Death and taxes may be certain, but obituaries are not.
Recently, the New York Times published a series of obituaries for special individuals who, for various reasons, didn’t get the one they deserved after they passed on. Here, we are filling a similar gap for an esteemed Permanente physician. Kaiser Permanente Heritage consultant and historian Steve Gilford wrote the following obituary immediately after Dr. Smillie’s death, but it was never published.
Permanente physician John “Jack” Graham Smillie, MD, passed away September 6, 2000, at the age of 83. The pediatrician joined the medical group in San Francisco in 1949 and steadily rose through the ranks of leadership, retiring in 1981. His 2000 book based on extensive research and personal experience, Can Physicians Manage the Quality and Costs of Health Care? The History of The Permanente Medical Group, may well be Dr. Smillie's most lasting contribution to the Kaiser Permanente medical care program.
Born in Eaton, Colorado, Jack entered University of Southern California's medical school in 1938. During World War II, he served in the U.S. Army Medical Corps. The military was segregated, but Dr. Smillie convinced his commanding officer to let him integrate their medical unit in the Philippines, becoming one of the first in the U.S. armed forces to do so. Many years after induction, he noticed that the signature on his physical examination was Lt. Sidney R. Garfield. Jack joked he was probably the only Permanente doctor who’d met Permanente's founding physician while in his underwear.
Dr. Smillie returned to a residency in Pediatrics at USC/LA County Hospital, where he showed a talent for administration. Doctors routinely admitted children with temperatures over 103 degrees and prescribed penicillin, which worked — but was not the best protocol. Dr. Smillie revised policy so that pediatrics residents reviewed each case, which dramatically cut down pediatric admissions. Parents were encouraged to bring children back a few days later to make sure their kids were OK, the hospital made better use of a 35-bed ward, and Dr. Smillie learned that he could reduce the cost of care and improve the quality of care at the same time.
Toward the end of his residency, he was invited to join a glamorous and lucrative practice in Hollywood. Although tempted, he discussed the offer with friend and mentor, Ray Kay, MD, who suggested he consider The Permanente Medical Group. He did, and accepted their offer to work in San Francisco at both the clinic at 515 Market Street and the 35-bed Permanente Harbor Hospital.
In the mid-1950s, Dr. Smillie told Dr. Garfield about a rooming-in concept from the Yale University School of Medicine, which increased physical contact between mothers and newborns. As a result, Dr. Garfield designed the baby-in-a-drawer, allowing the newborn to be moved between a mother and the nursery. The innovation caught the public imagination, and for a while was a kind of trademark of Kaiser hospitals.
Dr. Smillie became assistant physician in chief in San Francisco under Dr. Morris Collen, then served as physician in chief from 1961 through 1971. Dr. Collen recalled that Jack "was fond of saying that his greatest reward from his many years as a practicing pediatrician was seeing the children he had taken care of later bringing their children to him for care.”
In 1977 Dr. Smillie began a 13-year role representing TPMG in Washington, D.C. He was a strong advocate for the Kaiser Permanente health care model, later reflecting “I had an enormous satisfaction in dealing with the patients because I could do anything I wanted without worrying about how much it cost them. They have already paid me and our group for their care and for their hospitalization. And I was free to practice the kind of medicine I had learned to practice ... It was a source of enormous satisfaction.”