Posts Tagged ‘MD’

Kaiser Permanente Fresno marks its 25th anniversary

posted on December 29, 2011

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.”

On July 1, 1986, the Fresno team was ready and the doors opened at the medical offices at 1475 First Street, with seven physician offices, 14 exam rooms, two procedure rooms, waiting room and reception area. Seven physicians were there to treat patients the first day. They were physicians Paul Baker, Jose Rendon and Larry Coble; internists Tony Antoniou, Raj Banka and Red Uhrle; and family practitioner Sami Issi.

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

Madison Ballew, first baby born in Fresno’s Medical Center February 28,1995, with her parents Rob and Angela.

On opening day, KP Fresno swung open the doors to the Birthing Center and the Emergency Department. When the maternity staff unlocked the door at 6 a.m., they were met by expectant mom Angela Ballew who was in labor and gave birth to a daughter, Madison Ballew, the same day.

One-year-old Madison was the star of the show at the party celebrating 1,167 babies born in the center’s first year. Madison’s mom, a Sanger drama teacher, told the Fresno Bee that she would deliver her second child at the center the following August.

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.

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Long-time Vallejo physician leader leaves rich legacy

posted on July 12, 2011

By Edward J. Derbes

Heritage associate*

If Dr. Paul E. Stange had not attended medical school, he probably would have been a  football coach, said his son, Paul V. Stange, who works as a policy analyst for the Centers for Disease Control.

Instead of coaching, though, Dr. Stange served as the physician-in-chief (PIC) at Kaiser Permanente’s Vallejo Medical Center for 22 years, one of the longest-term PICs in Kaiser Permanente history. But, his son added, those two career paths were not far off. That’s basically what he became: a head coach. He was a great leader (to the doctors). Firm, but fair.”

Dr. Paul Stange riding a tractor during construction of Vallejo Medical Center completed in 1973. Stange family photo

Dr. Stange passed away earlier this year on April 28. He was 90 years old.

At his retirement in 1991, his portrait was displayed in the lobby of the original Vallejo Medical Center, which was replaced with a new facility in 2010. His portrait remains near his former office in the old facility, which still houses administrative offices.

“That looks like an intelligent man and a superb leader,” Dr. Donald Nix recalls saying when he first saw the portrait. Dr. Nix was Dr. Stange’s best friend, colleague and long-time golf buddy. “I think those are the qualities that best describe Paul,” he added recently.

Career starts in left-over World War II barracks

Dr. Nix said that although Dr. Stange was their boss, the Vallejo doctors loved him. His two executive secretaries dubbed him “Mr. Wonderful.” When Dr. Stange began his tenure as PIC in 1965, the Vallejo Medical Center was housed in barracks-type buildings originally constructed for the Mare Island Shipyard war workers. His son, Paul, described them as rickety, green-finished wood buildings that Kaiser Permanente took over from the government when they opened a makeshift medical center in Vallejo right after World War II. Dr. Stange served through the construction of the $12 million, seven-story medical center, w hich was dedicated in 1973.

After stepping down as PIC, Dr. Stange continued his medical practice until 1991. He continued to lend his medical expertise by returning to the facility to give follow-up readings of radiology reports and mammograms. Maribel Guerrero, the breast care coordinator for Kaiser Permanente’s Napa-Solano Service Area, writes in gratitude to Dr. Stange in a 2006 letter: “The Kaiser Permanente organization should be proud to have you in its midst. . . . My job as breast care coordinator would not have been possible without your gracious help.”

Dr. Stange with his fellow Kaiser Permanente associates circa 1950. From left to right: Wallace Neighbor, A. LaMonte Baritell, Morris Collen, Cecil Cutting, David Steinhardt, Paul Stange, and Joseph Sender.

Born in Milwaukee, Wisconsin, in 1921, Dr. Stange attended the University of Wisconsin School of Medicine during the mid-1940s. He served in the U.S. Navy from 1947 to 1951. After initially failing to get a residency in obstetrics,  he completed a residency in pathology in Washington, D.C.,  in 1950. Three years later, he finished a  residency in his preferred field, obstetrics, at the Kaiser Permanente Oakland Medical Center. Dr. Stange joined the Vallejo Medical Center’s  OB/GYN department later in 1953.

Dr. Stange also had an active community life. He served on the board of directors  for both the Vallejo Housing Authority and the Solano County Medical Society,  which honored him with a lifetime achievement award in 1997.

Stange inspires two generations  of medical professionals

Perhaps his greatest legacy to the medical community, though, is his family. Three of his daughters are registered nurses – Joan Pottenger, Gail Stange and Cynthia Stange-Zier.  Another daughter, Susan Stange, works in patient care in Santa Rosa, California.  And two of his grandsons are well on their way to becoming doctors; one of whom, Lucas Zier, recently received his medical  degree from the University of California, San Francisco, where he is in his third year of residency for Internal Medicine. Brent says that Lucas plans to complete a cardiology fellowship next to finish up his training.

Brent C. Pottenger, another of Dr. Stange’s grandsons, will attend the Johns Hopkins University School of Medicine in the fall. He wrote the following essay about Paul E. Stange’s legacy, and how his grandfather influenced his decision to pursue a career in medicine.

Carrying  on the tradition of physician leadership

By Brent C. Pottenger, MHA

From a hospital bed at Kaiser Permanente’s Vallejo Medical Center, where he served as  a physician and leader for five decades, my grandfather, Dr. Paul E. Stange,  first heard that I had been admitted to the Johns Hopkins University School of  Medicine, often ranked the top medical school in the nation.

“Number one!” he proudly exclaimed when my mom, his daughter Joan Pottenger, herself a registered nurse for over thirty years, shared the news.

Groundbreaking ceremony at Vallejo in 1970.

Upon hearing this story, I felt a responsibility to build upon his legacy of physician leadership; a legacy that, thankfully, my mom fostered in me by  connecting her own experiences as a health care leader with memorable stories about my grandfather’s career.

My grandfather passed away at 90 years old on April 28, 2011. I decided to write this memorial essay for him not only because he inspired me to pursue a career in medicine, but also because of his dedication to managing the quality and cost of health care as a physician  leader – a passion that ties in deeply with the legacy of Kaiser Permanente.

While I pursued a master of health administration degree at the University of Southern California, there was a primary question that drove my research: “Can  physicians manage the quality and costs of health care?” The question is derived from Dr. John G. Smillie’s book, “Can  Physicians Manage the Quality and Costs of Health Care: The Story of The  Permanente Medical Group,” which traces the history of Kaiser Permanente. (The book also features a photo of my grandfather with fellow physician executives of The Permanente Medical Group sitting around a table during the early 1950s.)

In many ways, my grandfather has shown that, yes, physicians can help manage the quality and costs of health care. Throughout his career as PIC, for example, he constantly balanced budget constraints with optimal medical care delivery to provide the most effective health care services to Kaiser (Permanente) patients. After retiring, he also spent about five years leading the creation of a partnership program in Solano County that established a much-needed safety net for patients from underserved communities.

Building bridges defined my grandfather’s legacy – he constantly thought broadly about how to create partnerships that could benefit wider communities. Genuine efforts like those mentioned above capture his interest in health policy and administration considerations: Dr. Stange was passionate about Kaiser Permanente because he believed deeply in the tremendous value that its integrated health care system provides to patients. From prevention to efficiency, my grandfather’s personal values magnificently matched those of Kaiser Permanente.

At Johns Hopkins, I hope to build on my grandfather’s legacy to improve our health care systems. In an effort to combine lessons learned from both my grandfather and my mom, for example, I hope to found the Doctors-Nurses Alliance (DNA) at Hopkins to better integrate the medical training of our future clinicians. The DNA program at Hopkins would facilitate increased interaction between the medical students and the nursing students. I believe that Doctor-Nurse-Aligned teamwork forms the double-helix DNA of medical care delivery, so hopefully I can contribute to this cause during my medical training.

With projects like DNA, I plan on carrying with me throughout my career those inspirations that led to my grandfather’s steadfast dedication to Kaiser Permanente – his legacy inspires me to learn, serve, and lead.

*Edward J. 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.

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Empowered women shape modern maternity care

posted on June 19, 2011

By Laura Thomas

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.

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Kaiser Permanente nursing excellence: 75 years in the making

posted on June 2, 2011

By Ginny McPartland

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 20th 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.

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Celebrated farmer urges Kaiser Permanente doctors to further healthy food traditions

posted on April 5, 2011

By Grace Emery

Heritage correspondent*

Joel Salatin, celebrity farmer. Photo by Rachel Salatin.

When I heard that famed farmer Joel Salatin had come to Oakland to speak with Kaiser Permanente (KP) doctors, I felt like this event almost constituted a brush with celebrity. I wrote my senior thesis on food movements in the Bay Area, and my longtime interest in food politics had introduced me to Salatin and his work to bring sustainable food to America’s tables.** While some may be puzzled at the idea of a “famous farmer,” I leapt at the chance to write about a veritable hero of the food politics world, and I was anxious to learn more about where KP doctors and Salatin crossed paths.

Thanks in part to Michael Pollan’s discussion of Salatin in “The Omnivore’s Dilemma” and his appearance in the 2008 popular documentary “Food Inc.,” Salatin has become a renowned advocate of sustainable food and farming, and somewhat of an icon in the healthy food movement.

During his visit, Salatin, who raises beef, pork, and poultry at his Virginia family farm, Polyface Inc., spoke of the challenges small farmers face at the intersection of healthy food and politics. Locally grown food is often healthier and more sustainable, but small farmers struggle when selling their products to large institutions, preventing the large-scale adoption of a local food system.

Salatin started his visit with a stop at the birthplace of local food sales—the farmers market. Preston Maring, MD, a KP physician in Oakland, Calif., founded the first Kaiser Permanente farmers market at the Oakland Medical Center in 2003, and today there are more than 35 KP farmers markets in several regions, demonstrating Kaiser Permanente’s commitment to total health through nutrition.

After a visit to the market, Salatin spoke to a group of KP physicians on the topic of “Local Food to the Rescue.” His message served to both validate the work Kaiser Permanente farmers markets and hospital cafeterias are already doing, and to inspire Kaiser Permanente officials to supply hospitals with even more locally sourced food.

History of healthy eating

Kaiser urged wartime shipyard workers to eat healthy, even grow their own vegetables, as this 2009 poster illustrates. Design by Pam Zachary, KP Multimedia Department.

Kaiser Permanente has long focused on the link between healthy eating and prevention. Before Kaiser Permanente was synonymous with health care, war workers flocked from all parts of the U.S. to Richmond and Oakland, Calif., where they helped to build ships in the Kaiser Shipyards during WWII. Henry Kaiser quickly realized that to build ships at a fast pace his workers had to be healthy and strong, and that meant they needed to eat nutritious foods. He saw that well-nourished workers translated into less absenteeism, more productivity, and happier employees.

In a 1943 memo written by Cecil Cutting, MD, a founding Permanente physician, there is a clear emphasis on the importance of nutrition. With healthier meals, Cutting hoped to “bring about greater vitality, greater psychological effect and consequently increased productivity.”

In “Ships for Victory,” author and historian Frederic Lane discusses the Maritime Commission’s initiative to improve in-plant feeding at America’s shipyards in 1943. Many shipyards received additional funds to provide more hot meals and make sure workers had access to healthy food in the workplace. In the Kaiser Shipyards on the West Coast the emphasis on good nutrition even spilled over into the Kaiser-run child care centers where children were fed three square meals, and mothers could pick up prepared meals when they collected their children at the end of the work day.

After the war when Kaiser established a health plan open to the public, nutrition and prevention were among the core principles. “Kaiser health planners supported concepts of holistic preventive care,” writes Rickey Hendricks in “A Model of National Health Care: The History of Kaiser Permanente.”

A focus on healthy food comes to Kaiser Permanente hospitals

Nutrition education was big in the WWII Kaiser shipyards, as highlighted in this poster created in 2009. Design by Pam Zachary, KP Multimedia Department.

A 1972 article from the publication “Institutions/Volume Feeding” highlights Kaiser Permanente hospitals’ progressive commitment to providing patient meals with higher nutrition at a lower cost.  Hospital dieticians were consulted so that every meal had optimal nutrition and calorie content for a patient’s needs. Kaiser Permanente even began to serve meals with an accompanying pamphlet that explained the nutrition information of the meal so that patients could “begin to learn more about the foods that they eat” while in the hospital.

Quality nutrition was at the center of meal planning, and administration felt that when it came to cost “it was of the utmost importance to separate patient feeding from other food-service activities necessary in a hospital.” While the development of an efficient system came about slowly, Kaiser Permanente never strayed from a focus on the healing power of healthy meals.

Oakland: an epicenter of progressive food movements

In my thesis research on the bay area, I was surprised to find that the city of Oakland has also long been a center of progressive food movements. In the 1970s, the Black Panther Party provided a free breakfast program and other “people’s community survival programs” in Oakland, serving residents hot meals with a side of political activism.

The effort of the Black Panther Party members to address hunger in their community was seen as revolutionary and empowering. Soup kitchens and free breakfast programs drew attention to the fact that the local food system was not currently meeting the needs of the West Oakland community. In “A Panther is a Black Cat,” (1971) author Reginald Majors explains that rather than wait on city officials, residents intended to subvert the power dynamic of the community by taking matters in to their own hands.

The free breakfast program for school children went hand in hand with revolutionary ideals and food became an expression of political power. Majors explains, “The Panthers would be betraying their own beliefs by not pushing a little political orientation along with the grits, bacon, and eggs” they dispensed each morning.

Today there are several West Oakland farmers markets in action that echo these themes of racial empowerment. My thesis focused on several of these markets, like “Mo Better Foods” and “Phat Beets Produce,” which provide both locally grown food and social empowerment within a community many residents believe to be historically disenfranchised.

Kaiser Permanente’s continued progress and inspiration

Given Kaiser Permanente’s nutritional history coupled with Oakland’s revolutionary food movement past, Joel Salatin could not have delivered his somewhat radical message to a better group in a better location. Kaiser Permanente initially focused on healthy food in hospitals, and then on bringing local, sustainable food to the community through the Kaiser Permanente farmers markets in Oakland.

What follows logically is a bridging of those two ideals: bring even more local and sustainable food in to hospital meals. Kaiser Permanente hospitals already bring in over 600 pounds per week of sustainably grown vegetables on patient entrée plates at 21 Northern California Kaiser Permanente Hospitals, and Salatin hopes his talk will encourage them to expand that trend and do even more. When he visited Oakland in January, Salatin said:

“The idea of bringing local food right into the façade of a hospital — there couldn’t be a better match. . . If anyone should lead the way in bringing this nutrient-dense food, food that heals people, heals the soil, heals communities, it should be the hospital. Every sphere of its existence should be healing.”

*Grace Emery is an intern with Kaiser Permanente Heritage Resources. She is a graduate of Whitman College in Walla Walla, WA, and is pursuing a career in public health.

**Grace Emery, “‘Feeding Ourselves’: Power and Participation in West Oakland Food Movements.” Senior Political Science thesis for Whitman College. Winner of the 2010 Whitman College Robert Fluno Award for Best Politics Thesis.

For more about Joel Salatin’s visit to Oakland Kaiser Permanente, http://xnet.kp.org/newscenter/aboutkp/green/stories/2011/021511joelsalatin.html

To learn more about Kaiser Permanente’s green programs:

http://xnet.kp.org/newscenter/aboutkp/green/factsheets/healthyfood.html

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Iron nurse Dorothea Daniels had a soft spot for nursing students

posted on March 21, 2011

Daniels at right, Lisker second from right, 1950 Permanente Foundation Nursing School capping ceremony in Oakland, California. Note Daniels' Phillips Beth Israel cap.

By Ginny McPartland
Heritage writer 

Read almost anything about Permanente Foundation School of Nursing’s first long-term leader Dorothea Daniels, and a caricature of a stern, tough-shelled, by-the-book and proper nurse comes to mind. Daniels, a product of New York, rattled her students, nurses and many physicians with her exacting demand for perfection in all things related to patient care and protocol.

She made the nurses work and study hard in restrictive conditions and she didn’t hesitate to correct a physician who displeased her. “She came from a different cut of cloth,” wrote John Smillie, MD, in his history of the Permanente Medical Group. “She regarded herself, and I think quite properly, as a peer of any of the doctors she was dealing with.” 

Migrating to California from New York City after the war ended in 1945, Daniels brought to Permanente her solid education (a doctorate in education from New York University) and experience running a nursing school in that city. From 1936 to 1945, Daniels was the director of the Phillips Beth Israel Hospital School of Nursing. 

Daniels imposed strict rules for student lifestyle

Not unlike other nursing schools of the time, Phillips stressed the students’ need to conform to strict standards of behavior, dress and health habits. House mothers hovered over the students to make sure they didn’t misbehave. “Nurses were not permitted to marry while in training, and subsequent marriage was grounds for instant dismissal,” according to the school’s current Web site. 

At Phillips, nursing students worked six days a week and curfews were rigorously enforced. Pupil nurses were disciplined if they stayed out all night. “Dress inspections took place in the dining room, and students were weighed once a week to make sure they did not ‘get too heavy’ since there was a professional necessity for nurses to ‘look well.’ 

Kaiser Foundation School of Nursing in an old hotel building on Piedmont Avenue near the Oakland hospital, 1948 to 1976

“Hospital director Daniels insisted on student nurses who looked healthy and fit, believing that if students were overweight, they could not work hard and take care of patients,” the school historians reported. “There was concern (during the 1930s) that nurses did not get enough exercise and recreation…’” 

Daniels gets support for her view of fitness in a textbook for orienting student nurses in the 1930s: “Curative medicine gives place to preventive medicine, so must (the nurse) be prepared to understand and apply intelligently the principles of prevention…“The nurse of the future must exemplify health, and teach it. Humanity is ready to cast off sickness.” 

Encouraging nurses to spend leisure time wisely

In 1940, Daniels embarked on a study to assess Phillips students’ leisure time activities, including physical activities. “What Ninety Girls Like to Do in Their Free Time,” authored by Daniels, was published in the National League of Nursing Education publication. A softer side of Daniels emerges in her discussion of the study results. 

“These young women (19 to 24 years for age) have developed abilities of discernment and judgment in their avocations as they develop in the school. While they are learning to assume increased responsibility, they seem to be learning how to spend their leisure time more wisely,” she wrote. She said many subscribed to a professional nursing journal, and “The most thorough inspection of the nurses’ quarters never reveals magazines of the ‘true story’ category.” 

The survey results conclude that the younger girls are spending an average of six hours a week on exercise and the older girls 7.3 hours. “Within a short walking distance there is a tennis court, a swimming pool, a roller skating rink and bicycle-riding areas. “Little equipment is necessary. Sport dresses are the only necessary paraphernalia for hiking, bicycle riding, and roller skating…these types of exercise are easy to learn and give one a sense of well-being and feeling of grace,” Daniels wrote. 

Once the anonymous surveys were compiled, Daniels returned them to the students and asked them to send them back with identification so she could: “aid in fulfilling the wishes stated on the papers. We found it possible to send some students to their first legitimate play; and some 25 were sent to concerts. Our physical education director was instructed to work out her program to include activities for which there were expressed preferences.” 

Bringing her ideals to California

Permanente Foundation Nursing School graduation 1951. Dorothea Daniels at far left, Clair Lisker, third from right.

When Daniels came to California, Permanente Foundation hired her as director of nursing in the Oakland hospital. That position grew in 1948 to include the job of director of the nursing school established in 1948. As expected, Daniels incorporated into the school policies many of the ideas she had adopted in New York. 

The first Permanente School of Nursing student handbook, developed in 1948, prescribed the dos and don’ts for students to get along well at the school. “Your ability as a nurse is reflected in the way you keep your room…Students must be in their own room at 10 p.m., and all lights will be out at 10:30 p.m…Guests may be entertained only in the living room between 8 a.m. and 10 p.m. (Exceptions were made if a mother came to visit.) 

“Pre-clinical students will be in the residence at 8 p.m. each day, Monday through Thursday, unless otherwise specified by the director of nurses…Your window shades will be kept drawn at night when the lights are on…Every student is expected to be adequately clothed when going through the halls…Students are expected to be tidy and well groomed at all times…The conduct of the student nurse on and off duty must be such as will not reflect discredit on herself, her chosen profession, nor her school.” 

In a 1961 nursing school report, a revised philosophy of the school was detailed. Revisiting the fitness theme, one stated role of a successful nurse was: “A teacher of healthful living.” A decade later, the Kaiser Foundation Nursing School brochure stated under Personal Qualifications required for admission: “General appearance is one of the considerations in the selection of students. Applicants must weigh within normal limits of the range established for height and structure.” 

Daniels helped students pursue bachelor’s degree

Daniels, at left, as a hospital administrator. Daniels was the first woman to serve as a hospital administrator in the Kaiser Permanente health plan.

Daniels left the school in 1953 to become administrator of the Los Angeles Permanente Foundation Hospital, making her the health plan’s first woman hospital administrator. She later returned to Northern California to take over as administrator at San Francisco Medical Center. Clair Lisker was one of Daniels’ early students who rose within KP hospital nursing administration. In a 2002 oral history, Lisker credits Daniels with “paving the way for all of us. She was in San Francisco, and she was at Sunset in Los Angeles, two major facilities. 

“She was a tremendously powerful woman, intellectually. I don’t ever remember seeing her sit down,” said Lisker. Daniels encouraged her best students to earn a bachelor’s degree in addition to an RN degree, believing that a well-rounded education would ensure a promising future. Lisker was one of those students. 

“Dorothea was encouraging me to go and enroll in Holy Names College in Oakland, which was then down by the lake (Merritt) where the Kaiser building is now,” recalled Lisker. “She wanted me to get the basics, like English 1A and 1B, and whatever else I needed, philosophy…I basically said: ‘I can’t afford it…she said ‘well, what I’ll do is I’ll pay your fee, and I will get reimbursed. I’ll take $5 out of your allowance (stipend) every month.’ ” Lisker remembers $5 being deducted from her stipend once but doesn’t believe Daniels ever claimed the rest of the $30 advanced ($10 per course unit). 

Kind, generous and impeccably dressed

“She was very kind and generous to those student nurses, and for a good student she would find scholarship money for that young lady to go on to get a degree, so (the student) would become a leader in nursing,” Smillie recalled. Avram Yedidia, a health plan leadership pioneer, said of Daniels: “Her dedication to patient care was as unblemished as her uniform, which miraculously never wrinkled.” 

“She wore these white starched uniforms with a little pointy hat with a black band, and a little pleated organdy cap on her head,” Lisker recalled, noting the cap was from the Phillips Beth Israel school. Daniels’ penchant for a proper nurse’s uniform was no doubt formed in her early years in New York. While she was at Phillips, student nurses were required to adhere to strict dress standards. 

The Phillips Web site: “Students wore black stockings, long sleeves, bibs, aprons, ankle length blue-check dresses, tight cuffs and a bishop’s collar. During the senior year, what was black became white: socks, stockings and dresses became the uniform of the professional nurse. Students wore no caps until the senior year.” 

To make sure they got the uniform right, the administration consulted etiquette expert Emily Post on the proper attire for student nurses on an outing. “Hats and gloves were de rigueur on field trips,” Phillips historians reported. 

The memory of Dorothea Daniels, who passed away in 1968, will always be of a woman to be reckoned with. Lisker summed it up: “Dorothea’s (attitude) was: ‘I’m in control. I’m in charge’…But she also had her other (tender) side, which she didn’t display very often…She loved her dog. She brought (Snuffy) to work every day, and the dog slept in a drawer in her desk…She was a wonderful lady, but she was a character.”

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Widow of Permanente pioneer shares fond memories of Garfield

posted on January 24, 2011

By Steve Gilford 

Senior KP History Consultant 

Ira "Buck" Wallin, MD, pioneer of Southern California KP

A recent phone call brought me the sad news that Jeanne Wallin, wife of the late Ira “Buck” Wallin, MD, a Southern California Permanente Medical Group pioneer, had passed away this month at the age of 89.  

I first met Jeanne a bit more than ten years ago when my interest in recording first hand accounts of the origins of Kaiser Permanente led me to her and Buck Wallin, one of the first Permanente doctors on the ground in Southern California. 

In 1950, after just a few weeks at the Permanente hospital at the Kaiser Steel plant in Fontana, Calif., Permanente founder and executive director Sidney Garfield enlisted Wallin to open medical offices to care for longshoremen at Los Angeles harbor in San Pedro. This was the first expansion of the program into Southern California outside of the steel plant and the beginning of the Southern California Region.  

After Buck’s death in 2002, I remained in occasional contact with Jeanne. A cheerful, articulate woman with an easy manner, she enjoyed reminiscing about “the old days.” Unlike others I had talked to about Dr. Garfield, Jeanne Wallin knew him neither as family nor as physician. He’d been a friend with whom she, her then-husband, Joe Lydon, and a group of other couples, would often share weekend afternoons and evening parties. 

Permanente founder had movie star quality 

Jeanne Wallin, at left, playing cards with Sidney Garfield, MD, on Sea Star about 1976

Jeanne, a native of Oakland, Calif., had married Wallin in 1987 after the death of Lydon, a marketing consultant.  It had been Lydon who, in 1972, had introduced her to Dr. Garfield. Before Jeanne met Sidney Garfield, Lydon told her, “You’ll like this man, he’s such a gentleman; everyone likes him.” Soon Jeanne and Joe had become close friends with Sidney, his wife Helen, Health Plan Regional Manager Karl Steil and Karl’s wife, May. 

“Almost every weekend, Sid and Helen came down (to Alameda) so we spent a lot of time together.” What they all had in common was a fondness for boats and so much of their social time together was aboard either the Steil’s boat or their own, berthed near each other at Alameda’s Ballena Bay Yacht Club.  

According to Jeanne, Dr. Garfield had a movie star quality. “He reminded a lot of people of Spencer Tracy . . . The women adored him.” Even so, she recalled, “He was very, very quiet around me.” However, after they’d become better acquainted, he began to open up a little. 

“One day, we were cruising somewhere.  He and I were sitting out in the cockpit and he told me all about designing the Oakland hospital. . . . and how originally he wanted to be an architect.  He had a very quiet way about him.  He was utterly charming.  I could see why women liked him so much.” 

Garfield pushed good health, not health plan 

Dr. Garfield didn’t mind that she and her husband were not members of the Permanente Health Plan. In the 1970s when Jeanne mentioned to him that she and Joe were planning a trip to Europe, he insisted that they have a medical checkup before they leave.  “You cannot go until you have a ‘multiphasic,’” he said. 

The multiphasic program was basically a battery of screening tests that was offered to Kaiser Permanente members. The advantage was that in a short period of time, with minimal inconvenience, a patient could get a complete health examination. Sidney told them that if they went through the multiphasic examination before they left, they could leave the country knowing that they were in good health. 

Garfield arranged simultaneous appointments for the couple at the Oakland Kaiser Permanente hospital. “Of course, my husband went one way and I went the other . . . Sid personally took me through the whole multiphasic. We’d have little stops: open a door and go in and there’d be cake and cookies and a cup of coffee.  It was the most wonderful way to get all these physicals done and over with.” 

Garfield as architect and planner collaborated with Wallin 

She remembered another one of the Garfield innovations she’d seen that afternoon: colored lines painted on the medical center floors to help patients find their way easily from one test station to the next. “Well, I thought it was fantastic, following the lines.  He told me how he’d invented all this stuff. 

“Then he showed me through the whole hospital and how he designed the rooms to be between the central corridors and the outside ones off of the center corridors.  It was so charming of him to share this with me, and you could tell the great pride he had in it.  Great pride. I felt very honored,” she related. 

In the mid-1950s, Dr. Garfield collaborated with Medical Director Wallin on the design of the 56-bed Harbor Hospital in Harbor City.  When membership grew, Wallin and Garfield worked together to plan that hospital’s expansions.  In the early 1960s, the two men again collaborated to plan and launch the new Bellflower service area, including the layout of the hospital, the budgeting and selection of the 60-physician staff. 

In 1966, when the health plan took over the financially troubled San Diego Community Health Association, Wallin became the founding medical director there.  Dr. Wallin served on the board of the Southern Permanente Medical Group until 1973. He stayed on in San Diego as a member of the staff there for several more years until he moved to the Bay Area. 

When Jeanne met and married Dr. Wallin, she took great pride that Buck had played an important part in what had become the largest private medical care program in the world. Following her death, her family paid her a high tribute, “Jeanne embraced life in both difficult and joyous times.”

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Kaiser-built 1954 sports car delights today’s collectors

posted on November 15, 2010
1954 Kaiser-Darrin donated to Oakland Museum by retired KP pediatrician Ed Schoen

By Ginny McPartland

When Henry J. Kaiser went into the car manufacturing business in the late 40s, he had big ideas, as he did in all his ventures.  Unlike his many successful start-ups – the most notable legacy being Kaiser Permanente – his foray into the automotive business seemed a failure at the time. He went on to make a success in producing Jeeps, but the economy sedans (the Henry J), luxury and family cars (Manhattan and Special), and the sporty, two-seater Kaiser-Darrin were no longer manufactured after 1954. The small Kaiser Motors Corporation had lost out to the big three: Ford, General Motors and Chrysler.

The happy part of this story is about the Kaiser-Darrin, which is living a charmed life today in the hands of avid collectors.  Earlier this year, a “supercharged,” red Kaiser-Darrin garnered a handsome $220,000 in a classic-car auction in Scottsdale, Arizona. Other Darrins have sold in recent years for $100,000 to $176,000 at the same auction.

One of the first American sports cars, the Darrin has a fiberglass body, sliding doors that disappear into the fenders, a three-position soft top, bucket seats, and a low center of gravity good for cornering. Only manufactured in 1954, the Kaiser-Darrin came in four classy colors –yellow satin, cream, red and light green. To date, only 80 or so widely scattered examples of the Darrin have escaped the junk heap.

Famed automobile designer-to-the-stars Howard “Dutch” Darrin, an on-and-off Henry Kaiser collaborator, developed the prototype of the fiberglass-body beauty on his own and unveiled it to Henry Kaiser as a fait compli. Henry Kaiser was not pleased. He is reputed to have told Darrin the idea was scatter-brained.  But Kaiser warmed up to the idea when his second wife, Alyce “Ale,” piped up: “Oh Henry, it’s the most beautiful thing I’ve ever seen.” 

Kaiser agreed to produce 435 of the stunning vehicle that turned out to vie with the 1954-released Ford Thunderbird and the 1953 and later Chevrolet Corvettes.  These sports cars were America’s answer to British models, such as the Jaguar produced as early as 1948. The Kaiser-Darrin and the Chevy Corvette compete for bragging rights for the first fiberglass body – the Darrin prototype was developed in 1952, and the Chevy Corvette was first shown and produced in 1953.

1954 Kaiser Motors Corporation sales brochure

Fifty to 100 unsold Darrins, touted in the sales brochure as the “the sports car America has been waiting for,” were reportedly left in a forgotten snowy lot in Willow Run, Michigan, during the winter of 1954-1955. Darrin, whose heart was in the Kaiser-Darrin, later bought the abandoned roadsters from Kaiser. He put them in saleable condition and souped up many of them with Cadillac V-8 engines.  A Willys Jeep 6-cyclinder engine was standard in the Darrins produced by Kaiser.

Permanente physicians drive Kaiser cars

The story of the Kaiser automobile intersects early on with the Kaiser Permanente saga.  As a perk of the job, Permanente physicians were given a Kaiser car to drive to work and for their personal use. In the days before 1952, doctors used the company car to make house calls ($5 per visit). The physicians had a choice of vehicles; most chose one of the sedans. But Ed Schoen, MD, a pediatrician who joined KP in 1954, saw the Darrin as an apt ride for a bachelor relocating from Boston to the San Francisco Bay Area.

Schoen had followed fellow resident and friend Cliff Uyeda to San Francisco where Uyeda was a KP pediatrician. Schoen joined KP in Oakland where he worked for 49 years, the longest tenure of any KP doctor. He became chief of pediatrics at the Oakland Medical Center in 1966 and regional director of newborn screening in 1990 before retiring in 2003.

Kaiser-Darrin postage stamp 2005

When the auto manufacturing venture ended in 1955, Kaiser offered to sell the cars to the doctors at bargain prices. The Darrin had originally retailed for $3,600. Schoen got his with 6,000 miles on it for $900. He would drive the unusual sports car exclusively for the next eight years, and he got a lot of attention driving around town. “People used to follow me home from work and ask me, ‘what is it?’” Schoen related. And as a bachelor, Schoen found that girls fancied a ride in the Darrin.

After meeting his wife, Fritzi, who came to the U.S. from Austria in 1958, Schoen took her many places in his cream-colored convertible. “I courted her in that car. . . She liked it,” he said. Ed and Fritzi married in 1960, and it wasn’t long before the Darrin was no longer practical. A daughter, Melissa, was born in 1963, and son Eric came along in 1968.

But Schoen kept the car and drove it to work for many years.  In recent years, he had it restored and preserved it in his garage. He entered it in car shows and won a couple of prizes competing with Ford T-birds and Chevy Corvettes. He also loaned the car for the 50th anniversary of Kaiser Permanente Vallejo and for display during another KP event in Oakland at Mosswood Park. The Darrin was never neglected:  Schoen took it out for a spin almost every weekend.

Rarity has its rewards

After owning the car for almost 50 years, Schoen donated his Darrin to the Oakland Museum in 2004 for the Henry J. Kaiser “Thing Big” exhibit. The Darrin was shown along with a 1953 Henry J Corsair Sedan in the ambitious exhibit that covered Kaiser’s amazing life as a 20th century industrialist and co-founder with Sidney R. Garfield, MD, of the Kaiser Permanente health plan. Today, Schoen’s Darrin is in storage awaiting a new venue.

Schoen was interested to learn about the high bids cast for the $220,000 Darrin in the 2010 Barrett-Jackson auction in Scottsdale. “When I donated mine in 2004 to the museum, it was appraised at $60,000 to $75,000,” he related.  He also noted the differences between his car and the one on the auction block. “The original Darrins did not have supercharged engines. Mine just had the 6-cylinder Willys Jeep engine . . . it was not a high performance car.”

To see a Kaiser-Darrin in action, go to: http://www.youtube.com/watch?v=MBtuXBVBPMY

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Kaiser Permanente’s LA Harbor Area Blossoms after Humble 1950 Start

posted on June 21, 2010

By Ginny McPartland 

Kaiser Permanente’s post-World War II public health plan was but an embryo in 1950 when famed labor leader Harry Bridges asked Dr. Sidney Garfield to provide medical care for West Coast longshoremen. The International Longshore and Warehouse Union (ILWU) had just adopted a health and welfare plan for its members, and Permanente’s prepaid health coverage fit Bridges’ vision. 

The health plan, then called Permanente, already had services in the San Francisco Bay area, so covering the six or seven thousand Northern California dock workers was no problem. But Permanente’s only presence in Southern California was at the Fontana Steel Plant, 70 miles inland from the Los Angeles harbor area where the roughly 3,000 longshoremen lived. 

Kennebec medical clinic in the 1950s

Garfield didn’t have to ponder Bridges’ offer for long. The struggling health plan needed members – desperately. After saying “yes!” to Bridges, Garfield flew into action. He hired a physician to run the longshoremen clinic, found a suitable building in the Port of Los Angeles town of San Pedro and opened for business in about two weeks. 

Today, Kaiser Permanente’s South Bay service area, boasts about 190,000 members, a 255-bed medical center, and medical offices in Long Beach, Torrance, Harbor City, Lomita, Carson, and Gardena. The KP South Bay community is celebrating its 60 years of history on Wednesday, June 23, in Harbor City. 

It’s been a rough ride 

The Harbor area health plan’s six decades of existence can be characterized as a roller coaster ride with its ups, downs, and unexpected turns. The years have brought growth, at times unmanageable, stopgap solutions to facility needs, the San Pedro murder of a popular doctor, and a fire that disrupted operations for a year – not all roses and sunshine. 

The early medical group, led by Ira “Buck” Wallin, MD, worked out of a small clinic in San Pedro and had to fight for legitimacy and for staff privileges at any of the area hospitals. They were blackballed by the local medical community for practicing what was called “socialized medicine” when the “Red Scare” was the order of the day. This contention was typical of the anti-group-practice atmosphere anywhere Permanente Medicine established itself. 

In the beginning, and for many years, the doctors made house calls and took turns sleeping overnight in a blood draw room in the clinic. They were at the beck and call of the longshoremen and their families. Over the first five years, the ILWU became steadily more impatient with the health plan for delaying construction of a sorely needed Harbor area medical center.

Early Parkview clinic in Harbor City

 Meanwhile, the group had expanded to Long Beach – first to an old house and then to the old posh Kennebec Hotel across from the Pike, a popular amusement park in Long Beach. The health plan also opened a Los Angeles clinic and then a hospital on Sunset Boulevard. From 1953 when the Sunset Hospital opened until the Harbor City hospital was built in 1957, patients were shuttled to Los Angeles for hospital care.

After a tussle with the ILWU that threatened the loss of the group, Sidney Garfield and Buck Wallin got the funding to build the Harbor City medical center. The first medical office building, called Parkview, was opened adjacent to the hospital in 1958.

South Bay no stranger to innovation

The South Bay/Harbor City movers and shakers contributed more than their share of innovative ideas over the years. Some examples:

  • In 1964, Harry Shragg, who later became area medical director, was the first in Southern California Kaiser Permanente to perform outpatient surgery, a practice that would become prevalent for its economy and medical soundness.
  • In 1964-65, Buck Wallin and Chief of Medicine William Fawell pursued the idea of discharging patients sooner and providing follow-up medical care in their homes. When Medicare came along in 1965, suddenly (home health care) became one of the ‘in’ things to do.
  • In the early 1970s, Harry Shragg, Internist Jay Belsky, and Medical Group Administrator Ed Bunting worked together to develop a new exam room layout that would leave more room for the patient and the examination table. “It was such a big success that it was adopted and became standard for all of Southern California, Bunting said.

The good, the bad and the ugly

  • In 1967, Dr. Shragg saw the opportunity to help disadvantaged Harbor City people through a local program funded by the federal Office of Economic Opportunity. Kaiser Permanente used its community service funds to provide medical care for 100 participant families.
  • In 1960, Leon Quattlebaum, a well-liked and respected 36-year-old Harbor City OB-GYN, was killed in San Pedro by a local tough who, unprovoked, punched “Q” in the jaw, knocking him to the cement floor and fracturing his skull. The prosecutor at the murder trial said the only reason for the killing was the murderer’s “malignancy of heart.”
  • In November of 1973, a night fire of unknown origin collapsed the three-story Parkview engineering tower and threatened to destroy Harbor City’s medical records and appointments data. The medical offices and appointment center were up and running again in about a week, said MGA Ed Bunting. But it took about a year to rebuild the burned out section at the center and make the complex whole again.

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