PermInNWCvrFinal.pdf 1 10/4/10 12:20 PM PERMANENTE IN THE NORTHWEST

“The history of this Northwest group parallels that of Garfield’s in California; two groups with separate beginnings shared a template and later became affiliated as geographic Regions in a national .

The author of this account, Ian MacMillan, for many years confined his writing to notes in medical charts as an internist and rheumatologist with Kaiser Permanente. For 14 of those years he was the well-regarded Chief of the Department of Medicine at Kaiser Sunnyside Medical Center. … In his narrative covering six decades of Kaiser Permanente Northwest history, MacMillan exploits the opportunity to tell the stories of physicians and others in both major and minor roles. Testament to his broad curiosity, he enriches his archive with historical detail and context.

Permanente in the Northwest relates through small stories how a change in financing medical care, implemented 60 years ago, created a rationale, and drove physicians to collaborate to deliver care to a population that included both the sick and the well. In telling this story, MacMillan has made the book relevant not only to past and present physicians who will find their names in the text, but also to the current national discussion of reform.”

C — From the Foreword by Arthur D. Hayward, MD M Successor to Ian C. MacMillan, MD, as Y Northwest Permanente Chief of Medicine

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MY

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Dr. MacMillan chronicles the growth and development of Northwest Permanente from the birth of the idea of prepaid Ian C. MacMillan, MD medical care to the large multispecialty medical group of today. He provides a thoughtful, well-researched account of the clinicians, leaders, and innovators, along with the challenges, triumphs, and near disasters along the way. — H. Raymond Blair, MD, Northwest Permanente Pediatrician for 43 years

A superbly chronicled account of the Northwest Permanente Medical Care Program from its humble beginnings to its evolution into a nationally recognized model. This book captures the true spirit of dedication and commitment by many talented individuals, professional and administrative, who contributed to the growth and advancement of the PERMANENTEPERMANENTE organization, while dealing with various challenges and conflicts. The text is easy reading, captivating, and fascinating. — Bhawar Singh, MD, Northwest Permanente Anesthesiologist for 42 years IN THE

Permanente in the Northwest is an accounting of a rich legacy of physician leadership, clinical excellence, and medical politics that serves as the foundation of Northwest Permanente, P.C. The early years through the turn of the 21st century demonstrate how Northwest Permanente has become the leader in the deployment of an electronic medical record, the application of evidenced-based principles, and in the delivery of integrated care in the Northwest market. I have confidence that we are well equipped to lead our community in health care reform. — Sharon M. Higgins, MD, Northwest Permanente Executive Medical Director NORTHWESTNORTHWEST

The Permanente Press Oakland, California • Portland, US $24.95 Ian C. MacMillan, MD

Cover image © Sharon O’Keefe Cover tree image © TL Max McMillen Cover design by Lynette Leisure PERMANENTE IN THE NORTHWEST

Ian C. MacMillan, MD

with contributions from Kitty Evers, MD & Allan J. Weiland, MD

Edited by Judy Hayward

The Permanente Press Oakland, California • Portland, Oregon About the Author: Ian C. MacMillan, MD has never authored anything before. He was born and raised in Regina, Saskatchewan where he was influenced by his physician father to become a doctor. He received his MDCM from Queen’s University, Kingston, Ontario and interned at University of Alberta where he met his future wife Shirley on the pediatric ward. A Fellowship in Internal Medicine at the Mayo Clinic convinced him of the desirability of group practice and, after a pathology residency in Victoria B.C. where he was impressed with the beauty of the Pacific Northwest, he joined The Permanente Clinic in 1961.

© 2010 by The Permanente Press

Published 2010 by The Permanente Press Oakland, California • Portland, Oregon

The Permanente Press is owned by The Permanente Federation, LLC Oakland, California

PERMANENTE IN THE NORTHWEST

14 13 12 11 10 1 2 3 4 5

ISBN: 0-9770463-3-8 Library of Congress Control Number: 2009937531

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, without permission in writing from the publisher. Permissions may be sought directly from The Permanente Press Publishing Office, 500 NE Multnomah Street, Portland, Oregon, 97232 USA; phone 503-813-4387, fax 503-813-2348.

Every effort has been made to trace the copyright holders of material reprinted in this book. The editors and publisher request that any copyright holder not listed here contact the publisher so that due acknowledgement may appear in subsequent editions.

Book design by Lynette Leisure Printed in the of America k

TO THE PHYSICIANS, NURSES, AND OTHER PERSONNEL WHO MET AND STILL MEET THE CHALLENGE OF PROVIDING HEALTH CARE CONSISTENT WITH THE CONCEPTS SET FORTH BY SIDNEY R. GARFIELD MANY YEARS AGO.

k TABLE OF CONTENTS k

FOREWORD...... XIII PREFACE...... XV ACKNOWLEDGMENTS ...... XVII INTRODUCTION ...... XIX NORTHWEST PERMANENTE CHRONOLOGY...... XXI PART I: A LENGTHY PROLOGUE Chapter 1: The Roots...... 2 • Early Prepaid Medicine in the Northwest • For-Profit Health Care Corporations • A Prepaid Medical Plan in Clackamas County • Group Health Cooperative of Puget Sound • The Clackamas Plan • Sidney Garfield and Desert Center 1933-1938 • Henry Kaiser and Sidney Garfield at Grand Coulee 1938-1941 • Prepaid Health Plans at Manhattan Project Sites • Ernest Saward at Hanford Engineering Works 1943-1945 PART II: THE EARLY DECADES Chapter 2: Wartimes 1941-1945...... 18 • Northwest Shipyards • Shipyard Workers • Shipyard Housing • Shipyard Life • Artists in the Shipyards • Day Care for Workers’ Children • Garfield’s Health Care Program for Shipyard Workers • Wartime Physician Recruitment • Medical Societies and Discrimination • Northern Permanente Foundation Hospital • The Physicians • Clinical Achievements • The Permanente Medical Journals Chapter 3: Hard Times 1945-1950 ...... 32 • Assault by the Washington State Medical Association and the American Medical Association

vii • Carrying On • Hanging On • Wrong Side of the River and Failure to Thrive • The Vanport Flood • First Partnership Chapter 4: The Fifties: Firm Foundation ...... 44 • Conflict, Crisis, Compromise: The Permanente Medical Group • What’s in a Name? Kaiser and Permanente • Internal Conflicts • Garfield’s Dilemma • Reforms • The Tahoe Agreement: Template for Permanente Medical Groups • External Pressures: Resolution 16 and the Larson Report • Public Image and Physician Recruitment • Bess Kaiser Hospital PART III: PEOPLE, POLITICS, AND PARADISE Chapter 5: Vienna, Vladivostok, and Vancouver: . The Norbert Fell Story...... 56 Chapter 6: Pariahs and Presidents...... 60 • Opposition to Permanente • Origins of the American Medical Association • Growing American Medical Association power • The Committee on the Cost of Medical Care • American Medical Association Code of Ethics • The Cold Shoulder • Battles • From Rejection to Acceptance and Respect • Presidents Chapter 7: Island Paradise...... 69 • Kaiser Honolulu Medical Center and Pacific Medical Associates • Problems • Saward to the Rescue • Hard Times and Good Times • Changing Needs PART IV: SPECIALTIES Chapter 8: The ER and the OR ...... 78 • Emergencies at the Northern Permanente Foundation Hospital • Emergencies at Bess Kaiser and Kaiser Sunnyside • Scalpels and Sutures, Hammers and Saws • Orthopedics viii • Neurosurgery • “TURPs” and Stones • History of Anesthesia in Oregon • Anesthesia at Northwest Permanente Chapter 9: Pediatricians, Obstetricians and Quints . . . . . 92 • Pioneering Pediatricians • The New Pediatricians • Innovations • Early Obstetricians • And Then There Were Five: The Quints Chapter 10: Ophthalmotorhinolaryngology...... 102 • Ullman, Mossman, and Hilbourne • Ophthalmologists • The Early Otolaryngologists • The Optometrists Chapter 11: Pathological Needs...... 108 • The Early Pathologists • The New Cadre • Turf Battles: Jones vs. Greenlick • Automation Chapter 12: Radiology...... 113 Chapter 13: Internists and the Early . Medical Subspecialists ...... 115 • History of Internal Medicine in the U.S. • Evolution of Medical Subspecialists at Northwest Permanente • Department of Medicine at Northwest Permanente • Cardiology • Hematology • Endocrinology • Rheumatology • Gastroenterology • Neurology • Infectious Disease • Nephrology • Intensivists • Pulmonology • Hospitalists • Geriatrics and Long-Term Care Chapter 14: Specialties Old and New...... 130 • Syphilis, Skin and Surgery • Industrial Medicine

ix • Oncology • Cancer Counseling and Education Chapter 15: Psychiatry and Physiatry: . Healing the Mind and Body...... 139 • Post-War Psychiatry • Permanente Psychiatry and the First Therapists • Growing Pains: Conflict, New Leadership, Innovation • ATP, ADRS, KPRR, and ACHP • Early Physical Therapy • Physiatry PART V: ADDITIONAL PERMANENTE PERSUASIONS Chapter 16: Social Conscience of Permanente . Health Care ...... 154 by Kitty Evers, MD • Physician Advocacy and Support • Healing Arts in the Workplace • Permanente Women • The Center for Health Research • Volunteering in the Community and in the World PART VI: THE RECENT DECADES Chapter 17: The Seventies...... 166 • Exit: The Icon Departs • Retirement Plans • Vervloet and Incorporation • Sunnyside Up • California Import • Help for Primary Care Chapter 18: The Eighties: New Directions...... 180 • South to Salem • William De’ak and Family Practice • North to Longview-Kelso • Family Practice Developments • Friends to the North • Nuclear Magnetic Resonance Tomography • Allergy and AIDS • Sunnyside Obstetrical Department Conflicts • Leadership Changes • The Quiet Pediatrician • The Nurses’ Strike • Competition x Chapter 19: The Nineties...... 198 by Allan J ..Weiland, MD • Becoming the Devil • Emerging from Fortress Permanente • Leading the Electronic Revolution • Becoming a Division and Flirting with a Kissing Cousin • Surviving the Capital Freeze and a Near-Death Experience • The Rise of The Permanente Federation • A Ritual Beheading • Tightening Up • Transitions: New Partner: New Compact: And We’re Number One! AFTERWORD: WHAT HAPPENED TO THE PIONEERS?...... 225 • Ernest Saward • Walter Noehren • Charles Grossman • Norman Frink • Roger George • Norbert Fell • Morris and Barney Malbin • Harold Cohen ENDNOTES...... 231 APPENDICES 1 ..Original Partnership Members, 1949...... 255 2 ..Northern Permanente Medical Staff, 1952...... 256 3 ..Speech to the Medical Society of Metropolitan . Portland, 1996...... 257 4 ..Reflections of a Lame Duck, 1975...... 260 5 ..Northwest Permanente Executive Medical Directors . . . 268 6 ..Northwest Permanente Distinguished Physicians . . . . . 269 7 ..Northwest Permanente Medical Families ...... 273 SOURCES ...... 275 INDEX ...... 295

xi FOREWORD k

What would later become Kaiser Permanente (KP) began as something of an afterthought for Henry Kaiser and as a job opportunity for young surgeon Sid- ney Garfield; Kaiser, the industrialist who drove himself and others to “Think Big,” couldn’t afford to let illness and injury among workers drain productivity on his big projects. Medical care had to be readily available in remote sites and capable of keeping workers healthy and on the job. For his part, the recently trained Garfield imagined a job that offered key features he’d enjoyed in his training: predictable pay, camaraderie with fellow physicians, and reliable cross-coverage during off hours. By 1933, Garfield had already opened a practice to serve workers constructing the Los Angeles aqueduct in the Mojave Desert. When Kaiser needed medical care for workers building the Grand Coulee Dam in Eastern Washington in 1938, he negotiated with Garfield to pay pennies per month per worker to provide this care. Prepaying for medical service to a defined population thus became the practical arrangement by which Kaiser and Garfield accomplished their objectives. Kaiser’s emphasis on productivity became even more critical in World War II, when he was assigned important projects in the Pacific Northwest. At his shipyards in Portland, Oregon and Vancouver, Washington, Kaiser sought to replicate his previous arrangement with Garfield to assure medical service to workers. The col- laboration between the two led to the hiring, in 1945, of internist Ernest Saward, who became Chief of Medicine. The KP Northwest (KPNW) organization did not come into being at that mo- ment. It wasn’t until after war’s end that Saward and others realized that the plan for shipyard workers also suited a civilian population: not only the salaried physi- cians, but also workers and their families whose costs for medical care would be predictable and shared among many others. A novel model for prepaid medical care emerged, linking physicians to groups of peace-time civilians. The history of this Northwest physician group parallels that of Garfield’s physicians in California; two groups with separate beginnings shared a template and later became affiliated as geographic Regions in a national Kaiser Permanente. The author of this account, Ian MacMillan, for many years confined his writing to notes in medical charts as an internist and rheumatologist with KP. For 14 of those years he was the well-regarded Chief of the Department of Medicine at Kaiser Sun- nyside Medical Center. He occupied the position when I joined the department

xiii PERMANENTE IN THE NORTHWEST

until I succeeded him in 1989. He was a proper and humane physician, born and reared in Saskatchewan, trained at Mayo Clinic, and proud of his Scottish anteced- ents—a red-head who invariably dressed in a trademark suit of muted color. He was unfailingly warm and encouraging to his younger peers and relished sharing stories that footnoted the humor and small surprises in our daily lives. In his narrative covering six decades of KPNW history, MacMillan exploits the opportunity to tell the stories of physicians and others in both major and minor roles. Testament to his broad curiosity, he enriches his archive with historical de- tail and context. The early concepts and arrangements by KP founders are tested by dramatic changes in public attitudes and expectations about health care and its costs and benefits. Prepayment was a cardinal feature of the arrangements Kaiser made with Gar- field and Saward and, as described by MacMillan, the issue that inspired hostility from the medical establishment of the day. Two other key features of the model were putting physicians on salary in an era of fee-for-service and assigning them shared responsibility for the ostensibly healthy in addition to the sick and injured. The implications of these have only gradually come to influence how physicians practice in KP. The use of collective resources for collective benefit turns physicians into trust- ees of members’ prepaid contributions or “resource stewards” in KP vernacular. The arrangement ought to encourage efficiency and health promotion—putting more emphasis on preventing disease or treating it early, refraining from unneces- sary testing and procedures, finding the simplest remedies, cutting out redundancy, and sharing important information among treating physicians. Permanente in the Northwest relates through small stories how a change in financ- ing medical care, implemented 60 years ago, created a rationale, and drove physi- cians to collaborate to deliver care to a population that included both the sick and the well. In telling this story, MacMillan has made the book relevant not only to past and present physicians who will find their names in the text, but also to the current national discussion of health care reform.

Arthur D. Hayward, MD Medical Director, Continuing Care Services Kaiser Permanente Northwest

xiv CHAPTER 1: THE ROOTS k

EARLY PREPAID MEDICINE IN THE NORTHWEST Although Kaiser Permanente (KP) was thought to be a radical departure from the established model of fee-for-service, its emphasis on prepayment, salaried phy- sicians and preventive health care was certainly not the first time these elements had been incorporated into a plan for delivering health care. Various other histori- cal precedents can be found for an alternative health care model. In 1883 St. Joseph’s Hospital in Victoria, British Columbia offered a health plan that included doctors’ visits, hospitalization, and medicine for one dollar a year. Even earlier, at the beginning of the 19th century, the men who built the railroads established systems to cover their workers’ medical expenses, employing com- pany surgeons to treat injuries. By the early 1900s mining and lumber industries, too, were hiring staff physicians, attracting them to isolated areas with guaranteed salaries. At first, facilities in the camps were primitive; physicians used homes or rustic offices as infirmaries. Later, companies built their own hospitals and clin- ics. Although contract medicine was recognized as a necessity in these isolated areas, medical societies viewed it with hostility. Contract medicine, they said, interfered with the patient-physician relationship and with fee-based remunera- tion. In addition, the medical community argued that contract physicians offered poor-quality care. Indeed, the medical community’s concerns about the general quality in medicine were justified. At the time, the profession of medicine was rife with unscientific practitioners and quacks promising unsound and unproven cures. Others, self-taught, with some knowledge of anatomy and pharmacy, passed themselves off as physicians. Unregulated medical schools proliferated. Until the late 1800s even regulated medical schools awarded an MD after just one year of post-graduate study. At the same time that industries were contracting for physician care for their workers, fraternal organizations and lodges were becoming popular in American life—especially among immigrants. Fraternal groups offered their own version of contract or “lodge” medicine. With dues collected from members, they placed phy- sicians under contract to provide medical care and the prerequisite physical exams

2 PERMANENTE IN THE NORTHWEST

GARFIELD’S HEALTH CARE PROGRAM FOR SHIPYARD WORKERS With the anticipated influx of 100,000 workers, the need for a health care program quickly became a matter of urgency. In January 1941 Henry Kaiser once again contacted Garfield to help provide medical care Eleanor Roosevelt visiting the Kaiser Vancouver for his rapidly growing labor force. Shipyard, April 1943; (left to right) Henry J. Kaiser, Eleanor Roosevelt, Edgar Kaiser, and Henry J. Kaiser, Jr. Garfield arranged contracts with in- Courtesy of the Oregon Historical Society, OrHi 49686. surance companies to cover medical and hospital care for on-the-job ill- ness and injury. The first group sickness and accidental insurance plan went into effect December 7, 1941. The cost was fifty cents per worker per day. By January 1942 the senior Kaiser and Edgar could see that medical care for the legions of men and women at the yards was still woefully inadequate. Again, Kaiser turned to Garfield for help. Making preparations for a tour of duty in India with the U.S. Army Reserve Medical Corps in Southern California, Garfield nevertheless re- sponded to his former partner’s call. This time he developed a far more comprehen- sive plan, using as his blueprint the basic health care concepts he had implemented for the huge construction projects at Desert Center and at Grand Coulee. By now influential in Washington DC, Kaiser was able to secure Garfield’s release from the army so that he might continue to organize health care for shipyard workers in California, Oregon, and Washington. Garfield believed that health care funding could be provided through a nonprofit medical foundation. Henry Kaiser must have concurred; in July 1942, they established The Permanente Foundation in California with Kaiser named Chairman of the Board of Trustees and his wife Bess a trustee. Within months Garfield established a similar Northern Permanente Founda- tion for the care of Portland-Vancouver shipyard workers, already numbering 10,000 and expected to grow to over 50,000. At first, both physicians and other health care workers were employed by the foundation. But because of American Medical Association objections to physicians employed by a lay organization, the physicians became employees of Garfield himself. Next Garfield arranged a separate prepaid health plan for shipyard workers at and at St. Helens with Oregon Physicians Service, an organization of the Oregon State Medical Society. Its agreement with Oregon Ship Corpora- tion stipulated that Oregon Physician Service would provide care for more than

24 Chapter 2: Wartimes 1941-1945

cal profession.” The editorial ended with the question, “Can established practitioners and specialists adapt themselves to this type of medical care?” Two Permanente physicians, Saward and pe- diatrician Charles Varga, also joined the edito- rial staff. Others—surgeons Norman Frink and Gilbert Rogers and orthopedist F.J. Roemer— were Bulletin contributors. In 1951 another Permanente publication—The Educational Pro- ceedings of the Permanente Hospitals—appeared. It had a 2-year life before combining with the Bulletin, to become The Kaiser Foundation Med- ical Journal.6 The Journal, after 4 years, ceased publication in 1958, leaving a void of 36 years. In the absence of a regional or national Per- manente publication, several clinical depart- First issue of Permanente Bulletin featuring papers by TPMG pioneer ments in the Northwest Region published Cecil Cutting on treating wounds of monthly clinical newsletters. Then in 1994, shipyard workers with Sulfonamides Permanente physicians Tom Janisse7 and and Morris Collen on the treat- Continuing Medical Education (CME) Di- ment of pneumonia. The successes described in the pneumonia paper rector Phillip Brenes, in collaboration with would draw national medical at- Merry Parker, Clinical Publications Editor, tention to the new Health Plan. consolidated these disparate publications Permanente Foundation Medical Bulletin into a new quarterly journal, with each de- courtesy of TPMG Archives. partment allotted space for newsletter con- tent. The Northwest Permanente Journal of Clinical Practice enjoyed a 3-year run. Then, with support from Regional Medical Director Allan J. Weiland, Janisse, by now Interim CME Director, and his CME Manager counterpart Chris Over- ton proposed to the Medical Directors of all Regions a national organizational medical journal to focus on physician practice, experience, and innovation. The Permanente Journal (TPJ) debuted in the summer of 1997. Published quarterly, TPJ enjoys a print circulation of 25,000, with distribution to 16,000 physi- cians (active and retired), 5,000 clinicians, and 4,000 leaders, managers, and researchers within KP. What Garfield could never have imagined is this: today, 66 years after the 1943 first publication of The Permanente Foundation Medical Bulletin, 600,000 people in 164 countries throughout the world access a Per- manente Medical Group journal through the Internet.

31 PERMANENTE IN THE NORTHWEST

In April 1948 the Board of Trustees of Northern Permanente Medical Foundation, meeting for the first time since its 1942 founding, gathered at the Oakland corporate headquarters around a large mahogany table in a meeting room overlooking the city and the San Francisco Bay. There Saward presented his case for partnership. Garfield did not support Saward’s request. Nevertheless, The Permanente Medical Associa- tion Partnership became official on July 1, 1948. The partnership agreed to pay the Foundation a $5,800 monthly fee for office space and clerical support at the Northern Permanente Hospital and an additional $900 monthly rent for the Broadway Clinic. No sooner had the partnership formed than the physicians had to confront serious disagreements about its mission and its elemental make up. Some advocated a private- practice model; others, like Noehren, envisioned a socially progressive practice. Other issues that aroused strong views were the optimal number of for each physician, the amount of time that should be allotted to each patient visit, and remuneration. In February 1949 Saward was an overnight guest at Grossman’s Berkeley home,4 in preparation for another meeting with the Board of Trustees. The following morning both men appeared before the Board around the impressive mahogany table in the room with its expansive views. This time, however, Garfield was not present. As part of a reorganized agreement, those assembled agreed to rename the partnership The Permanente Clinic. Grossman saw nothing unusual in the $1,500 check he received in the mail one month after this meeting. The accompanying explanation that the money was a return of his capital investment in the Permanente Medical Association seemed reasonable, a mere bookkeeping procedure, he thought. Then he received a warning from his friends Morris and Barney Malbin. They claimed that Saward appeared to be threatening Gross- man’s interest in the partnership. Only later did Grossman learn that his name had been omitted from the new partnership agreement. Looking back, Grossman said that these signals should have aroused his suspicions. As it was, on his return to Vancouver in Sep- tember, he enjoyed a pleasant evening with Saward and several medical residents who

The Broadway Clinic offices, opened in 1947 as the first Kaiser Permanente facility in Portland, Oregon. Courtesy of Kaiser Permanente Heritage Resources.

40 CHAPTER 5: VIENNA, VLADIVOSTOK, AND VANCOUVER: THE NORBERT FELL STORY k

Of all the journeys that brought physicians to Northwest Permanente (NWP), perhaps none was more compelling or more harrowing—with its elements of fear, courage, and luck—than that of the gentlemanly Norbert Fell. Born in Vienna in 1898, Fell was drafted into the Austrian army in 1916. Just 18 when he became a soldier, Fell quickly ascended the military ranks to become a lieutenant in charge of a company of Bosnian Muslims. Twice wounded at Trieste, once when he led his company to capture a hill and again when the bridge he stood on was destroyed by a dynamite blast, he recovered at a and made a pledge that should he survive his wounds, he would become a physician. Survive he did, and as a veteran he received the second-highest award of the Austro-Hungarian Empire. Returning home, he witnessed the awful aftermath of war: widespread poverty, hunger, and suffering. He re- solved then to make good his promise, and he completed his medical training in Vienna in 1923. His eminent teachers in- cluded Clemens Pirquet, who introduced the tuberculin test and coined the word “allergy”; Karl Landsteiner, the devel- oper of the modern system of blood group classification (A, B, AB, O); and the legendary Sigmund Freud. By the late 1920s, Fell had Bess Kaiser Hospital before the addition, circa 1960. a well-established practice in Courtesy of Acroyd Photography. internal medicine and pediat-

56 SOURCES k

INTRODUCTION Starr, Paul. The social transformation of American medicine. New York: Basic Books; PART I: A LENGTHY PROLOGUE 1982. CHAPTER 1: THE ROOTS 75th Finnish Hall Anniversary Program, April Smillie, John G. The story of the Permanente 1985. Medical Group. Oakland, CA: The Perman- ente Federation; 1996. Author interview with Merle Reinikka, Presi- dent United Finnish Kaleva Brothers and Gilford, Steve. On This Date in KP History Sisters Lodge #23, 2004 June. #133: Return to Desert Center. Heltzel EE. Finn Hall’s history often turbu- Gilford, Steve. On This Date in KP History lent. The Oregonian 1979 April 28; p B1. #265: Garfield as a Surgeon. History of Portland UFKB and S Lodge #23: Gilford, Steve. On This Date in KP History translation from Finnish; Grand Lodge His- #304, #305 Young Sidney Garfield: Part 4. tory Committee. Lewis Weeks interview with Sidney Garfield. Town Hall—Then and Now. The Pulse 1979 Hospital Administration Oral History Col- Oct;8(10). lection: Lewis E Weeks Series. American Hospital Association; 1986. Press release: Finnish group return to historic Portland landmark. Portland: OR, Kaiser Gilford, Steve. On This Date in KP History Permanente Northwest Department of Public #342: Garfield Centennial Year: First he was Affairs; 1991 Apr 3. a Surgeon. Cutting, Cecil. An oral history of KP medical Inside KP Northwest: Quints birth forges program Vol. IV. Berkeley, CA: Bancroft lifelong link with delivering doctor. Portland, Library; 1986. OR: NW History; 2003. Author interview with Cecil Cutting, June Gilford, Steve. Blasts From the Past 2003. 1996;I(7). Spitzer, Paul C. Grand Coulee: harnessing a Gilford, Steve. The road from Desert Center dream. Pullman, WA: WSU Press; 1994. Video; KP Audiovisual Center Steve Gilford. Foster Mark S. Henry J Kaiser: builder in the Communication from Steve Gilford, April modern American West. Austin, TX: Univer- 2002. sity of Press; 1989. Stewart, Walter. The life and political times Interview with Wallace Neighbor, Sept 20, of Tommy Douglas. Toronto, Canada: McAr- 1974. TPMG Archives. thur and Co; 2003.

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Hendricks, Rickey. A model for national Noehren WA. Briefs Plan. The Sandy Post health care: The history of KP. New Bruns- 1962 May 10. p 3. wick, NJ: Rutgers University Press; 1993. Noehren Walter, Hegrenes Jack Jr. Medical Author interview with Becky Kaiser, care of everyman. Report to the American August 2005 Medical Association. 1962 May 15. Gilford, Steve. Inside KP: KP days of PACC Report to the State of Oregon Con- yesterday in the wild west. sumers and Business Services. 1995 Sep 28. Robins George M. History of the Multnomah Crowley Walt. To serve the greatest number. County Medical Society: 1884-1954. Seattle, WA: University of Washington Press; The Oregonian. September 19 1935. 1996. Cleland John GP. Essentials of an indus- Glickstein D. Group Health Cooperative of trial health program. NW Medicine 1956 Puget Sound—A short history. Perm J 1998 Sep;44:973-4. Spring;2(2):60-1. The Oregonian. July 19, 1935. 39 Wh2d586 GHC appellant vs King County Medical Society Medical Society, et al. No- Cleland John GP. The history of medical care vember 15, 1951. in Clackamas County. 1976 May. Rhodes, Richard. The making of the atomic Author interview with Janet Hochstatter, bomb. New York: Simon and Schuster; 1986. June 2006. Wells, H.G. The world set free. London: Author interview with John Cleland, MacMillan & Co; 1914. July 2006. Libby, Marshal. The uranium people. New Author interview with Paul Brown, July 2006. York: Charles Scribner and Sons; 1979. The Scribe. March 1988. Author interview with Lady Elizabeth The Scribe. Vol. XII # 6 1995. Saward, April 2003. The Scribe. June and Nov 1997. Author conversations with Ernest Saward, 1962. The Scribe. Mar, Aug 1998. MacKenzie GM. Experiment in collective The Oregonian. April 15, 1993. medical service; JAMA 1932 July 9;99. Noehren W. A proposal concerning Noehren, Walter A. Psychiatry I Hanford. prepayment medical care. J Pediatr 1947 Am J Psychiatry 1946 Sept. Dec;31(6):704-9. Smillie interview with Ernest Saward, What is the Clackamas County plan? The June 2, 1982. Bulletin: MCMS 1962;SVII(4). Hawn, Clinton VanZandt. History of Mary Resolution 16, House of Delegates. Chicago, Imogene Bassett Hospital [monograph on the IL: American Medical Association; 1961. Internet]; excerpted from The Mary Imogene Correspondence: Clackamas County Plan. N Bassett Hospital. Cooperstown, NY: Bassett Engl J Med 1961 Nov 23. Healthcare Network; 2010 Mar 17 [cited 2010 Mar 17]. Available from: www.bassett. The Oregonian. June 25, 1962. org/history.cfm.

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Author interview with William Nelson, Author interview with Chuo Chang, December 2006. April 2007. Author communication with Joseph Davis, Author interview with Keith Riley, May 21, 2007. April 2007. Author interview with Thomas Syltebo, www.finegold.org [home page on the February 2007. Internet]. Rocky Pointe, NY: Finegold Author interview with Scott Feuer, Association of the United States; updated February 2007. 1/20/10 [cited 2010 Mar 10]. Available from: www.finegold.org. Author interview with Nicholas DeMorgan, January 2007. Kaiser Permanente Planning For Health. 1988 Spring. Author interview with Jon Blackman, June 2007. Regionalization of Ob/Neonatal Services: an outline of issues. Exhibit #3. Northwest Author interview with William Nyone, Permanente Board of Directors meeting February 2008. January 15 1987. Glickstein D. Group Health Cooperative of Hayward interview with David Lawrence, Puget Sound—A short history. Perm J 1998 November 2003. Spring;2(2):60-1. Northwest Permanente Board of Directors Crowley Walt. To serve the greatest number. meeting minutes, April 19,1985. Seattle, WA: University of Washington Press; 1996. Blomquist letter to Maurice Comeau, Chairman of Compensation Committee, Inside dope on x-rays. The Pulse 1944 April 23, 1985. April;2(10). Northwest Permanente Compensation Author interview with Henry Kavitt. Committee meeting minutes, May 6, 1985. April 2002. Northwest Permanente Board of Directors Gorsbach film with Henry Kavitt [video], meeting minutes, May 14, 1985. 2002. KPNW Public Affairs Department. Author interview with Fred Nomura, O’Boyle, Bobby. From x-ray to imaging October 2007. services. Portland, OR: KPNW Printing and Graphics; 1999. Author interview with Ronald Potts, October 2007. Author interview with Ben Brown, February 2007. The Columbian. July 7, 1988. Author interview with Darlene Fortuny, RN, The Columbian. July 8, 1988. March 2007. Weiland, Allan. The nurse strike of 1988. Author interview with Robert Lawrence, 2007. March 2007. Summer strike, record growth headline: Author interview with Michael Noonan, 1988 events. The Pulse 1989 Spring [Special April 2007. edition].

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Nomura memo to NWP Board March 11, 1989 AFTERWORD: WHAT Schecter P. History of the Oregon HAPPENED TO THE Nurses Association: The labor of caring. PIONEERS? Oregon Historical Quarterly 2007 Author interview with Elizabeth Gallagher Spring;14,16,18-19,24-29. Saward, April 2003. Robins, George. History of the Multnomah Smillie, John G. The story of the Permanente County Medical Society: 1884-1954. Medical Group. Oakland, CA: The Perman- Portland, OR: Multnomah County Medical ente Federation; 1996. Society;1990. Kneeland, Donald. An oral history: Interview Cleland, John GP. The history of medical with David W. Stewart. Rochester, NY: Blue care in Clackamas County. Oregon City, OR: Cross/Blue Shield of the Rochester Area; Clackamas County Medical Society; 1976. 1987. Cleland John GP. Essentials of an industrial Comments from Joseph Dolittle, Rochester health program. NW Medicine 1956 health care executive, July 2008. Sep;44:973-4. Telegram to Ernest Saward (invitation Author interview with Janet Hochstatter, to attend signing of Medicare Bill) from June 2006. Laurence O’Brien, Assistant to the President, July 29,1965. Author interview with John Cleland, July 2006. Saward, Ernest. Statement of Kaiser Medical Care Program before the Senate Committee Author interview with Paul Bowen, on Government Operations, July 11, 1968. August 2006. Saward E. Health Care Crisis, The University Collins C. Good Sam, HealthLink consider and Society Rochester Medical Review 1970 merger. Portland Physician Scribe 1988 Mar Fall;3(2). 7;4(5). Saward E. Physician Education in the Peoples Davis B. PACC taps Klevit to head medical Republic of China. Connecticut Medicine affairs. Portland Physician Scribe 1995 Mar 1976 Jan;39(1). 17;7(6). National and the internist PACC physician members OK sale to FHS: (comments from Ernest Saward). The merge with Qual Med. Portland Physician Internist 1975 Jun:10-11. Scribe 1997 Jun;15(11). Saward Ernest; Axelrod, Solomon; Sigmond, Collins C. Shake up at Qual Med. Portland Robert. Report of the Health Education and Physician Scribe 1998 Aug 21;16(16). Welfare Task Force on Appalachian Regional Hospitals to Joseph Califano, Jr. September 15, 1977. CHAPTER 19: THE NINETIES Letter to Ernest Saward from Edward M by Allan J. Weiland, MD Kennedy, Chairman, Senate Subcommittee On Health and Scientific Research, May 14, 1979.

293 PERMANENTE IN THE NORTHWEST

Saward EW, Gallagher EK. Reflections on change in medical practice. The current trend to large-scale medical organizations. JAMA 1983 Nov 25;250(20):2829-5. Maritato, Anna Maria. Saward Eulogy, Interfaith Chapel, University of Rochester. September 7, 1989. Author interview with Jaimie Noehren, April 2005. Author conversations with Charles Grossman, 2006. Grossman Charles M, editor. Evans Carlson’s legacy of friendship: 30 years of the Evans F Carlson Friends of the People’s Republic of China. Portland, OR: Evans F. Carlson Friends of the People’s Republic of China; 2005. Author correspondence from Norman Frink, Sr, 1984-1987. Northwest Permanente Retirement seminar, 1982. Communication with Norman Frink, Jr, November 23, 2004. The Oregonian. April 21, 1991. Author interview with Alyce Fell Rene, February 2006. Author interview with Norman Malbin, June 2006. Conversation with Charlotte Cohen, May 25, 2007.

294 k INDEX k INDEX k

Italicized page numbers indicate American Academy of General Angelic Conjunction (Mather), 158 photographs Practitioners, 115 Ansell, Barbara, 121 American Board of Family Antabuse, 146–147 Abrams, Stanley, 140, 142–143, 247 Practitioners, 116 antibiotics, 92, 111, 123–124 Ackerman, Douglas, 88 American Board of Internal Medicine, antidepressants, 139 acquired immune deficiency syndrome 115 Antoniskis, Diana, 190 (AIDS), 124, 189–191, 249 American Board of Medical Ariniello, Edward, 83 Specialties, 245 Acute Post-Operative Pain Services, 91 Armstrong, William, 81 American College of Physicians acute psychiatric emergency Arnold, Roberta, 59 (ACP), 115–116, 227, 230, 244 management, 145 arsphenamine (arsenic) injections, 15 American health care system addiction medicine, 109, 146–149, 248 artists, shipyard, 22–23 overhaul, 198–199 Adlhoch, George, 65, 84 artwork, 155–157 American Medical Association (AMA) Adolescent Chemical Health Program assisted-living facilities, 129 (ACHP), 148–149 annual meeting in Portland, 65, 235 Association of American Physicians code of ethics, 63 adult foster homes, 129 (AAP), 115, 244 health insurance position, 7, 64, 227 Aebi, Ernest H., 232 atom bomb, 10–11, 231–232, 240 , 34 Aebi, Ernest P. Au, Phillip, 119, 203 KP, relations with, 26, 33, 60–61, 65 background, 67–68 August, Peter, 261 “lodge” medicine condemnation, 3 induction speech, 257–259 autoanalyzer, 111, 244 origins, 61–62 MCMS membership, 103–104, 235 Axman, Michael, 99 policy, 4, 24, 33, 61–63, 115 ophthalmologist, 107, 232 Azevedo, Dan, 208–210, 213 Aeromechanics Union, 5 prepaid group-practice opposition, Aetna, 169 49, 61 Resolution 16, 48–49 AIDS, 124, 189–191, 249 Bach, Ruth, 138 American Socialist Party, 3 Albert, Thomas, 163, 243 Bactic machine, 112 American Society of Alcohol and Drug Recovery Services Baer, Daniel, 109, 110, 243 (ADRS), 147 Anesthesiologists, 240 Bailey, Kathy, 161 Alcohol Treatment Program (ATP), American Society of Internal Baker, George, 118, 119 146–147 Medicine, 116 Bakke, John, 117, 120, 202 Alcoholics Anonymous (AA), 147 amitryptiline (Elavil), 139 Ball, Lucille, 34 alcoholism treatment, 146–149 Amstutz, Paul, 87 Baragwanath Hospital, 120 Allen, Lee, 131–132 Anderson, Barbara, 75–76, 237 Barnaby, Richard, 212–213 allergists, 189–190 Anderson, Bradley, 149 Barnhouse, Dean, 68, 80, 238, 246 “allergy,” 56 Anderson, Eldon, 120, 137 Barrymore, Ethel, 22 allergy clinic, 92, 136, 185, 189–190 Anderson, Karen, 95, 100–101, 229 Barton, George, 123 Allergy Department, 92, 136, 185, Anderson, Roger, 81 Barton, Lane, 151 189–190 Anderson Quintuplets, 95, 100–101, 229 Basye, James, 169 Allied Health Council Award of anesthesia, history in Oregon, 88–89 Excellence, 240 Anesthesiology Department, 89–91, Bauman, Martin, 217 Altman, Ivan, 82, 83, 174 204, 240 Bayer, Rick, 239 Bean, Ron, 178

297 PERMANENTE IN THE NORTHWEST

Beaverton Medical Office, 177, 193, Bodie, Mary, 129 cardiac catheterization unit, 237 194, 242 Boehm, Rick, 148 Cardiology Department, 117–119, 237 Bedford, Clay, 9, 19 Bogaty, Eugene, 108 cardiopulmonary bypass surgery, 241 Behrens, Hans, 106 Bondurant, John, 52 Care Management Institute, 163, 211 Belluschi, Pietro, 20 Bondurant, Marjorie, 52 Caremark Services, 251 Benny, Jack, 22 Bonneville Dam, 9, 19, 34, 36 Carey, Thomas, 88 Berger, Ben, 178 Bookhotz, Frederick, 29, 81 Carlson, Evans, 228, 252 Bergeron, Lester, 105–106 Borok, William, 107, 243 Carney, Jean, 190 Berlin, Walter, 87 Boulevard Shopping Center, 20 Carpenter, Ted, 210 Bernardo, Augusto, 82, 235 Bowne, Stuart, 110, 191–194, 196 Carpenter, Timothy, 148, 180 Bernardo, Peter, 68, 235 Bradley, Bud, 34 Carty, Alex, 246 Bess Kaiser Hospital (BK), 56 Bradley, Edward, 92, 241 Cascade Park Medical Office, 157, anesthesia, 90 Brady, Raymond, 189–190 186, 206 closure, 88, 91, 119, 191, 201 Breen, Victor, 246 Caulfield, Harry, 212, 217, 218 construction, 52–54 Brenes, Judi, 148, 190 Cave, Colin, 67 , 79–81 Brenes, Phillip, 31, 96, 100 Cedar Hills Hospital, 147 evening clinics, 178 Brennan, Don, 186–187 Celebrex, 211 family practice, 177 Bridges, Harry, 36–37 Center for Ethics in Health Care, 249 gastroenterology, 122 Broadway Clinic, 41 Center for Health Research, 54, high-risk maternity services, 203 early years, 39–40, 92 140–141, 161–162, 226, 247–248 KPNW core facility, 198, 258–259 services, 113, 136–137, 190 Central Interstate Medical Office, 132, nursing strike, 195–197 Brodhacker, James 137, 138 pediatrics, 93, 97 assistant area medical director, 194 certified managed-care organizations (CMOs), 246 physical therapy, 149 career overview, 80 certified nurse midwives (CNMs), 99 pulmonary function lab dispute, 173 internal medicine chief, 117, 192 certified registered nurse radiology, 114 Medical Group leader, 219–220 anesthetists (CRNAs), 90 reputation, 201 VP of operations, 205 Chaffee, John, 12 surgery department, 83–84 bronchofibrescope, 127 Chan, George, 109 BestCare, 66, 251 Broselow, Robert, 99 Chandler, Stephen, 120, 137, 163–164 Bilboa, Joseph, 51–52 Brown, Ben, 114, 188 Chang, George, 83, 251 Bilboa, Marcia, 52 Brown, Jonathon, 210 Chang, Kuo, 189–190, 250 Bills, Richard, 156, 216 Browning, Joan, 134 Chapman, Anna, 97 Binkley, Chris, 213 Buie, Louis A., 33 Chapman, Jean, 246 Birndorf, Norman, 120, 137 Bunce, Louis, 232 Charles Varga Memorial Award, 241 Bisio, James, 84 Burgess, Ernest, 81 Chase, Alide, 208, 219 Biskar, Herbert, 141, 247 Burt, Richard, 88 Chate, David, 106 Blackman, Jon, 177, 185–186 Bush, George W., 245 Chawla, Sushma, 109, 158 Blackwell, Elizabeth, 158 Butler, Willis, 235 chemical dependency treatment, 109, Blair, Neil, 209, 242 Button, Lucius, 41–43, 82 146–149, 248 Blair, Raymond, 94–96, 242 Butzer, Mark, 93 Chester, Alyce, 45 Blakely, Timothy, 210 Byers, Lori, 161 childcare centers, 23 Blank, Nathan, 123, 244 Chin, Homer, 208–209, 213, 217, 219 Bledsoe, Turner, 187–188 chiropodists, 239 blood letting, 62 California Medical Association, 67 Chiu, Vincent, 121–123 Blue Cross, 12, 184, 199, 225, 251 cancer, 131–132, 138, 190, 246, chlorpromazine (Thorazine), 139 Blue Cross Cowlitz Medical 247. see also Oncology Department cholera epidemic (London), 252 Service, 184 cancer support groups, 138 Chronic Pain Management Clinic, 91 Blue Shield, 225, 251 Capital Health Care, 180–182 Chu, Phillip, 73–75, 235, 237 capitation, 48, 198, 199, 259

298 INDEX

Church, Gilbert, 15 Community Care Department, 164 Delaunay Center, 140 CIGNA, 187, 245 Community Choice Care, 184 DeLong, James City of Tualatin Art Walk, 157 Community Fund, 197, 251 background, 22, 34–35 Clackamas County Medical Society, community health plan promotion, 33 BK administrator, 35, 109 4, 7, 68, 197 community service funds, 250 with former NPH staff, 51 Clackamas County Oregon Proposal community volunteer physicians, Hawaii operations and, 72–74, 237 (Medical Care for Every Man), 7 162–164 Memorial Day Flood, 38–39 Clark, Louise, 129 computerized axial tomography Demas, Larry, 106 Clark, Marci, 160, 219, 248 (CT), 114 DeMorgan, Nicholas, 183 Clark County Hospital, 204 computer-tracking-and-reporting DeMuth, Tina, 86 Clark County Medical Society, 27 system, 111 Denker, Arthur, 246 Clark United Providers (CUP), 205 Consolidated Builders Incorporated, 9 Dermatology Department, 130–132, 246 Clarke, David, 122–123, 244 Consolidated Medical Management Desert Center, 7–8, 24, 60, 160 Team, 128–129, 245 Cleft Palate Team, 163, 243 DeSilva, Joe, 140 Contorer, Paul, 130–132 Clinical Microbiology Institute, 111 Devilliers, Gordon, 99 contract medicine, 2–3 clinical pathology, 111 DeWeese, David, 105 Contractors General Hospital, 7, 160 Clinton, Bill, 198–199 diabetes, 120–121, 210–211 Cooper, Bill, 157 Clinton, Hillary, 198–199 The Diabetes Project, 210–211 Cooper, Larry, 145–146, 163 Coburn, William, 99 dialysis, 124–126 Copeland, McCague “Mac,” 59, 124 Coffey Memorial Hospital, 29, 59 Dick, Jack, 21 Coronary Care Unit (CCU), 118 Cohen, Charlotte, 34, 38, 98, 230 Didlick, Lynn, 191 Corrigan, Rogert, 246 Cohen, Harold Diller, Duane, 103 Courogen, William, 85 Anderson Quintuplets, 100–101 Dillman, Theodore, 82 Crandall, Dale, 217, 218–219, 221 innovations, 99 disease management, population- MCMS acceptance, 65 Craven, Timothy, 246 based, 210–211, 216 Memorial Day Flood, 38 Crawshaw, Ralph, 66–67 disease registry, 210 NPFH internship, 34 critical care medicine, 127, 245 Dishman, Jess, 99 obstetrics chief, 98–99 Crosson, Jay, 217–218, 221 Dockery, Ray, 184 partnership member, 42–43 Crown Zellerbach, 184 A Doctor for the People (Shadid), 5 retirement, 230 Cuba, 154, 231 The Doctors (film), 244 Cohen, Richard, 97 Cuban Missile Crisis, 122 Doctors Clinic, 36, 233 Colbach, Josephine “Sunny,” 80, Cutting, Cecil, 9, 10, 31, 79, 160 Dodge, Richard, 70, 235 81, 158 Cutting, Millie, 160 Donovan, Marilee, 91 Colgate College, 11–12 cytogenetic laboratory, 112 Dougan, Craig, 80, 268 Collen, Morris, 29–31, 44, 46–49 Dougy Center for Grieving Children Collins, Jan, 124–125 and Families, 246 Colorado region, 128, 172–173, 192, Dafoe, Allan, 242 Dow, Robert, 123 212–213 Dammasch , 140 Drake, Richard, 124 Columbia Villa, 20–21 Daniels, Dorothea, 237 Drobac, Martin, 74 The Columbian, 78 Dantas, Lenora, 158 Drummond, Jane, 159 Columbo, Theodore, 146 Davis, Aubrey, 188, 250 Dubay, Charles, 178 Colwell, Fred, 63, 73, 93, 100 Davis, Brad, 67, 235 Duckler, Lawrence Comeau, Maurice, 66, 67, 68, Davis, Joseph, 133, 185 BK career overview, 54, 79, 82 105–106 Davis, Richard, 82 with former NPH staff, 51 Committee on the Cost of Medical Davolt, William, 99 industrial medicine organizer, Care, 62–63 De’ak, William, 182–185, 191 132–133 Common Plan, 169, 171–172 Dearing, Tom, 172 on-call shifts, 78–79, 84 communist conspiracy theories, 74, 252 Debley, Tom, 7, 160 Duckler, Mary Dawn, 99 Communist Party meeting notice, 3 Deering, Donald, 103, 173 Duewel, Helen, 129

299 PERMANENTE IN THE NORTHWEST

Dung, William, 74, 75, 176 Emergency Treatment and Feingold, Ben, 189 Dunham, Marcia, 159 Management (Flint), 79 Feldman, George, 126, 158, 164, 245 DuPont, 13–15 Emerick, Charles, 105–106 Feldman, Peter, 83, 126 Durant, Richard, 70, 235 Emeritus Staff program, 155 Feldman, Virginia, 97, 158, 159, 164 Durgan, Mildred, 132 Emery, John, 117, 176–177 Feldstein, Adrianne, 134–135 Dvorak, Carl, 209 Employee Retirement Security Act Fell, Albert, 57–58 Dworkin, Lawrence, 209 of 1974, 248 Fell, Alice, 57–58 Dwyer, Patrick, 81 endocrinology, 96, 120–121 Fell, Norbert Dwyer Memorial Hospital, 173 Enthoven, Allain, 199 background, 56–59, 102 Epic Systems, 208–213 physician leader, 29, 32, 43, EpicCare, 208–213 50, 54 East Interstate Medical Office (Health epidemiology, 161, 206, 252 retirement, 229 Center East), 137, 144, 146, 190, 191 Esselstyne, Caldwell, 64 Fell Jennie, 56–57, 59 economic credentialing, 199 Ethanolism Research Program, fellowship-trained physicians, Edwards, Jack, 89–90, 240–241 146–147 116–121, 126 Edwards, Lowell, 250 ether anesthesia, 89, 90 Fermi, Enrico, 231 Edwards, Miles, 249 Evers, Katherine “Kitty,” 142–147, 159 Filosa, Lawrence, 197, 251 Eigner, Frank, 185 Ewa Sugar Plantation, 74 Finch, Clementine, 51 Einstein, Albert, 10 experience rating, 250–251 Finnish Hall, 3. see also Town Hall Eisenhower, Dwight D., 122 External Affairs, 157 Finnish Workers Association, 3 Elavil, 139 eye-ear-nose-and-throat (EENT), Finter, Cynthia, 221–223 Elder, Charles, 224 102–103 Fishbein, Morris, 7, 26 electroconvulsive therapy (ECT), 91, Fisher, Carl, 89 139, 144 Fitch, Michael, 178 electromyography (EMG), 151 Fabian socialism, 25 Fitzgerald, Patrick, 128–129 electronic medical record system FACES Foundation, 163 Fitzgibbon, John H., 60 clinical information availability, Fairbanks, Virgil, 119–120 Flaherty-Robb, Marna, 190 211–212 Falstaff annual meeting, 168–169, Fleming, Scott, 71, 73, 166, 168, drug recall efficiency, 211–212 249, 260–267 249–250 early computerized record Family Practice Department. see also Fleming, Timothy, 88 keeping, 120 primary care flexible endoscopy, 122 in Northwest Region, 208–213, 219 developments, 185–186 Flexner, Abraham, 61 patient care improvements, early stages, 116, 176–177 Flexner Report, 61, 115, 158 209–211 family practitioners, 116, 159, 164, Flint, Thomas Jr., 79 176–179 Eleff, Morton, 93, 242 Florendo, Dennis, 142–143 nonphysician staff, 176–179 Elk City, Oklahoma, 5 flu epidemic, 25 residencies, 115–116 Elwood, Paul, 249 Folk Time, 163 scope of practice, 182–183 Emergency Department for-profit health care, 3–4, 44 women physicians, 159, 164 acute psychiatric emergency Forsythe, Matthew, 88 family practitioners, 116, 159, 164, management, 145 Fortsch, Byron, 65, 104, 106 176–179, 182. see also Family at BK, 78–79 Fortuny, Darlene, 189 Practice Department; primary care challenges, 80–81 Fossati, Dale, 122 Farm in Friesland (Pander), 157 electronic medical record, 210 four-lead electrocardiogram Faulkner, Judy, 209 at KSMC, 174, 238 machine, 117 Fawkes, Judith Poxson, 156 nurses, 80 Frank, Andrew, 129 Federal Employee Health Program, patient protocols, 216 Frank, Edmund, 87 231, 249 violent incidences, 238 fraternal groups, 2–3, 253 federal medical care, 64–65, 176 women physicians, 159 fee-for-service plans, 2–4, 7, 16, 25, 53, 66–67

300 INDEX

Frattaroli, Nicholas, 99 partnership problems, 40 regional medical director, 111, 132, Frederickson, Margaret, 59 PAS problems, 26–27 143, 147, 181, 182 Freis, Jack, 161 preventive medicine advocate, 60 resignation, 193 Freitag, Hal, 21 as the “red or gray fox,” 28 SCPMG area medical director, Fresenius Medical Care, 125 at Richmond, 25 San Diego, 175 Freud, Sigmund, 56 shipyard health care program, Goldberg, Sarah, 191–192 Friendenbach, Marilyn, 138 24–25 Goldman, Lee, 128 Fries, Jack, 168, 176 shipyard speaker, 22 Goldsmith, Oliver, 212, 218 Frink, Norman Tahoe sessions, 48 As Good As It Gets (film), 199 background, 34–35 TPMG involvement, 42–46 Goodwin, Morton, 64 Bulletin contributor, 31 Garrett, Elizabeth, 158 Gordon, Ann, 89 in Hawaii, 73 gastroenterology, 121–123, 245 Gordon, Steven, 209 medical group relations, 41–43, 166 “gay plague,” 190 Gorgeous George, 102 podiatry service advocate, 85 genetic consultations, 112 Gourley, Richard, 109, 243 post-KP career, 228–229 Geneva Medical College, 158 Graham, Alvin, 114 sabbatical, 78 George, Roger Grand Coulee, 8–11, 24, 60, 89, 154 surgery chief, 79, 82–83, 87, Anderson Quintuplets, 100–101 Grebstad, Jennings, 103, 107, 242 104, 108 background, 34, 242 Greenlick, Merwyn (Mitch), 111, 157, Tahoe sessions, 48 at BK, 59 161–162, 210 tuberculosis treatment pioneer, 35 medical group relations, 41, 43, 166 Gregory, Victor, 140–143 Underwood mentor, 90 obstetrics chief, 97–98 Grodsky, Pauline, 158 with young patient, 81 post-KP career, 229 Grossman, Charles Fritsch, Arthur, 189 Gerhardt, John, 149–152, 248 clinical research, 29, 34 Froelich, Walter, 109 Geriatrics and Long-Term Care with former NPH staff, 51 From X-rays to Imaging Service Department (GTLC), 121, 128–129 leave of absence, 34, 233 (Kavitt), 114 Germany, 18, 56–57, 234 medical group relations, 40–43 frozen-section procedure, 108, 243 Gilford, Steve, 8, 160, 233–234 Memorial Day Flood, 38 Fuchs, Kyle, 126 Gillette, Raymond, 9, 10, 22, 29, 97 with original partners, 42 Fuller, Albert, 141, 247 Gilliland, Virginia, 59, 92, 158 physician leader, 32–35 Gillis, Harold, 117 post-KP career, 227–229 Ginsberg, Jill, 164 at SCPMG, 34 Gabor, Ferenc, 88 Giralt, Carlos, 180 with Weiland, 198 Gangle, Martina, 22–23 Glass, Andrew, 135–138 Group Health (Cooperative) Garber, Seth, 196, 198, 214 Glauber, Harry, 120–121, 210 AMA challenge, 33 Gardner, Byron, 232 Glickman, Terry, 119 background, 4–6 Gardner, Susan, 161 Gloekler, Eberhard, 123, 239 family practitioners, 176–177 Garfield, Sidney Goff, Thomas, 140, 141 for ILWU workers, 37 AMA affiliation, 235 Goldberg, Marshall, 128 KPNW merger talks, 214–215 background, 11 Goldberg, Marvin management, 186–188, 199, BK design influence, 53 background, 175 231, 250 commendations, 30 friendship with D. Lawrence, Group Health of Spokane, 187 at Desert Center, 7–8 191–192 Group Health Permanente Medical founder of CA medical groups, 257 medical director for Medical Group, Group, 215 at Grand Coulee, 8–10 169, 173 group practice grant, 121 medical director of Permanente commission study, 49 at Hanford, 16 Clinic, 65–66, 84 cooperative medicine, 258 health research advocate, 161 at Montana Clinic, 172 endorsement of, 16, 30, 52, 62, 226 Northern Permanente Foundation pediatrician, 175 prepaid, 5, 10, 16 Hospital, 27–28 physician recruitment, 87 prevalence of, 49–50

301 PERMANENTE IN THE NORTHWEST

Resolution 16, 48–49 occupational medicine, 135 Heller, Karl, 29 stigma, 5–6, 25, 27, 33, 61 opposition to, 74 hematology, 119–120, 137 group sickness and accidental “pinkies,” 74 hemodialysis, 124–126 insurance plan, 24 vs. PMA, 235–237 Henry J. Kaiser Company, 8–9 Grover, John, 118, 119 team nursing, 75 Herring, Donald, 177, 185, 186 Groves, Leslie R., 10, 13 Hawaii Prince Hotel, 75 Herson, Michael, 121 Grufke, Lois, 96 Hawaii Village Resort, 69 Herter, W.B., 71 Gulley, Mary, 92 Hawaiian Medical Association (HMA), Higgins, Sharon Gurwith, Mark, 124 69–70 acting regional medical director, 222 Guziec, Jan, 129 Hawaiian Medical Service ENT chief, 106 Gypsy Rose Lee, 22 Organization health insurance medical director for specialty plan, 69 services, 207, 216 Hawaii-Kai residential development, 69 Medical Group team member, 219 Hacker, Lucille (Lucy), 108, 158 Hawkins, Donald, 104–105 NWP executive medical Hage, Will, 79–80 Haworth, James, 114 director, 160, 243 Haight Ashbury Free Clinic, 147 Hayami, Dawn, 209 recruited, 158 Hale, David, 80–81 Hayward, Arthur high-risk maternity services, 203 Hall, Betty, 30 background, 110, 245 Hilbourne, Jack, 51, 103, 107, 242 Hallam, Bertha, 33, 233 in GTLC department, 128, 129 Hill, Josiah, 85, 239 Halpert, Luis, 65, 87–88 ICU team member, 126 Hitler, Adolph, 18, 57, 149, 248 Halvorson, George, 213, 221 internal medicine chief, 117 Hodges, Clarence, 88 Hamby, Rex, 28, 34 healing arts, 156–157 Hoevet, Michael, 68, 80, 81 Hanford Health Appraisal Center, 179 Hoffman, Dieter, 106 barracks, 14 health care costs, 62–63, 198–200 Hoffman, John, 108 living conditions, 13–14 health care system overhaul, 198–199 Hohenberg family name, 234 Manhattan Project, 11, 13, 15 Health Center East (East Interstate Hokanson, Carolyn, 159 medical program, 258 Medical Office), 137, 144, 146, Holahan, Kathleen, 109–110, 159, 243 190, 191 meningitis outbreak, 13, 15 Holladay Park Hospital, 90, 144, 243 Health Center West, 85, 133, physicians, 15 home and extended-care service, 150–151, 189 plutonium production, 11, 231–232 140–141 Health Future, 197 psychiatric services, 15–16 home health services, 128, health literacy, 163 syphilis control, 15 140–141, 144 Health Maintenance Act (HMO Act), Hanschka, Mark, 99 homeopathy, 61 249–250, 266 Harner, Marvin, 124–125 Honolulu County Medical health maintenance organizations Society, 235 Harpole, Vernon, 133 (HMOs) Honolulu Medical Center, 52 Harris, William, 67, 103 background, 4 Honolulu Star-Bulletin, 73, 235–237 Harvard Medical School, 158 HMO Act, 249–250, 266 “Hoodwink’s Sarsaparilla,” 62 Haugen, Cameron, 250 opposition to, 66, 68, 199–200 Hooker, Rodney, 121, 244–245 Haugen, Fred, 89, 251 as revolutionary, 225–226 Hooper Center, 147 Haugen, O.D., 188 Center, Hoover Dam, 154 Hawaii Permanente Medical Group 146, 227, 247–248 Horton, Mary, 121 (HPMG) Healthlink, 251 cardiac catheterization unit, 237 Hospice and Palliative Care Hearst, Patty, 247 Program, 129 early years, 69–74 Hearst, William Randolph, 247 Hospital Association Act, 3–4 electronic medical record system, Hebrew Immigrant Aid Society hospitalists, 127–128, 204, 246 212 (HIAS), 58 expansion, 73–75 Housing Authority of Portland, 25, Hedges, Deborah, 160–161, 202, 219 37–38 hospitalists, 127 Heims, Phyllis, 190 housing projects, 13–14, 20–21, 37, 92 incorporation, 172

302 INDEX

Hovig, Dallas, 95, 96, 100, 101 NWP associate medical Insurance Companies of North Howard, Grant, 74 director, 265 America, 187 Hudson, Charles M., 65, 178 substance abuse protocol Integrated Pain Management Hudson House Dormitory G, 28 development, 146–147 Program, 91 Hufford, Sam, 34, 48, 113, 168, Hutton, John, 89, 240 intensive care, 96, 119, 126 233–234 intensivists, 126 Hughes, Lewis intermediate care nursing homes, 128 medical director, 166–169, “I Speak Against Socialized Medicine” Internal Medicine Department 173, 249 (Reagan), 65 history, 115–116, 244 speech at Falstaff annual meeting, imipramine (Tofranil), 139 medical subspecialties, 90, 116–129 168–169, 260–267 immune deficiency clinic, 190–191 physician staff, 122–123, 159 split practice, 84 immunizations, 242 Internal Revenue Service (IRS), 169 surgery chief, 83 immunohistochemistry, 112 International Longshoremen Workers transcontinental phone call, 239 immunology, 242, 247. see also Union (ILWU), 36–37, 74, 143 Humana, 214 acquired immune deficiency Interstate South, 219 Huntley, Chet, 50 syndrome (AIDS) interventional radiology, 114 Huntwork, Bruce, 83 impaired physician assistance, Israel, 120 Hurst, Lanni, 63 155–156 Israel, Jeffrey, 106, 163, 243 Hurst, Peter incorporation, 44, 171–173, 176, 250 Izumi, Homer, 71, 235 background, 50 Independent Provider Association (IPA), 180, 250 career overview, 92–93 indigent patients, 66, 204, 205, 228 family practice advocate, 176–177 Jackson, Jesse, 203 Industrial Medicine Division, 15, 60, innovations, 96 Jacky, Peter, 112 132–135. see also Occupational laboratory director, 108 Jacobs, Paul, 91, 126, 151–152 Medicine Medicare advocacy, 65 James, David, 97 Industrial Workers of the World ostracized, 63 (IWW), 3, 231 James A. Vohs Award for Quality, 91, 135, 148, 211 pediatric chief, 94–95, 135, 194 infectious disease, 25, 62, 123–124, pediatrician, 63 189–191. see also epidemiology Janisse, Tom, 31, 90–91, 219, 233 physician recruitment, 94–96 influenza epidemic, 25 Japanese Americans, 193–194 Hurst-Merkle syndrome, 50 information technology (IT), 208–210, Jawurek, Wilhelm, 80, 150, 248 Hurt, William, 244 217. see also electronic medical Jernigan, Peter, 180 Hurtado, Arnold record system Johanson, George, 232 administrative skills, 166, 171 Ingram, Margaret, 92, 158 Johns Hopkins University School of area medical director, 117 “innere medizin,” 244 Medicine, 158 at BK meeting, 53 innovations overview, 142–146 Johnson, Bonnie, 161 family practice committee, diabetes care, 120–121 Johnson, Endicott, 50 176–177 diagnostic techniques, 99 Johnson, Jeffrey, 88 health research advocate, 161 hospitalists, 127–128, 204 Johnson, John, 82, 239 in hematology, 119 in nursing, 75 Johnson, Lloyd, 93, 147 joins PMG, 51 in patient care, 128 Johnson, Lyndon, 235 KSMC area medical director, 146, in pediatrics, 96–97 Johnson, Mabel, 147 185–186 penicillin use pioneer, 30 Johnson, Toivo, 3 KSMC medical staff president, 174 pneumonia study, 29 Jones, Hugh, 212, 213 laboratory director, 108 prolotherapy, 150 Jones, Kenneth, 126 medical support in Hawaii, 73 in research, 128, 162 Jones, Lee Anna, 121 Medicare advocate, 65 streptomycin use, 35 Jones, Ronald, 109–111, 243 medicine chief, 173 sulfa drug use, 29 Joseph Teal (ship), 19 mental health program, 140 ultrasound pioneers, 99, 114 Josiah Hill Clinic, 239

303 PERMANENTE IN THE NORTHWEST

Josiah Hill Day, 239 board meeting, 72 family practitioners, 177 Journal of the American Medical business systems problems, 214 financial problems, 215–216 Association, 7, 26 chemical dependency coverage Group Health affiliation, 214–215 Joyce, Thomas, 27, 89, 240 lack, 147 healing arts, 156–157 “judge’s house,” 142 controversial, 50, 53 hospitalists, 204 Jurgens, Giffen Bolte, 132 in Hawaii, 74–76 innovations industrial medicine advocacy, overview, 142–146 134–135 diabetes care, 120–121 Kabat, Herman, 248 membership, 50, 53, 141–142, 195 diagnostic techniques, 99 Kabat-Kaiser Institute, 108, 248 organizers, 249 hospitalists, 127–128, 204 Kadner, William, 114 policy statement, 47 midwifery, 99 KaiPerm Committee, 200 prescription premiums, 74 in patient care, 128 Kaiser, Bess, 24, 45, 54 retirement plan, 170–172 in pediatrics, 96–97 Kaiser, Edgar Kaiser Foundation Hospitals, 47, 162 prolotherapy, 150 BK financing influence, 52 Kaiser Foundation Rehabilitation in research, 128, 162 at Desert Center, 7 Center, 248 medical center design, 27 with Eleanor Roosevelt, 23, 24 Kaiser Foundation research membership, 36t, 200–201, at Grand Coulee, 9 institute, 161 262–263 Hawaii consultation, 71 Kaiser Honolulu Medical Center, mental health program, 140–149 69–73 at Kaiser-Frazer automobile nurse practitioners, 96–97, company, 36 Kaiser Permanente (KP) 178–179 at Montana Clinic, 172 dual choice, 231, 249 nursing strike, 195–197 NPFH history/struggles and, 27, EpicCare, 208–213 obstetrical service outsourcing, 203 32, 35, 43 expansion initiative, 200 outpatient dialysis, 125–126 personal physician, 240 history, 9–10, 27–28, 36–37, pain management, 91 41, 45 Portland-Vancouver shipyards, patient satisfaction, 135 independent research, 161 19–24 physician efficiency, 203–204 membership, 36t, 176, 200 Kaiser, Henry J. physician recruitment, 135–137 prepaid medical programs, 132 construction projects, 257 research institute money, 171 regional consolidation, 213–215 at Desert Center, 7 Risk Management Department, 229 standards of care, 200–201 earliest endeavors, 154 Salem’s resistance, 180–182 Kaiser Permanente Northwest with Eleanor Roosevelt, 23, 24 service improvements, 219 (KPNW). see also Northwest first wife, Bess, 24, 45 service problems, 263 Permanente (NWP); specific at Grand Coulee, 8–10 hospitals, facilities “SNFist” support, 129 Hawaii region influence, 69 accreditation, 201 standards of care, 200–201 health care pioneer, 257 AIDS patients, 190–191 substance abuse program, 146–148 partnership decisions, 45–46 capital investments, 219 Kaiser Permanente Southern Portland-Vancouver shipyards, California (San Diego), 66, 145, 175 Cleft Palate Team, 163 18–24 Kaiser Sunnyside Medical Center Community Care Department, 164 second wife, Alyce, 45–46 (KSMC) community institutions, integration social mission of KP, 161 anesthesia department, 90–91 into, 201–207 unilateral actions, 72–73 campus, 171 competition, 197, 201–202 Kaiser, Henry J. Jr., 24 certified nurse midwives, 99 consumer satisfaction, 222 Kaiser, Henry Mead, 97, 242 computerized axial tomography discharge planning, 204 Kaiser, Sue, 160 (CT) machine, 114 electronic medical record system, Kaiser Family Foundation, 52–54 design/construction, 173–175 120, 208–213, 219 Kaiser Foundation Health Plan emergency services, 174, 238 EpicCare, 208–213 billing and documentation upgrade, family practice development, expansion, 198–207 132–133 185–186

304 INDEX

hospitalists, 127 endocrinologist, 251 Lanham Act, 37 inpatient dialysis unit, 125 healing arts advocate, 157 Larson, Leonard, 48–49 intensivists, 126 MCMS membership, 65–66 Lavoie, Joyce, 161 KPNW core facility, 198, 258 pediatric chief, 194, 241, 251 Law, Ivan, 136 labyrinth, 157 post-KP career, 197 Lawrence, David nursing strike, 195–197 Knox, William, 99, 106 area medical director, 191–192 OB/GYN Department, 191 Knudsen, Mark, 194 background, 182, 191–192 surgery department, 83–84 Koffel, BettyLou, 204 BK area medical director, 106, urology department, 88 Korn, Edward, 105, 106 133, 148, 184 Kaiser Vancouver Shipyard, 24, 32, Kortum, Joe, 207 expansion initiative, 200 78, 238 Kositch, Michael, 216 family practice advocate, 184 Kaiser Works, Inc., 135 Kosta, Louis, 84 Health Plan administrator, Kaiser-Frazer automobile company, Kostiner, Anthony, 114 212–214, 217–218 32, 36 Kostiner, Dana, 159 KP chief executive officer, 128 Kaiser-On-The-Job, 135 KP Cares (CAres in RESidence), 129 retirement, 221 Kane, Joseph, 124 KP Community Fund, 197, 251 Lawrence, Geoffrey, 106 Kaposi’s sarcoma, 190 KP HealthConnect, 221–222 Lawrence, Robert, 124, 189–191 Karlin, Manuel, 127 KP Recovery Resources (KPRR), Leahy, Michael, 148 Katcher, Michael 146–147 Lee, Chong, 127, 216, 245 financial planning, 195, 197 KP-Group Health Board, 214 Lee, Milton, 191 Health regional manager, 135, Krall, Michael, 182, 209 Lee, Tom, 75 201–205, 208, 214–215 Krall, Noah, 51, 53, 65, 73, 117 Legacy Emanuel Hospital, 191, 202, Katz, Vera, 202–203 Kreofsky, Nicholas, 142 228, 251 Kauffman, Susan, 125 Kreps, Randy, 91 Legacy Health System, 135, 202, 207 Kavitt, Henry, 63, 113–114, Kriss, Joseph, 29, 108 Legg, Edith, 88 240–241, 244 Kristallnacht, 57, 234 Lehman, William, 108–109, 243 Kay, Ray, 176, 237 Kroeker, Mark, 239 Leimert, Thomas, 136–137 Keefer, Chester, 30 Krook, Peter, 114 Leinhard, Gustav, 226, 252 Keene, Clifford Kruse, Karen, 129 Leong, Calvin, 216 background, 233–234 Kyler, Andy, 128 Lester, Steven, 209 Hawaii consultation, 71–73 Kyriakopoulos, Damianos, 106 Leucippus, 231 Health Plan administrator, 46–47, Leveaux, Mark, 146 49, 52 Leverton, Ian, 217, 218 Kennedy, John F., 64 laboratories Levine, Martin, 141, 247 Kennedy, Kathleen, 203 administration, 47, 109 Lewis, Michael, 182 Kent, Jay, 106 automation, 111–112 Liang, Louise, 215 Keppro, Vivian Gammon, 248 clinical pathology, 111 Liberator, Mary, 194, 196 Kerman, Freda, 124 cytogenetics, 112 Liberman, Eric, 51, 120–121 Kerr-Mills, Bill, 64 hematology, 119–120 Lieberman, Stephen, 88 Kesey, Ken, 143 pathology, 108–112 Ligget, Forrest, 85 Khan, Yiichiang, 85 pulmonary function, 126–127 Lima, Claudio, 121 kidney transplants, 126, 241 regional, 109 Lin, Tung Kwang (T.K.), 75, 237 King, Jerry, 114 labyrinth, 157 Linck, Lessa, 159 King County Medical Society, 5–6, 26 LaGuardia, Fiorello, 23 Lindsay, Patsy, 161 King-Anderson bill, 64 Lairson, Paul, 166, 249 Link, George, 47 Kitzhaber, John, 239 The Lancet, 138 Linman, John, 191 Klevit, Harvey Landsteiner, Karl, 56 literacy program, 163 background, 94–96 Lang, Jeff, 207 Liu, Joyce, 159 cooperative management, 194 Livingston, Mary, 22

305 PERMANENTE IN THE NORTHWEST

Lloyd, Clee, 106 Manildi, Barbara, 99, 158 Medicine. see Internal Medicine Lloyd and Mabel Johnson Mann, Vi, 59 Department Foundation, 147 Maple Syrup Disease, 50 MedPartners, 199 Local 49, 195 Marble, Michael, 85 Memorial Day Flood, 34, 37–39 Loch, James, 85–86 Marino, George, 135 Mengelberg, Brigitte, 99 “lodge” medicine, 2–3 Martin, Albert, 80–81 meningitis, 13, 15 London cholera epidemic, 252 Mason, Walsh, Atkenson-Kier Mental Health and Addiction Long, Adrian, 218 (MWAK), 8–9 Treatment, 109. see also addiction Long, David, 84–85 Mason City, 8 medicine; Mental Health Department long-term care, 121, 128–129 Mason City Hospital, 34, 89 Mental Health Department, 140–149. Longview Fiber, 184 Massengale, Oliver, 94, 242 see also psychiatry Longview Medical Office, 133 Mather, Cotton, 157–158, 248 clinicians, 140–146, 159 Longview Memorial Hospital, 183 McCarthy, Bob, 202 facilities, 144–146 Longview-Kelso, 133, 182–185, 195 McCarthyism, 251 home and extended-care service, 140–141, 144 Lord Halifax, 22 McCarty, Chester, 41 “judge’s house,” 142 Lorence, Thomas, 128 McClure, Peggy, 209 the “mind phone,” 145 Lum, Andrew, 222 McDonald, John A., 246 patient stay statistics, 144 “Lydia Pinkham’s Vegetable McDowell, Dale, 118–119 therapy goals, 145 Compound,” 62 McDowell, Robert, 99, 157 mental health residency Lyons, Mary, 132, 159 McFarlane, Robert, 83–84, 127, program, 146 239, 245 meprobamate, (Miltown, Equanil), 139 McGehee-Kelly, Margo, 129 Merchant Marine Act, 18 Maclan, Louis, 65 McGinty, Skip, 202 Meridian Park Hospital, 202, 238 MacMillan, Ian, 117, 121 McKenzie, George, 12 Merson, Christopher, 88 Madeleine Convent, 148 McKinsey and Company management methadone, 147 “Magic Carpet Specials,” 19 consultants, 128, 200, 245 Meunier, Kathleen, 159 magnetic resonance imaging (MRI) McKowne, Frank, 114 units, 188–189 McLarty, Jack, 232 Meyn, Noel, 177 Magnum, P.I. (television), 75 McLoughlin Heights, 20, 30, 92 Microscan Walkaway apparatus, 112 Malbin, Barney McNamara, Michael, 209 Mid-Atlantic Region, 213, 217, 218 medical group relations, 41, 43 medical care costs, 62–63, 198–200 midwifery, 99, 157 with original partners, 42 Medical Center Hospital, 147 migrant farm workers, 134, 164 physician leader, 34 medical cooperatives, 4–5. see also Mill Plain One, 206 post-KP career, 229–230 Group Health (Cooperative) Miller, Jay, 205–206 social activism, 233 Medical Directors’ Quality Committee Miller, Robert, 80–81, 148 Malbin, Morris (MDQC), 201 Mills, Debra Defaccio, 240 medical group relations, 41, 43 Medical Directors’ Quality Review the “mind phone,” 145 with original partners, 42 (MDQR), 201 Minot, George, 12 physician leader, 32, 35 medical ethics, 63, 250 Miyaji, Roger, 111 post-KP career, 229 medical records, 137, 162, 208. see Miyatake, Sam, 124 also electronic medical record system in radiology, 113 Moanalua Medical Center, 75–76 Medical Records Department, 137 wartime physician, 29 Mohs, Frederic, 246. see also Mohs Medical Security Clinic, 5 surgery Malbin, Virginia, 233 Medical Service Agreement, 48, Mohs surgery, 131–132, 246 managed care, 134–135, 145–146, 169, 171 199–200, 246 Moiel, David, 181 Medical Society of Metropolitan Managed-Care Organization (MCO), Monahan, Jean, 142, 190 Portland (MSMP), 67, 152, 235 134–135 Monjou, Adolf, 22 medical subspecialties, 90, 115–129 Manhattan Project, 10–11, 13 Montana Clinic, 172 Medicare, 7, 64–65, 176, 243, 266 Monticello Medical Center, 183

306 INDEX

Morgan, Clarence, 96 New and Nonofficial Remedies Oakland corporate headquarters, Morrow, Terry, 128 (NNR), 62 36, 40, 193, 217–218 Mossman, Frank New England Journal of Medicine, occupational medicine, 135 background, 34 29, 109, 128, 136, 249 optometry, 107 medical group relations, 41, 43 Newton, Charles, 126 research institute, 171 ophthalmologist, 102–103 Nicholson, Jack, 144 TPMG and, 44–50 Mt. Scott Medical Office, 132,171 , 174 No Margin No Mission: Health Care Northern Permanente Foundation, Multidisciplinary Chronic Pain Organizations and the Quest for 34–40, 42, 45, 69. see also Northern Management Program, 91 Ethical Excellence (Sabin), 146 Permanente Foundation Hospital multiphasic program, 179 Noall, Lawrence, 81 Northern Permanente Foundation multiple sclerosis, 248 Nobel, Marjorie, 240 Health Plan, 25–26, 32–33 Multnomah Athletic Club, 66-67 nocturnal dialysis program, 125 Northern Permanente Foundation Hospital Multnomah County Medical Society , 128 (MCMS), 4, 37, 60–67, 240–241, Noehren, Walter accreditation, 34, 81–82 257–259 background, 29, 32 certified nurse midwives, 99 Murphy, William, 12 Clackamas Plan, 6–7 departments, 81–91, 113–114, Murray, Joseph, 241 pathology/autopsies, 108 117–120 Myers, Ken, 174 physician leader, 33 history, 27–33, 54 post-KP career, 227 membership, 35–36 Noel, Ray, 147, 247 outpatient visits, 78 Nag, Tushar, 86, 239 Nolte, James, 83 physician residencies, 34 Nash, Harry, 84 Nomura, Fred streptomycin use, 35 National Association of Inpatient background, 193–194 tuberculosis treatment, 35, 126 Physicians, 128 financial plan, 195 ultrasound pioneers, 99 national health insurance program, 266 NWP associate medical Northern Permanente Health Plan, National Labor Relations Board director, 168 36, 98, 139. see also Northern (NLRB), 143 NWP associate medical director Permanente Foundation Health Plan National Mental Health Act, 139 at large, 265 Northwest Health Foundation, 197 Nazi Germany, 18, 56–57, 234 NWP medical director, 193 Northwest Kaiser Foundation Medical Care Program, 34 Neary, Joseph, 86 pediatric chief, 96 Northwest Medical Teams Neighbor, Wallace pediatrics, 95 International, 163 at Grand Coulee, 9–10 regional medical director, 135, Northwest Permanente Journal of Northern Permanente Foundation 196–197, 198 Clinical Practice, 31 medical director, 25–26, 34 Noonan, Michael, 189 Northwest Permanente (NWP). see physician leader, 28–29, 32–33, 39 Nordstrom, Eugene, 140–141, 247 also Kaiser Permanente Northwest North by Northeast Health Center, 164 shipyard speaker, 22 (KPNW); specific facilities North Clackamas , wartime physician, 10 allergists, 189 173–174 Nelson, David, 133 anesthesiology, 89–91 North Lancaster Medical Office, Nelson, William, 184 chemical dependency 181, 182 nephrology, 124–126 treatment, 147 Northeast region, 214–216 nerve conduction velocity (NCV) dermatology, 130–132, 246 Northern California Region research, 151 electronic medical record system, early years, 44–50 Neuberger, Richard, 8, 231 120, 208–213 electronic medical record Neuburg, Janet, 180, 246 Emeritus Staff program, 155 system, 212 Neufeld, John, 108 EpicCare, 208–213 emergency department, 79–80 Neurology Department, 123, 248 expansion, 182 family practice, 176 Neurosurgery Department, 86–87 family practice, 182 health plan, 192 Nevill, Bobby, 67, 103–104 financial problems, 195 Nevis, Harold, 120 membership, 36t

307 PERMANENTE IN THE NORTHWEST

Hawaii development assistance, nurse anesthetists, 88–90, 240 ophthalmotolaryngology, 102–103, 69–73 nurse practitioners (NPs), 96–97, 121, 242–243 history, 56 129, 178–179 optometry, 102–104, 107, 243 leadership, 221 nursing Ordway, Alonzo B., 9, 36, 231 Longview-Kelso, 182–185, 195 certified nurse midwives, 99 Oregon Federation of Nurses (OFN), medical society opposition to, contributions, 160–161 195–197 65–68 in ED, 80 Oregon Health and Science University medical subspecialties, 115–129 innovations in, 75 (OHSU), 29, 84, 145–146, 249 membership, 36t, 220–221, nurse anesthetists, 88–90, 204 Oregon Medical Association (OMA), 246-247 nurse practitioners, 96–97, 121, 7, 23, 66 mobile health clinic, 163 129, 178–179 Oregon Medical School, 29, 86, 89, nursing strike, 195–197 ONA, 195–197 130, 243. see also Oregon Health and Science University (OHSU) obstetrical anesthesia, 204 in oncology, 136 Oregon Nurses Association (ONA), optometry, 107 school of, 237 195–197 palliative care, 129 strike, 195–197 Oregon Physicians Service, 4, physician assistants, 178 nursing school, 237 24–25, 37 physician pension plan, 169, nursing strike, 195–197 Oregon Ship Corporation, 24–25 171–173 Nyone, William, 186 Oregon Society of Anesthesiologists physician recruitment, 154–155 (OSA), 90, 240–241 physician volunteerism, 162–164 Oregon State Workers’ Compensation physicians, support of, 155–156 Oak Ridge, 11, 232 Board, 132 podiatrists, 86 Oakland corporate headquarters, 34, The Oregonian pulmonology, 127 40, 193, 217–218 dependence on, 196 retirement plan, 228 O’Brien, Mary Lynn, 97 Garfield quote, 60–61 Salem’s resistance, 180–182 obstetrical anesthesia services, 204 Grand Coulee dam article, 8 women in management, 160–161 Obstetrical Department, 97–101, 177, Medicare endorsement article, 65 women physicians, 158–160 191, 203–204 nocturnal dialysis program Northwest Permanente, P.C., Occupational Medicine Department, article, 125 176, 233 134–135. see also Industrial patent medicine advertising, 62 Northwest Region. see also specific Medical Division Ullman quote, 102 hospitals, facilities Ocean Vanguard (ship), 18 Orthopedics Department, 81–86, electronic medical record system, Ochsner, Altan, 51 150, 247 208–213, 219, 222 Ogden Meadows, 92 Osler, William, 61–62, 115, 158 growth, 36, 52, 200–207, 216–217 Oh, George, 68 Oswald, Bernice Hawaii Permanent struggles, 73–74 Ohio Region, 172 chief accountant, 34 inpatient dialysis unit, 125 Oken, Stuart, 144–146, 163 Memorial Day Flood, 38–39 mental health program, 140 Oleinick, Arthur, 135 regional controller, 160, 172 newsletters, 31 Olmsted, Richard, 94, 95 retirement, 168 optometry, 107 Olson, Neal, 109–110, 112 otolaryngology, 104–105, 163 physiatry, 149–152 Olson, Richard, 117 outpatient dialysis, 124–126 reorganization, 214–215, 221–222 On Lok, 249 Overstreet, Mary, 164 research focus, 171 Oncology Center at Central Overton, Chris, 31 Northwest Renal Nephrology Interstate, 138 Group, 124 Oncology Department, 120, 136–138 Norwood, William “Dag,” 15 One Flew Over the Cuckoo’s Nest Pacific Medical Associates (PMA), Novak, Larry, 5 (Kesey), 143–144 71, 73, 235–237 Nuclear Awareness Group (NAG), 188 Ono, Hirohisa, 87, 240 Pacific NWP, 215 Nudelman, Phillip, 187, 199, Ophthalmology Department, 102–104, Packwood, Robert, 104, 176 214–215 107, 181, 182

308 INDEX

pain management, 91, 150, 248. see The Permanente Foundation Medical physician benefits, 196–197 also physiatry Bulletin, 29–31 Physicians Association of Clackamas Palliative Care Program, 129, 250 Permanente Health Plan, 37, 41, 92, County (PACC), 4, 197 Pander, Henk, 157 102–103. see also related health Physicians for Social Responsibility, Papworth, Phil, 161 plan categories 134, 239 Park, Chung Hee, 235 The Permanente Journal (TPJ), Physicians Health Committee, 155–156 Parker, Merry, 31 31, 233 Physicians Medical Laboratories, 108 Parmenter, Judy, 161 Permanente Medical Association Pierce, Earl, 189 Partnership, 40–43 Parrish, Philip, 7 Pierre-Rob Syndrome, 243 Permanente Medical Group Parvaresh, Guy, 66 Pigeon, Walter, 22 (Northwest) patent medicine marketers, 61–62 Pike, Helen, 80 incorporation, 171–173, 176 Pathology Department, 108–112, 159 “pinkies,” 74 physician staffing, 167 Patient-Controlled Analgesia Pinney, Charles reorganization, 168–169 (PCA), 91 at allergy clinic, 189 The Permanente Medical Group Patterson, Paul, 92 Bronze Star recipient, 51, 235 (TPMG). see also Southern Paul, Kate, 213, 215, 217 MCMS trustee, 66 California Permanente Medical Paulson, Dorothy, 89 Group (SCPMG) pulmonologist, 122, 126, 170 Paxton, Harold, 86–87 decision-making power, 213 Pirquet, Clemens, 56 Peacock, Willis, 246 incorporation, 44, 250 Pletsch, Daniel, 99 Pearce, Earl, 92 IRS rulings, 169 pneumonia study, 29 Pearson, John, 97 Medicare advocacy, 65 Pockell, David, 212, 213 Pediatric Department physician recruitment, 49 podiatry, 85–86, 239 family practitioners, 177 physician staffing, 167 Polansky, Carolyn, 163 history, 92–97 physicians ostracized, 63–64 polio, 93 nurse practitioners, 178 reorganization, 44–46 polygraphs, 247 overnight call, 167 retirement plan, 169, 176 Pons, Lily, 22 physician shortage, 59 Permanente Physicians Retirement population-based disease shared practice, 155 Plan, 196–197 management, 210–211, 216 women physicians, 159 Permanente Psychiatry Porter, Henrik, 122 Pemberton, Peg, 80, 238 Department, 140 Portland Neighborhood Health penicillin, 29, 30, 130, 228 Permanente women physicians, 158– Clinic, 163 Penwarden, Dixie, 111 160. see also specific physicians Portland Physicians and Surgeons Pepper, Claude, 26 pertussis (whooping cough), 242 Hospital, 29 Permanente Cement Company, Peterson, F. Y., 249 Portland State University, 36 45, 69 Petroff, Eugene, 104 Portland-Vancouver program, 48, 231 The Permanente Clinic phacoemulsification, 104, 242–243 Portland-Vancouver shipyards, 18–24 as Northwest Permanente, P.C., pharmacy, 62, 130, 137, 211–212 Portloch Estate, 69, 73 176, 233 Phelan, Jerry, 172 “Potential Use of Computer Systems in Proving Cost Efficient Care” management, 65 Phillip, Louis, 82, 84 (Thompson), 111 origin, 40 PhyCor, 199 Potts, Ronald physician recruitment, 50–51, 64, Physiatry Department, 149–152 area medical director, 194 79, 84, 89, 170 Physical Therapy Department, assistant area medical director, 143 retirement plan, 169 149–150 BK area medical director, 192–193 The Permanente Federation, 215, 217 Physician Assistants in American The Permanente Foundation, Medicine (Hooker et al), 244 emergency medicine, 80, 81 24–31, 60 physician assistants (PAs) KP career overview, 238–239 Permanente Foundation Health Plan, history, 178, 244–245 pianist, 68 44–46, 50–51, 141, 231. see also scope of practice, 85, 86, 119 regional medical director for related health plan categories Ohio, 200 utilization of, 129, 179, 182

309 PERMANENTE IN THE NORTHWEST

Powell, James, 97, 176–177 Pulmonary Department, 126–127, 173 Robertson, Ray, 219 Powell, Jane, 22 pulmonary function testing, 126–127 Roche, Leora Baldwin, 28 Prefabricated Engineering pulmonology, 126–127, 245 Rockwood Medical Office, 185–186, 209 Company, 14 Purcell, Helena, 161 Rodriguez, Gilbert, 206, 207 preferred provider organization (PPO), Pure Food and Drug Act, 62 Roemer, F. J. (Fred), 31, 81 184, 250 purging, 62 Rogers, Alton, 149 Preizler, Martin, 197 Rogers, Gilbert prepaid medical programs at BK meeting, 53 background, 4, 7–16, 24–27, 49–50, the “Quad Squad,” 100–101 Bulletin contributor, 31 61–63, 225–226 Quality Management Department, 211 on-call shifts, 78–79, 84 preventive medicine, 5, 7, 60, 135, QualMed, 197 physician leader, 53 155, 186 surgeon, 51 Pribnow, Jock, 246 surgery chief, 82, 83 Prihoda, James, 121 Rabie, Ezra, 246 Rogers, Wayne, 118 primary care. see also Family Practice Radiology Department, 113–114. see Romaine, Richard, 131–132 Department also magnetic resonance imaging Romm, Vicki, 138 electronic medical record (MRI) units system, 209 Roosevelt, Eleanor, 22, 23, 24 Radmore, Barbara, 141, 142 evolution of, 116 Roosevelt, Franklin D., 10, 21–22, Raether, Paul, 151 193–194 nonphysician staff, 176–179 Raff, John, 86, 123 Roosevelt Hospital, 32 physician gatekeepers, 199 Rainier Medical Center, 188 Rose Vista Nursing Home, 234 Probst, Kevin, 121 Reagan, Ronald, 64 Rosenbaum, Edward, 64–65, 113, Procurement and Assignment Service Rehabilitation Center of Hawaii, 235 243-244 (PAS), 26 Reich, Jerry, 127 Rosenfeld, Sally, 128–129 prolotherapy, 150, 248 Reiss, Betty, 155 Roth, Arthur, 242 Providence Health System, 202 Reiss, Jacob, 112, 155 Roth, John, 241 Providence Milwaukie Hospital, 173–174 Renshaw, Larry, 114 Rubendale, Robert, 51 Providence-St. Vincent Hospital Reres, Mary, 208, 211 Rule of 80, 196–197 KP collaboration with, 88, 118–119, Resolution 16, 48–49 Running Horse (Ricken), 157 191, 202–204, 219 Retail Clerks Local 770, 140 Runquist, Albert, 22–23, 232 patient stay statistics, 145 Reubendale, Robert, 78, 84 Runquist, Arthur, 22–23, 232 psychiatric social workers, 140 rheumatology, 121 Runyen, Betty, 160 Psychiatry Department. see also Ribicoff, Abraham, 64 Rustin, Arnold, 65, 87 Mental Health Department; Richardson, Elliot, 249 psychiatry Richardson, Robert, 126, 127, 129, background, 139–141 136, 250 Sabin, James, 146 clinicians, 140–146, 159 Richland, Washington, 13–15, 32, 188 Sabin on Sundays (SOS), 93 drugs, 139 Richmond shipyard, 18–19 Salem’s market, 180–182 emergency management, 145 Ricken, John, 157 Salk vaccine, 93 inpatient services, 145 Rieke, Forrest, 23, 232 Salmon Creek Medical Office, 189, the “mind phone,” 145 Riley, Keith, 124, 190 242, 250 post-war, 139 “Rio Permanente,” 45 Salomon, Herb, 123 psychiatric social workers, 140 Risk Management Department, 229 Sams, Bruce, 250 therapy goals, 145 Robbins, Frederick C., 93 Samuels, Charles, 107 psychoanalysis, 139 Roberson, Clifford, 87 San Diego, 66, 145, 175 psychoneuroimmunology, 138, 247 Robert Wood Johnson Foundation, 252 Sanders, Connie, 59, 96 public health, 134, 163, 242. see Roberts, Alden, 207 Sanders, Mary, 118 also acquired immune deficiency Robertson, Barbara, 174, 237, 249 Sandor, Stephen, 99 syndrome (AIDS) Robertson, Nan, 209 Sandvig, Roy, 82

310 INDEX

Saqueton, Angelito, 131–132 Seligson, David, 34 Society of , 128 Sarda, Raju, 99, 242 Selleck, Tom, 75 Soldevilla, Francisco, 87 Satyanarayas, Kadavil “Satyan,” 151 Senft, Robert, 143, 147, 191–192, 265 Solters, John, 125 Saward, Ernest sequential multiple analyzer South Sacramento Medical Center, 128 background, 11–16 (SMA), 243 Southeast region, 213, 214, 216 Bulletin editor, 31 sequential multiple analyzer with Southern California Permanente Hawaii consultation, 71–73 computer (SMAC), 243 Medical Group (SCPMG) HMO advocate, 225–227 Setziol, LeRoy, 181 electronic medical record ILWU views, 37 Shadid, Michael, 5 system, 212 internal medicine chief, 117 Shanahan, Michael, 125 family practice, 176 leave of absence, 166–167 Shipbuilding Corporation, 18–19 “Kaiser” added, 45 medical director, 39–40, 43 shipyards, 19–25, 29, 154. see also management, 65 medicine chief, 32 specific shipyards Medical Service Agreement, 48 mental health referrals, 140 Shneidman, Robert, 123 medical support in Hawaii, 73 NW medical groups founder, shock treatments, 139, 144 membership, 36t 257–258 Sidney Garfield and Associates, 44 mental health program, 140 ouster attempt, 42 Sidney Garfield grant, 121 merger with Northern California partnership participation, 40–41, Siegal, Lori, 129 region, 213 175–176 Silverado Medical Center, 188 occupational medicine, 135 physician leader, 6, 33, 35, 53, Sims, Barbara, 21 psychiatry, 140 64, 88 Singh, Bhawar “Bo,” 90–91, 241 retirement plan, 169 post-KP career, 174 Sironian, Harry, 85 Tahoe sessions, 48 Richland home, 15 Sisk, Clark, 131–132 Southwest Washington Medical social mission of KP, 161–162 Sisters of Providence, 202, 251. see Center, 196, 204–207 Tahoe sessions, 48 also Providence hospitals Sowles, Gary, 21 tuberculosis treatment “Site X,” 11 Spaltfholz, Christa, 97 training, 126 skilled-nursing facilities, 128–129 specialty services, 205–206 wartime physicians, 28 Skinner, Robert, 88 Spence, William, 231 Saward, Virginia Wagner, 54, 155, Skyline Medical Office, 182 Spiegel, David, 138, 246 156, 232 Slater, Gregory, 50 Spielman, Sheldon, 93, 99, Schaefer, Joseph, 92 Slepack, Jerry, 124 191, 242 Scheer, Cire, 92, 158 Sloop, Perry, 117, 121, 128, 169 Spitzer, Ernest, 130 Schieber, Olga, 89 Slowik, Margaret Campbell, 238 Spock, Benjamin, 64 Schiedler, Michael, 83 Smillie, John, 166, 239 St.Helens shipyards, 24–25 Schloss Schonbrun palace, 79, 234 Smith, Izetta, 138, 246 Stadter, Carolyn, 99, 100–101, 242 Schoen, Jeffrey, 85–86 Smith, John, 109 Stark, Edward, 84–85 Scholl, William, 86, 239 Smith, Paul, 181 Starr, Albert, 118, 119, 250 school immunizations, 242 “SNFists,” 128–129 State Accident and Insurance Schwartz, Martin, 203 Snow, John, 252 Fund, 135 Schwartz, Richard, 87 Social Security, 64–65, 169 Stathos, Harry, 196, 219 Scott, Cheryl, 215 Social Work Department, 141 “Steer’s Genuine Opedelor,” 62 Scott, David, 109–110 social workers, 140–141. see also Steiner, Edward, 117 Scott, Robert, 168 specific individuals Stenton, Joseph, 33 Scribe newsletter, 67–68 socialism, 3, 12 Stenzel, Ann, 161, 219 Scribner, Belding, 124 socialized medicine, 3–4, 12, 25 Stevland, Nelson, 123 Scribner Shunt, 124 Society for Research and Education Steward, David, 225–226 Searcy, Geraldine, 89 in Primary Care, 116 Stibolt, Thomas, 127, 209 sectarian practitioners, 61 Society of General Internal Stokes, Deborah, 215 Selberg, Jeff, 205 Medicine, 116 Stollwerck, George, 97

311 PERMANENTE IN THE NORTHWEST

The Story of Dr. Sidney R. Garfield: The The Teenage Years (Roth), 242 EENT physician, 34, 102–103 Visionary Who Turned Sick Care into Terral, Vivian, 242, 249 MCMS membership, 240–241 Health Care (Debley), 7, 160 Texas region, 213–214 partnership participation, 43 Stradley, Joan, 86, 240 They Can’t Find Anything Wrong: 7 ultrasound pioneers, 99, 114 Strain, Donna, 159 Keys to Understanding, Treating and Underwood, Rex, 90, 101, 241 Strategic Positioning Assessment Healing Stress Illness (Clarke), 244 “unitary” medical record system, 208 (SPA), 201 Thiele, Henry, 113 United Finnish Kaleva Brothers and streptomycin use, 35 Thiessen, Curtis, 135, 246–247 Sisters Lodge #23, 3 subspecialties. see also specific Thomas, Stephen, 85 University of Oregon Medical School, subspecialties Thompson, John, 110, 111, 186 130, 179 for Clark county, 205–206 Thompson, Robert, 186 Urology Department, 87–88, 240, 247 medical subspecialties, 90, 115–129 Thomsonian (botanic) methods, 61 Ursin, Ekhard, 59, 73, 234 surgical subspecialties, 168 Thygesen, Megan, 129 U.S. Army Medical Corps, 10, 87, substance abuse protocol Tilford, David, 136–137 122, 133 development, 146–147 Tilford, Nancy, 138 U.S. vs. Basye tax case, 169 substance abuse treatment, 109, Tilson, Donald, 85, 133, 134, 246 utilization management, 216, 146–149, 156, 248 time-and-motion study, 217 250, 262 sulfa drug use, 29–30 A Tiny Boat at Sea: How to Help sulfathiazole, 30 Children Who Have a Parent sulphadiazine, 29–30 Diagnosed with Cancer (Smith), 246 Van Buren, Linda, 128 Sunnybrook Medical Office, 109, 157 Todd Shipbuilding Corporation, 18–19 Van Hee, Steven, 107 Sunset Medical Office, 144, 209 Totonchy, Matti, 88 Van Leeuwan, Katherine, 29, 92, 158 “Supermarket Medicine” Saturday Town Hall, 3, 54, 137 Vancouver Medical Office, 59, Evening Post (June 20,1953), 50 tranquilizers, 139 136, 242 surgeons’ guild (c. 1540), 157 transplant surgery, 126, 241 Vancouver Permanente Health Plan, Surgery Department, 82–84, 126, transurethral resection of the prostate 97–98 131–132, 241, 246 (TURP), 240 Vandenbark, Margaret, 159 surgical subspecialties, 168 Trautman, Paul Vann, Robert, 114 Sutton, Craig, 67 background, 51 Vanport, 21, 25, 36, 37–39 Sutton, James, 103–104 board exams, 109 Vanport College, 36 Swan Island Shipyard, 18, 19, 23–25, joins medical group, 82 Vanport Hospital, 25, 37–38 27, 52, 248 MCMS trustee, 66 Vantage PPO, 251 Sweetman, Per, 146 on-call shifts, 78–79, 84 Varga, Charles Swift, Greg, 177, 180, 183 ostracized, 63–64 author, 241 Syltebo, Thomas, 133, 186, 202, 216, surgery chief, 83 background, 50 219–220 Trefethen, Eugene, 47, 48 Bulletin editor, 31 syphilis, 15, 130 Truscott, Allan, 215 pediatric chief, 92 syphilology, 130 Tualatin Art Walk, 157 pediatrician, 59 Sytsma, Virginia, 129 Tualatin Medical Office, 157 physician leader, 53 tuberculin test, 56 Varga, Jacqueline, 50 tuberculosis, 35, 56, 126, 139 Venes, Donald, 128 Tahir, Mian, 86 “Turlington’s Balsam of Life,” 62 Vervloet, Albert Tahoe Agreement, 47–48, 169–170 Tyson, Bernard, 213, 217, 220, 221 background, 170 Tank, Edward, 88 BK medical director, 173 Tanner, Nolan, 104 emergency in The Dalles, 245 A Taste of My Own Medicine Uhlig, Sandy, 97 pension plan advocate, 169, (Rosenbaum), 244 Ullman, Egon, 92 170–171 Tatum, Donald, 189 background, 102–103 pulmonologist, 101, 127 Taylor, Elizabeth, 103 death, 103, 104 Vessely, Laurie Hurtado, 121

312 INDEX

Veterans’ Administration (VA), 35, 36, regional medical director for NW Works Progress Administration 37, 160 region, 31, 200–203 (WPA), 22 Victory in Europe (VE) Day, 32 SWMC board of trustees, 207 The World Set Free (Wells), 231 Vienna, 102, 234 Weinerman, Richard, 225, 251 World War II, 18–31. see also Vienna View of Portland with Bess Kaiser Weinstein, Mitchell, 87 Carlson’s Raiders, 252 Hospital tapestry (Fawkes), 156 Weise, Sally, 96 end of, effect on KP, 32 Village Medical Division, 15 Weitz, Martin, 130 in Europe, 56–57 Vioxx, 211 well-baby practitioners, 96 food rationing, 28 Virginia Garcia Memorial Health Wells, H.G., 231 Hitler, 18, 57, 149, 248 Center, 134 Wenkert, Walter, 225, 252 Japanese Americans, 193–194 Virginia Mason Clinic, 5–6, 10, 49 Wesche, Daniel, 141–143 Japanese occupation, 121, 170 Vohs, James, 76, 172, 174, 192. West, Barbe Manhattan Project, 10–11 see also James A. Vohs Award for cooperative management, 194 Nazi Germany, 18, 56–57, 234 Quality KSMC administrator, 202 physician recruitment, 25–26 Vu, Hau, 75 medical records improvement shipyard workers, 19–20 efforts, 208 VE Day, 32 with Normura, 193 war bond drives, 22 Waage, Gunnar, 95–97 regional health plan president, wartime physicians, 28–29 Wachler, Robert, 128 217, 219 Wright, Edwin, 85 Waging War on the Home Front termination, 220 Wright, Frank Lloyd, 7 (Arsdol/Mack), 23 West, Christina, 104, 158 Wright, Maureen, 128, 159 Wagster, Daniel, 147, 172, 176, 183 Westrup, David, 185 Wrigley family, 120 Wainwright, Jonathan, 22 Weyerhaeuser, 184 Waknitz, Frederick, 41, 43, 82 whooping cough (pertussis), 93, 242 Wallace, Paul, 211, 216 Wicklund, Roger, 88 Yao, Max, 96 Walnut Creek Hospital, 45–46, 50, Wilbur, Ray Lyman, 62 Yarusso, James, 85 53, 73 Wild, John, 103, 117–118, 119 Yee, Samuel, 71, 235 war bond drives, 22 Wiley, Dudley, 29, 97 Yoshinaga, Derrick, 246 Warden, Gail, 186–188 Wiley, Eugene, 9, 10, 29, 81 Young, Lauretta, 146, 159 Ware, Carrie, 159 William M. Scholl College of Podiatric Young, Robert, 151 Warren, Stafford, 13 Medicine, 86, 239 wartime physicians, 28–29 Williams, James, 200, 214 Washington, Ed, 21 Williams, Robert H., 118 Zager, Warren, 113 Washington State Medical Wilson, James, 133–134 Association, 33, 258 Zalutsky, Morton, 172, 173, 176 Wobblies (IWW), 3, 231 Watt, David, 68 Zarling, Suzanne, 91 Wolff, George, 23, 25, 27 Watters, Marjorie, 82–83 Zeller, Trudy, 118 Woman’s Medical College of Zeps, David, 126, 128 weekendists, 128 Pennsylvania, 158 Zerzan, Charles, 68, 122–123 Weidler House, 136, 138, 189 women physicians, 157–160. see also Zimmer, Gunsul, Frasca Weil, David, 203 specific physicians Architects, 174 Weiland, Allan women welders, 23 BK area medical director, 67, 196 Women’s Health Initiative estrogen clinical information system study, 211–212 efforts, 208, 212 Wong, Richard, 191, 209 medical group president, Woo, See, 129 219–220, 222 workers’ compensation, 132–134. see NWP medical director, 198–199 also Industrial Medical Division population-based disease Workers Party of American Finns, 3 management, 210

313 PermInNWCvrFinal2.pdf 1 10/7/10 11:41 AM PERMANENTE IN THE NORTHWEST

“The history of this Northwest physician group parallels that of Garfield’s physicians in California; two groups with separate beginnings shared a template and later became affiliated as geographic Regions in a national Kaiser Permanente.

The author of this account, Ian MacMillan, for many years confined his writing to notes in medical charts as an internist and rheumatologist with Kaiser Permanente. For 14 of those years he was the well-regarded Chief of the Department of Medicine at Kaiser Sunnyside Medical Center. … In his narrative covering six decades of Kaiser Permanente Northwest history, MacMillan exploits the opportunity to tell the stories of physicians and others in both major and minor roles. Testament to his broad curiosity, he enriches his archive with historical detail and context.

Permanente in the Northwest relates through small stories how a change in financing medical care, implemented 60 years ago, created a rationale, and drove physicians to collaborate to deliver care to a population that included both the sick and the well. In telling this story, MacMillan has made the book relevant not only to past and present physicians who will find their names in the text, but also to the current national discussion of health care reform.”

C — From the Foreword by Arthur D. Hayward, MD M Successor to Ian C. MacMillan, MD, as Y Northwest Permanente Chief of Medicine

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MY

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Dr. MacMillan chronicles the growth and development of Northwest Permanente from the birth of the idea of prepaid Ian C. MacMillan, MD medical care to the large multispecialty medical group of today. He provides a thoughtful, well-researched account of the clinicians, leaders, and innovators, along with the challenges, triumphs, and near disasters along the way. — H. Raymond Blair, MD, Northwest Permanente Pediatrician for 43 years

A superbly chronicled account of the Northwest Permanente Medical Care Program from its humble beginnings to its evolution into a nationally recognized model. This book captures the true spirit of dedication and commitment by many talented individuals, professional and administrative, who contributed to the growth and advancement of the PERMANENTEPERMANENTE organization, while dealing with various challenges and conflicts. The text is easy reading, captivating, and fascinating. — Bhawar Singh, MD, Northwest Permanente Anesthesiologist for 42 years IN THE

Permanente in the Northwest is an accounting of a rich legacy of physician leadership, clinical excellence, and medical politics that serves as the foundation of Northwest Permanente, P.C. The early years through the turn of the 21st century demonstrate how Northwest Permanente has become the leader in the deployment of an electronic medical record, the application of evidenced-based principles, and in the delivery of integrated care in the Northwest market. I have confidence that we are well equipped to lead our community in health care reform. — Sharon M. Higgins, MD, Northwest Permanente Executive Medical Director NORTHWESTNORTHWEST

The Permanente Press Oakland, California • Portland, Oregon US $24.95 Ian C. MacMillan, MD

Cover image © Sharon O’Keefe Cover tree image © TL Max McMillen Cover design by Lynette Leisure