It’s been a quarter of a century since Kaiser Permanente (KP) established a prepaid medical care outpost in Fresno, then unbroken territory for the health plan. Since its opening in 1986, KP Fresno has grown from 400 initial area members to over 100,000 today. Its facilities have expanded from a remodeled space in a shopping center to several large clinics and a hospital the Fresno Bee newspaper labeled KP’s local “crown jewel” when it opened in 1995.
“It’s big, bright and modern and epitomizes health care competition in Fresno,” the Bee writer effused.
KP officials began to ponder a move into Fresno in 1985 when large statewide employers began to expand into the burgeoning Central Valley. The health plan already had a clinic in Stockton, which is north of Fresno and south of Sacramento.
It made sense to go to Fresno since KP health plan members were moving there and getting their care at other KP facilities, the closest of which was three hours away. Also, employees of big companies, such as Bank of America, Pacific Gas & Electric Company and Pac Bell were retiring and settling in Fresno and other communities in the Central Valley.
“These employers wanted the advantages of having similar benefits for their employees in multiple sites, and the employees wanted access to the same quality of care and service they had grown to appreciate in the Bay Area and Southern California,” explained Larry Coble, MD, retired Fresno pediatrician and physician-in-chief. Dr. Coble wrote a history of the first 13 years of KP Fresno when he retired in 1999.
Behind the scenes, high level KP leaders had been debating about where the boundary should be between Northern California region, with a facility in Stockton, and Southern California region, which was developing a presence in Bakersfield. The argument was settled when Northern California entered Fresno and thus staked its claim in the Central Valley.
To launch a KP facility in Fresno, whose isolation made it different from most other expansion areas, KP leaders had to start at square one. No existing facility could take Fresno under its wing as a satellite.
In 1984, TPMG executive director Bruce Sams, MD, tapped Albert Kahane, MD, associate executive director and former Sacramento Medical Center’s physician-in- chief, to work with the regional medical group to assess the potential for KP’s entry into Fresno. By early 1985, the decision to go to Fresno was made.
As the medical group facilities planning liaison, Dr. Kahane was called on to spearhead the acquisition and conversion of clinic space where the Fresno medical care program would be launched. He was also responsible for contracting for community hospital beds for KP’s patients.
In the fall of 1985, The Permanente Medical Group (TPMG) and health plan leaders began to assemble a team to make Fresno a reality. They set the opening date for July 1, 1986, and leased a four-story building at First and Shaw streets in the former Fashion Fair Plaza. Remodeling of space for the primary care areas began right away.
The start-up team, affectionately called the A-team, was selected from the Sacramento service area. Led by Dr. Coble, the team members were: John Bowden, medical facility administrator; Shirley Edmons, RN, nursing director; Toni Hays, Support Services manager; and Edie Yoder as secretary.
In the spring of 1986, Dr. Coble began his quest for willing professionals to make up the KP core team of primary care staff physicians, contracted specialists and laboratory and x-ray professionals. “(I was) literally going from door to door meeting with physicians, optometrists, podiatrists, laboratory supervisors, etc. At times I felt like a salesman, handing out my card wherever I went. . .that’s exactly what I was doing, selling Kaiser Permanente.”
On July 1, 1986, the Fresno team was ready and the doors opened at the medical offices at 1475 First Street, with seven physician offices, 14 exam rooms, two procedure rooms, waiting room and reception area. Seven physicians were there to treat patients the first day. They were physicians Paul Baker, Jose Rendon and Larry Coble; internists Tony Antoniou, Raj Banka and Red Uhrle; and family practitioner Sami Issi.
The first patient was 19-month-old Sara Beadle, who was brought in by her mother (Debra Shriver-Sprinkel) at 8:40 a.m. on the first day. She grew up to be a healthy young woman and distinguished herself on Fresno State University’s equestrian team in the 2003-2004 season. She studied philosophy and business in the Fresno pre-law program.
Dr. Coble says the people of Fresno, especially the major employers, for the most part welcomed Kaiser Permanente to the Fresno community. It took the Fresno City Council five minutes to approve a zoning change for 38 acres at Fresno Street and Alluvial Avenue to allow KP to build a 200-bed hospital and medical offices for 180 physicians. At the time, the health plan had no immediate plans to build a hospital, but opened a huge outpatient facility at the site in 1991 and added an outpatient surgery center in 1992.
There was, however, initial resistance from the Fresno area fee-for-service physicians who objected to KP’s prepaid group practice. Dr. Coble recalls: “One very ugly situation occurred in which someone obtained a copy of our contracted physician list and posted it on (a local) hospital’s physician lounge bulletin board.” The list of specialists taking referrals from KP doctors was circled with black crepe, the symbolic “black ball” meant to intimidate physicians from supporting KP.
Dr. Kahane says he also encountered resistance when he negotiated with local hospital administrators for KP’s use of hospital beds. He says favorable contracts were elusive because hospital leaders believed KP would eventually build its own hospital in Fresno. He told local hospital officials: “Whether it costs us less (to operate our own hospital) or not is your decision.” He explained that if the community hospitals charged prohibitive fees for contracted beds, KP would be forced to build its own Fresno hospital. “And that is exactly what happened,” he said in a recent interview.
In the early 1990s, with rapidly growing membership and medical staff, KP Fresno leaders started making plans for a hospital of their own. Construction began in 1993 on the site at Fresno Street north of Herndon Avenue. In 1994, Ed Glavis was appointed as administrator of the new hospital; Maura Hopkins, RN, as nursing director; and Davidson Neukom as facilities manager.
When the new hospital opened in February 1995, the Fresno Bee said: “The Kaiser Permanente Hospital is the crown jewel in a $100 million Kaiser building project in Fresno, including the $30 million ancillary building which opened in late 1992.”
“I’m terribly excited,” Dr. Coble told the Fresno Bee. “It’s going to be easier because our physicians now will be able to literally walk down the hall to see their (hospitalized) patients. . . In addition, he said, all the ancillary services, such as laboratory, x-ray and pharmacies are close at hand . . . It’s professionally a very satisfying way to provide health care.”
On opening day, KP Fresno swung open the doors to the Birthing Center and the Emergency Department. When the maternity staff unlocked the door at 6 a.m., they were met by expectant mom Angela Ballew who was in labor and gave birth to a daughter, Madison Ballew, the same day.
One-year-old Madison was the star of the show at the party celebrating 1,167 babies born in the center’s first year. Madison’s mom, a Sanger drama teacher, told the Fresno Bee that she would deliver her second child at the center the following August.
The rest of the hospital complex was opened in October of 1995. Having received “full accreditation with commendation,” Dr. Coble reported in his memoir: “We were a full-scale, high-quality medical group and hospital!”
From its early milestones, KP Fresno has continued to grow and prosper. The Fresno KP community has been honored recently for its commitment to reduce waste and prevent pollution in its facilities. The staff has also been recognized for its excellence in employee wellness efforts and for its work to overcome obesity in the community.
KP’s Fresno Medical Center, which stopped accepting free baby formula years ago, is close to being designated as Baby-Friendly* with 75.8% of new mothers exclusively breastfeeding their newborns, the highest rate in Fresno County in 2009. The center's maternity staff places an emphasis on breastfeeding and discourages formula supplementation for infants whose mothers intend to breastfeed exclusively.
KP’s presence in the rest of the Central Valley has continued to expand as well. In 2008, the health plan opened another exquisitely designed hospital to serve the area. The new Modesto Medical Center** follows the current version of the evolving KP hospital design template, which incorporates functionality, as well as sustainability, patient comfort, optimal use of natural light, staff efficiency and accommodation of the latest medical technology.
*Baby-Friendly USA is a national campaign to encourage breastfeeding. Fourteen of Kaiser Permanente's facilities have received the designation, and KP leaders have vowed to have all 29 medical centers called out as “baby friendly” by Jan. 1, 2013. Already designated are: Los Angeles, San Diego, Fontana, Downey, Riverside, Anaheim, Panorama City, Irvine, Baldwin Park, and Woodland Hills in Southern California; Hayward and South Sacramento in Northern California; Honolulu, HI, and Clackamas, OR.
**For more about the KP facility template, click here.