. Guests climbed the gangplank to the deck and descended the steel ladders to squeeze into the ship’s former cargo hold that today houses a gift shop and museum.

Lois Boyle, president of the museum association and a key figure in the acquisition and renovation of the ship

The crowd made up of veterans, former shipyard workers, museum volunteers, local dignitaries and lovers of history were entertained by color guards, World War II singers and a reenactment of the ship’s blessing.

Marie Sauer, a Rosie and the day’s matron of honor, shattered the ceremonial champagne bottle over a flag-draped replica of the Red Oak bow, exploding the bubbly over herself and revelers standing nearby. Chevron Oil Company, whose wartime role in Richmond parallels the shipyards, hosted a buffet lunch following the ceremony.

Red Oak Victory fans greeted the ship as it returned to its home on the Richmond waterfront. They also had a chance to inspect the recovered 1940s shipyard fire truck.

More chances to visit park

If you missed the recent doings at the Richmond waterfront, you still have a chance to experience the Rosie park and the Red Oak Victory ship in upcoming events. A Vision for Victory ship tour, conducted by museum volunteers, is scheduled for Saturday, Dec. 3. You can also take a bus tour of the far-flung historic park with ranger Betty Soskin on Saturdays, Dec. 3, Dec. 10 and Dec. 17.

Park rangers also conduct Wednesday and Saturday afternoon tours of the newly restored Maritime Child Development Center at Florida Avenue and Harbour Way in Richmond, also part of the Rosie park. An upcoming tour is scheduled for Dec. 17.  You need to make a reservation for the school tour and the bus tour. For more information, call 510-232-5050, ext. 0, or go to www.nps.gov/rori.

For more about the Red Oak Victory go to: http://www.richmondmuseumofhistory.org/.

Photos by Ginny McPartland

Heritage correspondent

Second of two articles

KP Bellflower Hospital built in 1965 in Southern California

In the beginning, Sidney Garfield and Henry Kaiser, promoters of the fledging Kaiser Permanente Health Plan, didn’t have to think: do we build a big hospital, or a small hospital? With only a few thousand members in 1945, they only had to consider “where, and how quick?

The first clinics were primitive and small, often in space adapted from an office building, storefront, old home, or automobile dealership. Atmosphere and aesthetics didn’t figure into the mix.

But that was to change phenomenally over the next few decades. In 1950, KP Northern California membership, with the recent addition of the longshoremen’s union and some government employers, was 120,000. In Southern California, with longshoremen and retail clerks, the number was smaller: 20,000.

By 1990, KP Northern California boasted more than 2 million members; Southern California had about the same. Where hospitals in Los Angeles, Fontana, and Harbor City had sufficed in the 1950s, by 1990 there were seven more: San Diego, Bellflower, Anaheim, Woodland Hills, Riverside, West Los Angeles, and Panorama City.

Downey Medical Center replaced the Bellflower hospital in 2009.

Where Oakland, Richmond, San Francisco, South San Francisco, and Walnut Creek had been enough for the north in the 1950s, by 1990 there were eight more: San Rafael, Hayward, Santa Clara, Redwood City, Santa Teresa, Sacramento, South Sacramento, and Martinez.

Big hospitals draw from satellite clinics

These hospitals, varying in size from 100 beds to over 500, played the role of kingpin to a network of medical office buildings (MOBs) in communities within a reasonable distance. If patients needed emergency care, surgery, or had to be hospitalized for any reason, they were taken to the hub hospital.

Generally, KP has grown by establishing satellite offices in areas where membership numbers can support an MOB. Then when membership grows in an area and overwhelms established MOBs, another clinic is built in a nearby area. When the MOBs start to overwhelm the designated hospital, another hospital is built to take the overflow. This has been the trend.

For example, when membership in the San Jose area outgrew the Santa Clara Medical Center, built in 1964, KP purchased a community hospital and established a second medical center, Santa Teresa in 1976. Similarly, when the Fairfield-Vacaville area membership outgrew Vallejo Medical Center, a Vacaville Medical Center was built in 2009. When Los Angeles Medical Center became stuffed with too many patients, Baldwin Park Medical Center was established nearby in 1995.

Facility planners get a workout

Another view of Downey Medical Center.

By now, membership in both regions has soared to more than 8 million, and that means more hospitals and MOBs. By last count, KP has 35 medical centers (including Ontario to open later this year) and about 430 MOBs in California. All this growth and construction has given KP facilities planners plenty of experience, and caused them to spend a bucketful of money.

So in the late 1980s and early 1990s, planners began to “plan” for a more efficient way of meeting the demand for more medical office and hospital space. Taking best practices and design success stories, they developed a template that could be used to build new buildings with a minimum of effort, lead time, and government review. Gateway was the first template developed in the 1990s and was used in part to design and build the Fresno Medical Center, Roseville Medical Center, and others.

Vacaville Medical Center, built in 2009, serves members formerly part of Vallejo Medical Center area.

Today’s flexible template calls for efficiency, sustainability, and beauty

The current version of the template calls for the combination of hospital and medical offices in one structure with a common entrance. However, the template is flexible and constantly evolving to address specific needs of each KP service area. The template ideas have been garnered from many sources and have been reviewed by a wide array of stakeholders, including labor, medical staff, and other employees. The functionality has been tested in mocked-up clinical situations, and designs have been validated by leading health care designers.

Modesto Medical Center in Modesto, showcase of modern, green hospital design, 2008

Throughout the years, KP architects have retained many of Sidney Garfield’s innovative ideas and incorporated them into updated hospital designs. Garfield’s idea of decentralizing nursing by creating “circles of service” survives to the present day in the triangular towers built in gateway and template model Kaiser Permanente facilities from the late 1980s onward. With the nursing station at the center and patient rooms surrounding, nurses save steps and are closer to their patients, thus they’re able to provide better care.

Garfield and architect Clarence Mayhew pioneered the design in 1962 with the construction of the first “binocular” hospital in Panorama City. It was used again for Santa Clara hospital built in 1964, but this time the circular towers were enclosed in rectangles. Garfield’s early hospital designs also called for the latest available technology. (See previous blog: “What’s the Big Idea?” posted Oct.18.)

The current iteration of the hospital template informs future construction in functionality, as well as sustainability, patient comfort, efficiency for staff, accommodation of the latest technology, effective use of light, and more. In 2008, KP opened the exquisitely designed Modesto Medical Center, a showplace for the newly evolved template and for accompanying green initiatives.

Architects vie for best small hospital design

The latest KP hospital design calls for lots of natural light, as in the Ontario Medical Center lobby.

Meanwhile, this year KP asked architects around the world to design a new prototype for a small hospital, one that challenged the status quo way of thinking about health care delivery.  The Small Hospital, Big Idea competition, with three finalists still in the running, will conclude with the presentation of final designs in late January. If the stars are happily aligned, the new small hospital design may offer a viable alternative for KP to move into new areas with a self-contained, integrated medical facility.

In the competition, KP asked all contenders to think about how to make the hospital an inviting place associated with “health,” rather than “health care,” according to John Kouletsis, vice president of facilities planning. “It should be a ‘wow’ experience,” he said, “where people come out of it and say, ‘this was difficult in terms of the clinical things, but it was such a great experience. The facility was beautiful. It supported me in every way’.”

Snooping for a glimpse at the “Big Idea” design

Submissions from six semi-finalists offer a picture of what the new facility might be like. Many responded to the mandate for stressing wellness by seeing the new hospital as a place for patient health education where members can come to use a fitness center or attend classes in a facility designed to be attractive and welcoming.

In Kaiser Permanente’s new small hospital, telecommunicating expertise will help staff expand their ability to offer a range of acute, diagnostic, and surgical services as well as emergency and, perhaps, maternity care. There are numerous visions of making the facility blend both functionally and physically with the community with the possibility for storefront clinics in nearby neighborhoods or a farmers market, vegetable garden, or community park on the site.

The gadgetry so favored by Garfield in patient rooms will be ever more sophisticated and will also move into the hands of members in the guise of mobile devices that monitor their health, connect them to medical staff, and provide education and advice in the hopes of keeping them away from the hospital.

No doubt the design or designs accepted for the small hospital will incorporate the concepts so important to creating the “total health” experience in all KP’s facilities. Also, Garfield’s ideas of keeping patients healthy through illness prevention and health education will come through in plans for the compact hospital to be a pleasant place where support for healthy lifestyles and learning is paramount.

Heritage correspondent

First of two articles

Inpatient ward at Garfield's Contractors General Hospital at Desert Center, circa 1933

When the winner of Kaiser Permanente’s “Small Hospital, Big Idea” design contest is announced in February, at first glance it may appear the 65-year-old health plan is taking a major turn off the road it followed for decades: building large hospitals as hubs for satellite medical clinics in surrounding communities.

In the competition, architects have been asked to dream up a model for a community health center with many of the features of a larger KP hospital, including surgery, emergency, laboratory, and pharmacy. The small hospital will leverage the newest diagnostic, treatment, and communications tools for outpatient and inpatient basic and acute care — all in one cutting edge hospital.

KP Sunset Hospital in Los Angeles, built in 1953, was one of Dr. Garfield's "dream" hospitals.

The key for planners is to find a set of design concepts that will balance the latest in technology with a humanistic approach in providing efficient, affordable, and high quality care. The “hospital” will create a place to encourage and nurture a healthy lifestyle for KP’s members and the community at large.

Garfield's idea for a "small city" hospital featured plenty of natural light. This is the innovative Walnut Creek hospital built in 1953.

The winning design will be used to wildly modernize and perfect the self-sufficient hospital design pioneered by Garfield on construction sites in the Southern California desert and the Grand Coulee Dam in Washington State in the 1930s and 1940s.

The plans, promising to be ingenious, will be the blueprint for construction of the “best of the best” small KP hospital, likely to be built in the High Desert northeast of Los Angeles. Rather than being a major departure from tradition, the Small Hospital, Big Idea concept will bring the medical plan’s legacy of hospital building full circle.

Ironically, the setting for the early Garfield hospital designs, as well as the imminent creation of the KP futuristic “Big Idea” small hospital, was and is the Southern California Mojave Desert.

Ingenious health care for Garfield’s time

Garfield’s ability to keep 11,000 Los Angeles Aqueduct workers healthy improved greatly as the men came in for routine checkups instead of waiting until they were really sick. His other initial foray into prevention was direct: To reduce head injuries and nail punctures, he went to the job sites and lectured the workers about pounding down nails and then inspected tunnels for dangerous shoring.

Visitors to the early Walnut Creek hospital (1953) could access patient rooms from an outside walkway, leaving the central corridor of the nursing wing free for nurses.

Garfield eventually built three hospitals in the desert, equipping them with air conditioning — the latest technology — and newly invented venetian blinds. He furnished the wards with soothing color schemes, flower containers, and personal radios to elevate patients’ moods.

Garfield’s three hospitals were far flung — the first at Desert Center, another at the east end of the aqueduct at Parker Dam, and the third at the Imperial Dam near Yuma, Arizona. He staffed each with a physician, and he zipped back and forth by car across 100-mile stretches of desert to perform surgery.

Garfield’s next project was to refurbish and outfit a rundown 35-bed facility for Henry Kaiser’s workers on the Grand Coulee Dam project in Mason City, Washington. The union was excited when Garfield promised air conditioning, but Kaiser’s son Edgar, who was running the project, said no. (Garfield installed it anyway, paying for it out of his pocket; a slightly annoyed Kaiser reimbursed him).

That small hospital, with its early team of group practice doctors, went full bore into preventive care for the 15,000 residents (workers and their families) in the company town.

“They saw simple acute appendicitis instead of peritonitis; earaches instead of mastoiditis; upper respiratory infections and less pneumonia; early lumps in the breast instead of metastatic carcinoma,” writes Dr. John Smillie in his history of the Permanente Medical Group. “The Coulee physicians were capable of handling just about any case that came their way, including serious cancer surgeries. Only one patient, a suspected brain tumor, had to be referred to Spokane.”

They also established a satellite community service: Millie Cutting, a nurse and wife of job site physician Cecil Cutting, solicited funds door-to-door — and received generous contributions from the brothel madams — to set up a well baby clinic in a local church.

Bigger challenges on the Home Front

The urgent need for quality health care for Kaiser West Coast Shipyards workers during World War II dictated the facilities Henry Kaiser and Sidney Garfield could establish for their often sick, weak, and injured patients. The Richmond Field Hospital, later serving the community at large, was thrown up in a hurry and opened with 10 beds in August of 1942.

Garfield carefully designed the modern 70-bed Oakland Medical Center, although it was the hurried resurrection of the surviving maternity wing of the Victorian Fabiola hospital, which had been torn down years before. The Oakland hospital, also opening in August of 1942, expanded twice (to 145 beds) before the end of the war and its successor structures remain the hub of East Bay facilities to this day.

The Panorama City Hospital in Southern California, built in 1962, featured two circular towers. Within the towers, the concept of "circles of service" was born. Later KP hospitals retained the basic design but the "binocular" towers were enclosed in rectangles.

With World War II behind him and the Kaiser Permanente medical plan beginning to grow, Sidney Garfield was able to experiment with various ways of using architecture and design to improve both the efficiency of staff and services and patient comfort as well. In the early 1950s, Garfield, whose boyhood dream was to become an architect, designed his first two large “dream” hospitals in San Francisco and Los Angeles and his last two “small city” hospitals in Walnut Creek and Fontana.

Innovative, efficient mid-century designs

He designed them all around principles he held dear: efficiency, economy, and patient comfort. Renowned architect Clarence Mayhew designed Walnut Creek and Fontana to echo the mid-century desire to have the indoors and the outdoors meld. Each was Y-shaped with two wings of rooms that opened to the natural environment to both soothe the patient and give visitors access while nurses, doctors, and orderlies circulated freely down an interior corridor.

Despite being small, they incorporated the features of the larger hospitals. The central work area was abolished in favor of stations distributed along the corridor so each nurse would be a few steps from her patients with records and supplies shelved nearby.

Santa Clara Medical Center, built in 1964, featured the decentralized interior corridor dictated by the circular design debuted in Panorama City.

And the mostly private patient rooms were equipped with all manner of modern convenience with power-drawn curtains and bed adjustments operated by push buttons, a built-in lavatory, toilet, closets, oxygen outlet, plus phonograph outlet and radio.

Garfield received national attention for his rooming-in maternity section where babies were kept close to their mothers, but also within reach of the nurses through a bassinet that slid between the room and nursery.

Architectural Forum magazine in July 1954 lauded all the new technology and design innovations in Walnut Creek: “For all its luxuries, care at Walnut Creek actually costs less than at older hospitals. The gadgets speed recuperation and encourage patients to care for their own minor needs.” Thus, the nurses’ time spent as errand girls would be reduced. He was a great believer in the power of human contact in the healing process.

Garfield said in the KP Reporter in 1963, “Over the years, we have been working for development of functional design in hospitals in which our staffs can serve patients with a minimum of wasted time and energy. They will then have more time to be with patients, and this human contact makes for happier patients, more stimulus to recovery.”

View a 1953 video about the Kaiser Permanente “dream” hospitals.DreamHospital

Next time: Kaiser Permanente member growth spurs new thinking on how to create the ultimate patient experience.

Heritage writer

Dorothea Lange photo on the cover of "Wax"

At first glance, one would think the newly released novel “Wax” is about women working in the West Coast shipyards during World War II. Famed photographer Dorothea Lange’s powerful photo of proud, bold “girls” stomping through the yard implies a story about their struggles and triumphs in that setting.

Once inside, however, the reader pretty quickly understands that the stories to be told play out far from the shipyards. Three young women who met in Henry J. Kaiser’s Richmond Shipyards in 1943 formed friendships that endured for decades. The “Rosies” earned a bit of freedom and independence that they would refuse to relinquish when they returned home.

First-time novelist Therese Ambrosi Smith says she wrote the book about “Rosie the Riveter” to spark an interest among today’s young people, especially girls. Rosie national park Ranger Elizabeth Tucker turned Smith on to actual Rosie oral histories, and the would-be author was off on her quest.

World War II’s sociological impacts explored

Smith proclaims the novel’s premise on the front cover: “Pearl Harbor Changed Everything.” Historians know this fact, and they have written millions of words about the social, economic and political effects of World War II.

Author Therese Ambrosi Smith

Smith’s approach is to place a spotlight on personal lives. She creates three main characters, Tilly Bettencourt from a small town near Half Moon Bay, California; Doris Jura from Pittsburg, PA, both in their early 20s; and slightly older Sylvia Manning, 32, from Kansas City. She shows a smattering of their shipyard employment experiences and then places them back in their peacetime lives. These war-time experiences will color all they do from then on.

Author Smith takes the theme of women’s independence full bore as the young women return home and establish a candle factory on their own. (Yes, that’s where the book title comes from!) Such a bold move had seemed impossible before the war. Despite obstacles, Doris and Tilly’s dream comes to fruition.

Life lessons learned in the shipyards

Other life lessons are to be learned as well. At the shipyards, the girls awaken to the idea that blacks should be treated equally with whites. Smith writes of Tilly’s encounter with a caring black coworker who helps her to the clinic when she receives a serious eye injury and is temporarily blind.

Later, Tilly ponders the experience: “I don’t know why,” she (Tilly) told Doris, “but this whole thing has rattled me. I mean being helped by a colored.” Smith as narrator explains: “There weren’t any coloreds in Montara or Moss Beach; she had no history with them.”

Tilly then comes to the realization: “The work was dangerous and difficult, and everyone who did it, regardless of color or background, was helping to win the war. They were all in it together.”

Doris chimes in with: “I feel like we are seeing the world up close here. It looks different.”

Although this book is fairly light on the historical significance of the Rosie experience, I enjoyed it. The characters are creditable and the description of the settings took me there. At times, I felt like I was sitting in Tilly’s uncle’s comfortable café perched on the coast near Half Moon Bay.

The Red Oak Victory has been renovated and will be open for the Home Front Festival Oct. 15

More about Rosies at the Home Front Festival Saturday October 15

Learn more about the Rosie experience from 11 a.m. to 6 p.m. this Saturday at the Fifth Annual Home Front Festival in the Craneway Pavilion at the southern end of Harbour Way in Richmond, California. Admission is free.

Area historical societies, the Rosie national park and the Pacific Region of the National Archives will have exhibits and information to share with visitors. Kaiser Permanente Heritage Resources will have displays highlighting the pioneering medical staff who launched the Permanente Medical Care Program in the Kaiser Shipyards during the war.

The Red Oak Victory, a World War II ship built at the Richmond Kaiser Shipyards, will be open on Saturday for visitors to tour. The ship, owned by the Richmond Museum of History, is just returning to the shipyard Friday from dry dock where it has received an extensive renovation.

Lena Horne helped launch the SS George Washington Carver in Richmond, May 1943

Historian Steve Gilford will debut his new book on Saturday aboard the ship. Gilford will be signing the book, “Build ‘Em by the Mile, Cut ‘Em off by the Yard, How Henry Kaiser and the Rosies helped Win World War II,” from 2 to 4 p.m. on the ship. Shuttles will ferry visitors between the Craneway and the Red Oak.

Lena Horne tribute at USO Dance Friday, Oct. 14

The Home Front party actually starts on Friday night with the Rosie the Riveter 1940s USO Dance, featuring a tribute to Lena Horne, also in the Craneway Pavilion. Robin Gregory will play the role of the legendary singer. Also on the bill are the Singing Blue Stars, Junius Courtney’s Big Band and the dance group Swing or Nothing!

Tickets for the dance may be purchased online at www.HFF2011.com or by calling the Richmond Chamber of Commerce at 510-234-3512. Advance tickets are $20 general and $15 for seniors; tickets may be purchased at the door for $25 general, $20 senior. Anyone showing a military i.d. or wearing an armed forces uniform will be admitted for free.

Event: Home Front festival

Description: Historical exhibits and 1940s-era entertainment

When: Saturday, 11 a.m. to 6 p.m., Oct. 15, 2011

Where: Craneway Pavilion (end of South Harbour Way [1414] in Richmond, California)

Admission: Free

Information: www.HomeFrontFestival.com

Heritage writer

Rosie park curator Veronica Rodriguez explains the set up of the child care center's dining area.

The Bay Area community of Richmond – birthplace of Permanente medicine – has been bustling this year with activities related to the commemoration of the California city’s role as a World War II shipbuilding hub. The economically depressed and high-crime community is pulling together to create positive change in its image and livability. Recent achievements give its diverse population reason to be proud and to celebrate.

Two major developments – renovation and reopening of the stellar Maritime Child Development Center and significant progress on the conversion of a shipyard oil house into a visitor’s center for the Rosie national park – can be called milestones in the city’s quest for its place in the sun.

The renovated Maritime Child Development Center rear view. Note portholes. The bottom was the end of the fire escape chute for kids in the early days.

These successes are putting smiles on the faces of Richmond’s movers and shakers who have worked for years to bring them to fruition.

The $9 million renovation of the child care center, built in 1943 by Henry Kaiser with federal funds, was a collaboration of many community groups – The Richmond Community Foundation’s Nystrom United Revitalization Effort (NURVE), the city of Richmond, the Rosie the Riveter Trust, Rosie the Riveter/World War II Home Front National Historical Park, Richmond College Prep Schools and West Contra Costa Unified School District. (For more on the preschool program, see “Sounds of children return to Richmond historic child care center”  posted here on August 25.)

Local champions play major role

Colorful play equipment is part of the center's new look.

Richmond City Councilman and local architect Tom Butt has been a constant cheerleader for the project for the past six years. Rosie Trust leaders Jane Bartke and Diane Hedler, Kaiser Permanente’s representative on the trust, among others, have been relentless in efforts to secure federal financing for restoration of the national historic landmark. The trust hired its first executive director, Marsha Mather-Thrift, this year to help with its continuing fundraising work to support the park.

The restored center’s future will be celebrated with a grand reopening 10 a.m. Thursday, September 29, at 1014 Florida Avenue (on the corner of Harbour Way). Host Joan Davis, president and chief executive officer of the Richmond Community Foundation whose office is in the center, has invited the public to come to see the jewel of a school inside and out.

The renovation features the reuse of many of the original materials, including the transforming of bunk bed wood into office partitions. The inside also features: the original redwood on the stairways, double banisters – one at a child’s level and one at an adult’s level – as well as the preservation of a fire escape chute intended for the children in the event of a fire. (It was never used and has been closed up at the outdoor end.)

Note double bannisters, one for children, one for adults.

The Maritime center is considered a part of the multi-site Rosie the Riveter national park, and park service curators have created a time warp for visitors to get a glimpse of how the original preschool classrooms looked. The center was the site of an exemplary child care program for the children of Kaiser Richmond Shipyard workers and was considered way ahead of its time.

National park visitor’s center on the horizon

The Rosie park visitor’s center – in discussion stages for several years – is under construction and scheduled to open to the public early next year. With interpretive exhibits, a theater, offices, and a place to meet for tours, the long-awaited center will provide a focus for the far-flung national park.

Established in 2000, the park consists of the Rosie the Riveter Memorial on the Richmond waterfront, the Red Oak Victory ship docked at the former Shipyard 3 off Canal Boulevard, an office in downtown Richmond, the Atchison Village housing tract and community center, the Ford Assembly Plant, known today as the Craneway, and now the Maritime Child Development Center.

Child-sized sinks shined up for the new kids.

The oil house/visitor’s center is adjacent to the beautifully restored Craneway Pavilion, originally the Ford plant designed by the great industrial architect Albert Kahn in 1930.  The cavernous structure that once housed a World War II tank factory today hosts weddings, wine-tastings, conferences and festivals. Its owner, local developer Eddie Orton, has won a number of architectural awards for the integrity and impeccability of the restoration.

More good vibes out of Richmond

A number of other developments in the city of Richmond have to be considered positive harbingers for its future:

View from inside the indoor fire chute.

The Richmond Museum of History, in the old Carnegie Library on Sixth and Nevin, has a new director, Inna Soiguine, who was formerly with the centuries old Russian State Hermitage museum in St. Petersburg. Ms. Soiguine has brought wonderful exhibits to the museum, including the current Richmond Day at the Panama Pacific International Exposition of 1915 exhibit and a show of Dorothea Lange World War II Richmond photos opening on October 8. http://www.richmondmuseumofhistory.org/calendar.htm

Revitalization efforts continue

Even though this project was completed in 2009, it bears mentioning for those who haven’t been to Richmond in a while or at all. The bold brick structures known as the Richmond Civic Center have been revitalized and brought up to seismic standards. The remarkable part is that the renovated center, originally imagined by local architect Timothy Pflueger who also designed Oakland’s Paramount Theatre, looks exactly the same as it did in 1949.

Richmond Civic Center off Macdonald Avenue. Designed by Paramount Theatre architect Timothy Pflueger in 1946, the center was updated in 2009.

The Main Street Initiative, a dynamic Richmond group working to revitalize historic Macdonald Avenue, is always promoting the downtown area and bringing cheerful and uplifting events like the recent Spirit and Soul Festival to the people of the city. The group encourages downtown business development and sponsors workshops for entrepreneurs. http://www.richmondmainstreet.org/

The Macdonald Avenue “Main Street” commercial area has also benefited from the city of Richmond Community Redevelopment Agency’s 2009 streetscape renovation project, including new sidewalks, curbs, light stands, and the placement of “Macdonald Avenue Landmarks” monuments commemorating historic sites on five downtown street corners. The city and other agencies have also helped downtown residents with funding to renovate the Nevin Community Center, which reopened to fanfare in March.

On Saturday, Oct. 15, the public is invited to join in a celebration of Richmond’s rich past from 11 a.m. to 6 p.m. in the Craneway Pavilion at the south end of Harbour Way.  The Fifth Annual Richmond Home Front Festival will feature exhibits sponsored by the National Park Service along with many other historical groups, such as Kaiser Permanente Heritage Resources and the National Archives, Pacific Region staff.  Festivalgoers will also be treated to a wide variety of music, food and fun activities. Admission is free.  http://rcoc.com/current-events/home-front-festival/

Photos by Ginny McPartland