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.

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 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

Heritage associate

Medical historian Matthew Smith's book discusses Feingold Diet controversy of the 1970s.

In the mid-1970s, a book by Kaiser Permanente’s leading allergist Dr. Ben Feingold (1899-1982) ascended “The New York Times” Best Sellers list.

Feingold was featured prominently in the press, from “The Washington Post” to “Newsweek” to the “Phil Donahue Show,” claiming  to have discovered a link between food additives—such as artificial coloring—and hyperactivity, now commonly known as Attention Deficit Hyperactivity Disorder (ADHD). He published his findings in the popular book, “Why Your Child Is Hyperactive,” (Random House, 1974), which was soon followed by another bestseller he co-authored with his wife, Helene, “The Feingold Cookbook for Hyperactive Children” (Random House, 1979).

He called his new diet the Kaiser Permanente (K-P) Diet. (The abbreviation was also short for “Kitchen Police.”) It became widely known as “The Feingold Diet.”

An alternative history of hyperactivity

Matthew Smith, Lecturer and Wellcome Trust Research Fellow at the University of Strathclyde (Glasgow, Scotland), recently published “An Alternative History of Hyperactivity: Food Additives and the Feingold Diet” (Rutgers University Press, 2011). The book chronicles the development of the Feingold Diet, the sensation it caused, and its ramifications for medical research and the history of medicine.

Allergist Ben Feingold, MD, with young patient and mother at Kaiser Permanente in San Francisco.

Smith writes that hyperactivity was a new and urgent worry of Cold-War America. As the country became increasingly interested in scientific and mathematical advancement, Americans became anxious about their children having the discipline and focus to do well in those subjects.  Before 1957, the year the Soviet Union launched Sputnik, there were few journal articles pertaining to hyperactivity, Smith writes, and those that were published differ from more recent descriptions of hyperactivity. After 1957, “hundreds of researchers began studying the disorder.”

Smith said in a phone conversation that by the late 1960s, after a decade or so of intense debate, there was more or less a consensus that hyperactivity was caused by a “genetic glitch.”

A few years later, Feingold presented an alternative cause. Through his medical practice, Feingold discovered that when children’s diets were stripped of food additives, symptoms of hyperactivity disappeared in some patients.

Feingold’s breakthrough occurred during the height of the first organic food movement in the United States, Smith pointed out. A lot of parents were also dissatisfied, he added, with the idea that “the solution was a bottle of Ritalin,” a drug used to treat hyperactivity beginning in the 1960s.

When Feingold published his book in 1974, he tapped into a lot of that dissatisfaction, Smith said. The press ran with the story.

Feingold and Kaiser Permanente

Kaiser Permanente was “quietly supportive” of Feingold’s research, Smith said.

Feingold joined the organization in 1951 as the chief of the department of allergy. He had earned his MD from the University of Pittsburgh in 1924. In the late-1920s, he worked at the Children’s Clinic at the University of Austria inVienna with Clement von Pirquet, who coined the word “allergy” in 1906.

Feingold with Permanente founding physician Sidney Garfield

Feingold believed that “Kaiser Permanente’s system of private medical insurance was ‘a new trend in medicine,’” Smith writes.  Over the next quarter of a century with Kaiser Permanente, Feingold set up numerous allergy clinics and became a “highly respected researcher” and “dedicated clinician.” He was perhaps previously most renowned for his work on flea bite allergies. With a grant from the National Institutes of Health, Feingold established the Laboratory of Medical Entomology in San Francisco, where he brought in “millions of fleas.”

In 1976, for Feingold’s 25^th Anniversary with Kaiser Permanente, Cecil Cutting, MD, executive director of The Permanente Medical Group, said: “Dr. Feingold has repeatedly brought national acclaim and recognition to our program with his expertise in allergy, his development of poison oak desensitization, flea antigen work, basic research in immune mechanisms, and presently in the effects of food additives.”

Controversy over Feingold’s findings

The rest of the medical community, for the most part, did not support the diet. Some treated Feingold’s latest work as “nothing more than quackery,” Smith writes.

There were numerous studies to test the effectiveness of the diet in the years following Feingold’s publication. Many of those pointed toward evidence that the Feingold Diet was ineffective, Smith said

There were problems with a lot of the studies, though, he added. Some of those studies were funded by the Nutrition Foundation, a lobbying organization for the food industry.

Smith said that when some of the studies showed that the diet was effective in some of the population, the findings were deemed inconclusive. He said that those studies “rejected the positive findings.”

Smith also added that Ritalin has only been effective in 80 percent of the population. Without making a definitive claim, he hypothesized that the Feingold Diet may be effective in some of the other cases.

The thesis of Smith’s book is that there could be a lesson for medical research from the case of the Feingold Diet. He talked with many parents who used the diet and found it effective. “Trials are always going to be an artificial situation,” he said. In the real world, things may play out differently. In short, “Talk to the people who use it.”

Regardless of the circumstances, the Feingold Diet lost its wide appeal by the mid-1980s.

A new day for the Feingold Diet?

The diet did not disappear altogether, though. The Feingold Association of the United States, for example, kept promoting the diet. Some of the diet’s supporters even took it further than Feingold would have, Smith said

The Feingold Diet appeared in the press again this year. In March, the Food and Drug Administration (FDA) opened hearings into a possible connection between artificial food coloring and hyperactivity, in which the FDA panel was to decide whether to ban artificial coloring in food.  The FDA specifically cited Feingold’s research in calling for the new hearings.

The FDA panel decided not to ban artificial colorings. They said there is not a definitive link between food additives and hyperactivity, but there is enough evidence to call for more research. They also suggested that artificial food coloring may negatively affect those children already prone to hyperactivity.

Smith said that there has been other positive research done on the link between hyperactivity and food additives, some of which does not mention Feingold, perhaps because of the controversy surrounding his diet.

“It’s still a possibility that the Feingold Diet may have its day,” Smith said. “Who knows?”

Edward Derbes is a 2010 graduate of the University of California, Berkeley (UCB), earning a bachelor’s degree in Rhetoric with High Distinction (Magna Cum Laude).  He co-founded and was senior editor of Divergence Magazine of Cypress, California, and formerly served on the editorial staff of the College of Environmental Design e-News at UCB.  Derbes grew up in New Orleans, Louisiana.

Second of two parts 

1978 American Journal of Nursing article authored by KP San Francisco’s then Maternity Coordinator Deloras Jones, RN, BSN.

In the 1970s, Kaiser Permanente responded to the rising influence of feminism and a popular trend calling for home births, drug-free deliveries and family participation by establishing the Family-Centered Perinatal Care Program (FAMCAP) at the San Francisco Medical Center. 

With patients demanding a more natural birthing experience, the Kaiser Permanente family-centered birth program zeroed in on one particular aspect of the trend: Shortening the mother and infant’s postpartum stay in the hospital. KP San Francisco’s then Maternity Coordinator Deloras Jones, RN, BSN, began recruiting participants in 1973 and found many expectant parents were enthusiastic. 

“The parents wanted increased father involvement, less family separation after birth, and treatment of mother and infant as though they were well, not ill,” Jones wrote in “Home After Delivery,” a 1978 article in the “American Journal of Nursing,” after 1,200 families had used the program successfully. 

In the decades after World War II, the length of stay standard for childbirth had risen to as many as 10 days, keeping mothers away from their families and in the sterile environs of the acute care hospital. A picture in a KP newsletter from the late 1940s shows a new mother preparing to leave the hospital after 10 days of rest and recovery. 

Patient education key in shortening hospital stay

As an essential part of the 1970s shortened-stay program, KP began to offer prenatal classes and encouraged the father’s participation in childbirth preparation as well as in labor and delivery. The hospital experience included rooming-in for mother and infant after 24 hours of observation in the nursery, breast feeding training, and infant care classes. 

With an eye to shortening stay, the program focused on protocols for assessing mother and baby’s health and ability to go home within 12 to 24 hours. A nurse was assigned to visit the family at home for three days and to be available for questions and assistance for up to two weeks. 

In 1976, Jones and colleagues Mark J. Yanover, MD, and Michael D. Miller MD, published a report of their study of the experience in the San Francisco family-centered program. They compared a group of 44 low-risk mothers who delivered their babies along the typical routine with 44 others who elected the early discharge program. The researchers concluded that “this method of perinatal care is as safe as that traditionally provided at our medical center.” 

FAMCAP had a major influence over early discharge standards developed for both the American College of Gynecology (ACOG) and the American Association of Pediatricians (AAP) and marked an acceleration of a trend toward shorter hospital stays for postpartum mothers. 

Kaiser Permanente provides tools to help smooth a new mother's transition to home. Photo originally published in the Permanente Journal, Fall 2005.

The shorter stay phenomenon in the 1970s was wholly embraced by cost-conscious health maintenance organizations, often without the follow-up care that was the hallmark of the Kaiser Permanente approach – and became the source of intense national debate in the 1990s. 

Shortened stays too short?

According to figures that came out in Congressional hearings, the median length of stay for postpartum women across the U.S. had dropped almost 50 percent between 1970 and 1992 – from four days to less than two days for a vaginal delivery. “Within the last three years, stays have declined from 48 hours to 24 hours. Some (women) were even required to leave the hospital in as little as eight hours after delivery,” according to Debra Kuper writing in the “Marquette Law Review” in 1997. 

There were increasing reports of kernicterus, a rare and preventable complication of jaundice, and mental retardation due to failure of postpartum mothers to return for Phenylketonuria testing, amongst other tales of women being kicked out of hospitals before adequate assessment of their or their infants’ readiness to go it alone. 

In response, Congress enacted the Newborns’ and Mothers’ Health Protection Act of 1996 to mandate 48-hour stays for vaginal births and 96-hour stays for cesarean births unless mother and physician agree to a shorter stay. Both the national OB-GYN and pediatricians associations revised their standards to reflect the new mandates. 

Nonetheless, shorter hospital stays with more choice and control over the childbirth experience have become the norm for parents across the country. Expectant Kaiser mothers and fathers are now given a birth plan to fill out that allows them to select the delivery room environment, methods of inducing labor and controlling pain, delivery position and various postpartum procedures. 

Recent national trends show the cesarean section rate for first-time low risk mothers climbing – California rates increased from 20 to 26.5 percent from 2000 to 2005. Statistics also show a retreat from the 1980s surge in women wanting vaginal deliveries after cesareans (VBAC) with California rates for repeat cesareans up from 84.4 to 94.3 percent from 2000 to 2005. 

Kaiser Permanente continues to support women who want to deliver vaginally after they’ve had a C-section, and offers programs and procedures that encourage strong mother-baby bonding practices, including breastfeeding. Today, about 75 percent of American new mothers nurse their newborns. 

Honors for KP “baby-friendly” hospitals

Kaiser Permanente Southern and Northern California regions were honored in 2008 by the California Breastfeeding Coalition for leadership in supporting nursing mothers while medical centers in Clackamas, Oregon; Honolulu; and Hayward and Riverside, California, were all been named “baby-friendly hospitals” by the Baby-Friendly Initiative of the World Health Organization. 

Keeping birth “normal” is still a worthy goal for the organization, Fontana midwife and nurse specialist Iona Brunt wrote in 2005 in “The Permanente Journal.” 

“We must empower mothers with the belief that their bodies are made to give birth and, in most circumstances, will do well. We must dissipate the idea that without our high-technology intervention, babies cannot be born healthy and safe.” 

“It makes sense,” she said. “It’s cost-effective and it’s the right thing to do.”

Heritage correspondent

First of two articles

Nurse tends newborns in the Oakland Permanente hospital during World War II

Seventy-five years ago, two-thirds of American women gave birth at home with no painkillers, often attended by a family doctor, as the tradition of relying on midwives and practical nurses was falling away.

The practice of modern obstetrics was on the rise and the trend toward the majority of births occurring in hospitals was just around the corner as the American Medical Association met in Kansas City in May 1936 and hotly debated the benefits of new childbirth analgesics and how far to go in relieving the pain of childbirth.

According to Time Magazine, Dr. Gertrude Nielsen of Norman, Okla., denounced such pain killing innovations as twilight sleep – a combination of morphine and scopolamine – and a synergistic anesthesia accomplished by injecting a mixture of morphine and Epsom salts into the muscles and introducing a mix of quinine, alcohol and ether in olive oil into the rectum.

“An analgesic that is perfectly safe for both mother and child has not been discovered,” she told the convention. She asserted that fear of childbirth contributed to pain and called for prenatal education to reduce fear: “That is the modern physician’s duty.”

Part of the tumult over the issue had been provoked by articles in the press describing these new drugs and their use. Dr. Buford Garvin of Kansas City observed: “American obstetrics seems to be becoming a competitive practice to please American women in accordance with what they read in lay magazines.”

Childbirth trends change dramatically in the 1960s and 1970s

We could fast-forward to the 1950s when hospital childbirths had become the norm, the pain of the experience was reduced by epidural anesthesia and women relinquished control over the process to the physician. When Dr. Sidney Sharzer joined Permanente in Southern California in 1956, he became an early proponent of change.

During prenatal consultations Sharzer encouraged women to consider breastfeeding, advice which ran counter to the then-popular American pediatric practice of giving “modern” formula.   At the University of Toronto, where he received his degree, breastfeeding was still considered preferable: “It provided early immunity and was just the right formula in that there were no problems with digestion and it was the right temperature,” he said.

Formula was seen as a convenience, especially for many women who remained in the workforce after World War II, and it allowed fathers to take part in infant care. It was also heavily promoted by the cereal companies who manufactured it. Most of Sharzer’s patients were bombarded “with a lot of propaganda, or advertising, as we call it,” he said, and resisted his advice. “If you bottle-fed, you were liberated. And, in those days, you were not going to whip out your breast at a shopping center.”

“Liberated” women demand natural childbirth

Mother and baby "rooming in" in Kaiser Permanente's Walnut Creek hospital 1953

Ironically, it was the “liberated” women of a later era who demanded a more natural approach to childbirth and support for breastfeeding. Those whispers from the 1930s questioning drug use were getting louder.

“The mid-1960s and early 1970s saw a wholesale consumer revolt against highly structured, hospital-centered prenatal care,” Sharon Levine, MD, Northern California Permanente Medical Group executive, testified before a U.S. Senate committee in 1995. “Rooming in became commonplace. Home deliveries returned. Nurse midwives, who had all but disappeared from the American health system, became increasingly commonplace.

“Maternal-infant bonding became recognized as an essential part of postnatal care. Breastfeeding of infants made a dramatic resurgence,” she said in her testimony against a law to dictate length of hospital stay for new mothers.

Some innovation had already occurred at Kaiser Permanente. In the mid-1950s at Permanente founding physician  Sidney Garfield’s behest, the “rooming-in” program began at new facilities in San Francisco, Walnut Creek and Los Angeles. In these early “dream hospitals,” the nursery had been built adjacent to the maternity rooms with slide-through drawers for the babies to be passed in from the nursery through a soundproof wall.

The baby-in-the-drawer configuration allowed a mother to pull the baby into her room to nurse and hold her child as long as she desired. “It keeps mother and baby closer together. Nurses are able to help the new mothers learn better how to care for their infants,” said a Kaiser Permanente newsletter of the era. Most hospitals of the time kept newborns separate from their mothers, under the care of the nursing staff, except for feeding times. 

Bringing dad into delivery room

Around 1961, when he took over as chief of service at Harbor City Hospital, Sharzer made a couple of bold moves. He decided to bring fathers directly into the birthing room, and he began to encourage women to use the “prepared childbirth” techniques. He was inspired by British doctor Grantly Dick-Read’s book, “Childbirth without Fear,” which advocated the use of breathing techniques to minimize pain and increase the joy of the experience.

Lamaze breathing techniques were introduced in the U.S. by Marjorie Karmel after she gave birth in France assisted by Dr. Fernand Lamaze, who developed his techniques based on Dick-Read’s. She started an organization in 1960 – now Lamaze International – that currently focuses less on birthing methods and more on achieving a natural childbirth without drugs or technological intervention.

Sharzer remembers his struggle to get these ideas accepted: “The consumers were pushing for it and it was the right thing…husbands should see what their wives are going through.” At the time, fathers were ushered into a waiting room or went home to await a phone call and while some were thrilled to be invited to watch the process, others were less so. The nurses would good-naturedly chide a reluctant father. “They’d say he was a lousy husband to desert his wife at a time like this. They would appeal to his better nature and then insult him,” Sharzer said.

Outside of Harbor City, it was an uphill fight. When Sharzer first suggested the notion to his colleagues at the five other Permanente Southern California facilities, he was voted down 5 to 1. There was a lot of hostility from both doctors and nurses who assumed the fathers would try to get in the way by second guessing the medical staff, he said. But even their resistance couldn’t stop the forces of history. Fathers were finally allowed in delivery rooms at all Southern California facilities by the end of the 1960s.

Sharzer moved on to West Los Angeles in the 1970s and became assistant medical director: “It gave me the opportunity to be innovative.” There, he was able to inspire younger and more progressive doctors to go along with the trend toward treating childbirth as a natural process.

Natural birth after C-section?

Sharzer questioned the long-held “once a cesarean, always a cesarean” policy after he observed countless women scheduled for cesarean arrive at the hospital late in labor and give safe births. “If it’s that dangerous, how come these women come in and two minutes after they hit the bed, the baby comes out naturally?” he said.

Doctors feared that the vertical incision made through the large uterine muscle would rupture during contractions and for years women who had had a cesarean were discouraged from having subsequent vaginal births. But an innovation – the transverse incision made across the lower belly – was introduced that reduced the likelihood of rupture and more doctors began to experiment with allowing women to try vaginal births, under close monitoring.

A five-year study of vaginal births after cesarean deliveries in multiple hospitals showed that reverting to a natural birth process could be successful for many women. “Kaiser Permanente conducted the definitive study concluding that vaginal birth after a prior cesarean section is possible and safe … vaginal births are generally safer and less expensive for the mother and infant,” Permanente’s Dr. Levine told senators.*

Sharzer recalls:  “A doctor had to be present all the time and there was a lot of resistance” among the general obstetrical crowd, but at Kaiser Permanente, vaginal birth after cesarean, known as VBAC, was easier to implement because a doctor was always on duty in the maternity ward. “In our setup, it was very good and we were one of the early ones to do VBAC.”

Nurse practitioners deliver prenatal care

In those years, Sharzer also helped establish the first program in Southern California for training nurse practitioners at Cal State Los Angeles and when they graduated, he hired them to work under supervision assisting the doctors with prenatal care.

Retired since 1993, after delivering some 7,000 babies at Harbor City and West Los Angeles, Sharzer attributes the tremendous change in maternity care since 1960 to the Civil Rights Act of 1964: “It also changed the philosophy of equality…and that applied to women in our society.  It had a lot to do with female power.” 

That piece of legislation guaranteed equal rights to women as well as African-Americans. But women, especially those active in the civil rights and anti-war movements, found themselves relegated to supportive roles to male leadership and many split off and created the feminist movement, founding the National Organization for Women, among others. Health care and childbirth became a major arena in women’s struggle for equality and power over their lives.

Next time: How Kaiser Permanente responded to member demands for shorter postpartum hospital stays.

*Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990: 76(5 pt 1):750-4.

Heritage writer

Last in a series

Kaiser Permanente's first nurse, Betty Runyen, at Desert Center in 1933.

The history of nursing at Kaiser Permanente actually begins in 1933 with Betty Runyen, Dr. Sidney Garfield’s sole nurse at the Desert Center Hospital near the construction site of the Los Angeles Aqueduct. Runyen, a young nursing graduate from Los Angeles, was just starting out and looking for adventure.

She was well aware of the early 20^th century restrictions on her career options. Her mother had told her she could be a secretary, a teacher or a nurse. Nursing sounded the most intriguing. She became bored with her first job helping to birth babies, and sprung at the opportunity to help launch this pioneering hospital in the desert.

In 1933 nurses were not expected, or even allowed, to perform such a task as starting an IV (tube to introduce liquid intravenously). But Garfield, co-founder of Kaiser Permanente with Henry J. Kaiser, was forward thinking. He had taught Runyen how to start an IV, and the skill came in handy one day when she received an emergency call that one of the workers had succumbed to heat exhaustion. Dr. Garfield was not around, so she drove the ambulance to the job site and immediately inserted a saline IV. The patient quickly recovered.

Looking back from 2011, it seems absurd that nurses – usually women – weren’t entrusted with a task that is now considered routine. But this fact is indicative of how far nurses have come in 75 years in America and at Kaiser Permanente. A review of Kaiser Permanente’s history reflects the major strides the nursing community has made, bringing them to a place and time where their skills are as varied and as specialized and expert as physicians.

KP history reflects national trends

Nursing history is also punctuated with challenges related to the nurse’s evolving role on the medical care team and with major changes in technology, including medical equipment and use of computers to record medical notes.

In the 1960s, 1970s, and 1980s care of patients shifted away from the hospital to outpatient settings. Advances in technology made it possible for surgery patients to spend less time in the hospital, and Medicare reimbursement policy revised in 1983 dictated shorter hospital stays. Despite a growing and aging population, the length of stay national average trended down from 8.5 days in 1968 to 6.4 in 1990 to 4.8 in 2005, according to the Centers for Disease Control (CDC).

Wartime Oakland nurses confer with pioneer KP physician Cecil Cutting.

These changes spawned the same day surgery program that allowed patients to have a procedure without staying overnight. The KP home care program was beefed up to provide surgery and hospitalization follow-up. Outpatient chronic condition management – for the benefit of the patient and the health plan – became ever more important to minimize the time patients had to spend in the hospital. Changes in maternity care also led to shorter hospital stays and an emphasis on family-centered perinatal practices.

New nursing specialties emerge

New categories of nursing have popped up throughout the decades. In the 1970s, the nurse practitioner role was developed to perform many of the tasks formerly done by the physicians. For example, the KP multiphasic or annual physical, initiated in the 1950s for the longshoremen’s union and expanded to the general membership, began to be administered by nurse practitioners working under supervision of physicians. Nurse practitioners were also tapped for well baby care and routine pediatrics visits as medical roles morphed during a critical shortage of medical manpower in America.

With KP’s emphasis on preventive care, its nurses have been called on to create outpatient education programs to help members manage their own health in partnership with their medical care team. Nurses have become specialized in outpatient management of chronic conditions such as heart disease and diabetes, and in providing home and hospice care. Specialized nursing roles have multiplied exponentially over the decades with today’s nurses trained in every aspect of medicine: surgery, intensive care, cardiac care, obstetrics, geriatrics, orthopedics, and the list goes on.

First in a series

Nurses pose on the lawn of the Permanente Oakland hospital during World War II

Like other underappreciated groups who came home to a seemingly unchanged society, nurses were discouraged and hesitated to pursue their chosen profession due to low pay, low status and poor working conditions. Many nurses chose to be waitresses or factory workers where they could make more money and work more reasonable hours. The exodus from the nursing profession created a shortage of qualified nurses, which would intensify in later years.  

Home-front nurses had been content to work without making demands during the war emergency. But after the war, they wanted more. Alameda County nurses had affiliated with the California State Nurses Association (now California Nurses Association or CNA) in 1941 and relied on the association to represent them to East Bay hospitals administrations. But in 1945 these nurses realized that the statewide association had not been effective in bringing them better pay and working conditions.  

The association had developed employment guidelines for the benefit of nurses, but the association had no power to force hospitals to follow the voluntary rules. The East Bay Hospital Conference, made up of administrators from 12 hospitals, adopted a “Statement of Policy” regarding nursing issues in 1941, and dropped it after the war emergency was over.  

Alameda County nurses form their own guild 

Major Edith Aynes, a recruiter from the Army Nursing Corps, gave force to the East Bay nurses’ argument that their profession deserved a better status. Quoted in the San Francisco Chronicle in 1946, Aynes spoke about the military model of the registered nurse as someone who performed patient care, while other untrained staff performed peripheral menial tasks.  

“Instead of taking temperatures, serving (food) trays, making beds and carrying bath water, the nurse is free to change dressings, give medications, care for sick patients and in general supervise the entire ward,” Aynes said.  

Article published in the San Francisco Chronicle in 1946

Alameda County nurses took Aynes’ message to heart and decided to form their own nurses union in November of 1945. “The objective of the guild will be to establish standards relating to salaries, personnel practice and conditions of employment and to maintain an economic security program for registered nurses, members of the guild,” Kathleen Koepke, president of the guild, told the Oakland Tribune.  

In March of 1946, the guild asked the U.S Conciliation Service to recognize the guild as bargaining agent for the nurses in negotiations with the East Bay hospitals. In April of 1946, guild members voted to affiliate with the Public Workers of America (PWA) and the CIO (Congress of Industrial Organizations), a federation of unions. This was at the same time the CIO and AFL (American Federation of Labor), then separate groups, were fighting in Sacramento over political endorsements for state offices.  

Guild appeals to public for support 

Soon after joining the CIO, the guild began a public relations campaign to win community support for their demands for better pay and working conditions. “You Needed the Nurse…Now the Nurse Needs You” was the title of the pamphlet the new Nurses’ Guild of Alameda County’s leaders developed and delivered to 8,000 trade unions, teachers, doctors, dentists and other professionals in Alameda County.  

In the pamphlet, the nurses laid out their demands: “The immediate goal of the Nurses’ Guild is a collective bargaining contract that will guarantee the nurses a decent wage, reasonable amount of leisure, and fair working conditions …living symbols of our American Way of Life. Standing united, the nurses are determined that, no matter how long it takes, the hospitals must finally recognize the justice of the nurses’ case by signing the contract.  

Alameda County Nurses' Guild circulated this pamphlet in 1946.

“The nurses’ requests are for your protection!” the pamphlet declared, appealing to the public’s self interest in quality care. Specifically, the guild was asking for a better salary (minimum of $200 a month), a 40-hour work week, down from the standard 48-hour week for nurses, designated holidays, vacation with pay, reasonable sick leave with pay, adequate maternity leave, pre-employment and annual health examinations, protection under the Social Security Act and protection under the Unemployment Insurance Acts. The nurses also demanded the right of collective bargaining through “organizations of her own choosing without discrimination or intimidation and a job as an American Citizen, regardless of race, religion, color, ancestry or national origin.”  

The guild leadership invoked the words of a prominent economist of the time, Varden Fuller, to bolster their case: “There will be no real end to the shortage of nurses in Alameda County until nurses can be guaranteed decent working conditions in hospitals,” Fuller was quoted in a guild press release. “It’s no wonder that so small a percentage of nurses coming out of the armed forces are returning to hospital work. A nurse can go to work in a warehouse or a cannery and earn as much or more money as in a hospital.” The nurses augmented that claim in the pamphlet, declaring that a woman paring and peeling in a cannery made $202.50 and a grocery clerk made $241 per month, while nurses were making $175.  

KP’s chief physician Sidney Garfield makes history by signing first nurse contract 

The Nurses’ Guild leaders urged the public to write to the hospitals and “let them know you’re in complete sympathy with the nurses’ just requests.” On the list of hospitals whose nurses had voted to be represented by the guild was the (Kaiser) Permanente Foundation Hospital at Broadway and MacArthur in Oakland, the first Permanente hospital, opened in 1942. Permanente administration distinguished itself by being the only hospital representatives that allowed a secret ballot for its nurses to select an organization to speak for them in labor negotiations. Sidney Garfield, MD, Permanente’s founding physician, was also the first to sign a collective bargaining contract with the newly energized nurses’ organization.  

The nurses’ initial campaign for labor representation came to a close on August 1, 1946, with the announcement of Garfield’s signing. “Permanente’s historic contract gives working nurses a 40-hour work week for the first time in Alameda County hospitals,” the Guild press release stated. “Besides reducing the former 48-hour work week to 40 hours, the Permanente agreement raises the former basic wage of $175 to $185. The basic rate will go up to $190 on October 1 and $200 monthly on January 1, 1947.” Meanwhile, the California State Nurses Association was negotiating with other East Bay hospitals. Spokeswoman Edna Behrens told the Tribune their contracts called for a 44-hour work week beginning July 1 and a 40-hour week as of January 1, 1947. She said the shortened week would not mean a reduction in the minimum salary of $200 per month.  

While nurses felt empowered after the war to pursue higher positions in the field of medical care, not everyone was anxious to embrace them in new roles. A case in point is neurosurgeon Howard Naffziger, who spoke in 1947 at a two-day conference of the Association of California Hospitals at Hotel Claremont in Oakland. “Highly specialized nurses should be called something else, because they have specialized themselves right out of the care of the sick.” He said nurses could learn all they needed to know in two years, or even one year of training. “The needs of the public for nurses exceed the ability of the public to pay,” the renowned neurosurgeon said.  

Marguerite McLean, then superintendent of nurses at Highland Hospital and later director of the Permanente School of Nursing, countered his remarks: “Doctors …have had to spread themselves so thin that one wonders what would happen if nurses hadn’t been qualified to step in and take care of the situation,” McLean told the Oakland Tribune. She added that even the practical nurse with less training would need a living wage, which would have to be close to the $200 basic monthly pay of the trained nurse. “Nurses feel they are best qualified to know and understand nursing requirements.”  

(Next time: In 1966, Kaiser Permanente nurses stage first work action in California history.)

For more on Kaiser Permanente nursing click here.