When the Pittsburg, Calif., Kaiser Permanente Medical Office opened in September, 1953, it was ground zero in the struggle between Kaiser’s comprehensive, prepaid, group practice model of medicine and the private practice medical establishment.
Wallace “Wally” Cook, one of the founding physicians in the Permanente Health Plan, recalled that epic confrontation in a 1986 oral history*:
When we were trying to grow rapidly, after Walnut Creek had started in 1952-53, Mr. Kaiser was putting a lot of pressure on the health plan. He built this beautiful facility — "he" in quotation marks — and by gosh, we needed members. We marketed the health plan in the steel workers' union [United Steelworkers Local 1440] in Pittsburg, California… The steelworkers all went to their fee-for-service doctors up there, and here we were recruiting on their turf for members. This was in the summer of 1953. And there was going to be a vote by the steel workers. The fee-for-service doctors' wives handed out leaflets, anti-Kaiser, anti-Permanente — very, very negative and, in many cases, untrue.
They hired a sound truck to go around the city of Pittsburg, announcing that Kaiser was trying to invade, and let's keep them out, let's preserve what you have with your fee-for-service physician. When the vote finally occurred, we got about 95% of the steel workers. So we immediately had an infusion of 10,000 members overnight, and they were going to be members within a month, or something like that.
Well, that put an even greater burden on the recruiting effort. We had to find some place to see these members. So we leased a building that was about to open as a motel in Pittsburg — a U-shaped, old-fashioned 1940s motel, with room, room, room around in a U-shape. And we converted that into an office. You came in the front, and you'd peel off for dermatology, or medicine, or whatever, each motel room complex being an office space. It wasn't good, but it worked.
Cecil Cutting, MD, who was also from the original Permanente Health Plan cohort, shot these slides of the clinic in 1958. It was a far cry from the elegant “hospitals of the future” that Kaiser Permanente had built in Walnut Creek, San Francisco, and Los Angeles — but it valiantly served an important working-class community.
The KP Reporter laid out the situation in a 1962 article:
Sometimes the staff of our Medical Office in Pittsburg wonders if the rest of the Kaiser Foundation Medical Program knows they're there.
Of course, relations with the Walnut Creek hospital are close and continuous, but Pittsburg is quite a distance from other facilities, and everyone there is so very busy — handling more than 3,100 patient visits a month with a staff of 4 doctors — they regard themselves as the "sheepherders" of our Program.
"When I came here in October, and this office opened," says Dr. Bulgarelli, Physician in Charge, "each doctor saw about 800 patients a month. Our first purpose was to serve the steelworkers and their families.
"In four months patient visits went up to 1,200 per doctor. Of the original medical staff of five doctors, only Dr. Anna Grinbergs and myself remain. How we worked! And on Sundays, we walked. Or rather, Dr. Grinbergs walked, and still does. Myself, I could not keep up with her. She walks every day before breakfast- gets up at 4 a.m. She is younger today than when she took this job eight years ago."
Membership continued to grow, and in 1954 Dr. F. W. Treubel was added to the staff, in 1955, Dr. B.B. Taylor. In 1956 Lenore Crane came from the Walnut Creek hospital to be clinic administrator. Patient load went over 3,800 a month while 6 doctors were on the staff, but has dropped to 3,200 now that there are only 4 physicians. The Medical Department at Walnut Creek sends a physician each afternoon to help see drop-in patients, who now comprise roughly 60 percent of the patient load at Pittsburg.
The humble motel-as-clinic closed in April 1964 when services were moved to Antioch. Dr. Bulgarelli, physician-in-chief at the new facility, noted the difference in a KP Reporter article January, 1964:
The opening of new Medical Offices in Antioch next month is awaited as eagerly by Health Plan members as by the clinic staff. We outgrew our quarters in Pittsburg where offices had to be scattered about several buildings. One was in the same building with a bar where a juke box kept the customers happy all day long, but was not so pleasing to our patients.
The new building at 3400 Delta Fair Blvd. is a tremendous improvement. It is more centrally located for all the Health Plan members in our area. It is an attractive, modern building, spacious and air-conditioned, where all our services can be united under one roof. And, in addition to those practical advantages, it is surrounded by 5-1/2 acres, and commands a fine view across green fields to the river and the hills beyond.
Color images are scans from Kodachrome slides shot March, 1958 by Dr. Cecil Cutting.
* Wallace H. Cook, M.D., "History of the Kaiser Permanente Medical Care Program," an oral history conducted in 1986 by Sally Smith Hughes, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1987.