October 17, 2013

Kaiser Permanente Sacramento founders spread wings in bustling 1970s

Carl Henriques, MD, a Sacramento Kaiser Permanente allergist, became the medical director and instructor of nurse practitioners in the Department of Preventive Medicine in the 1970s. He is pictured here with his wife, Thelma.

Millie Kahane, a former professor of nursing at California State University, Sacramento, and John Mott, MD, collaborated to open the Kaiser Permanente Health Appraisal clinic in Sacramento. The center was staffed by some of the health plan's first nurse practitioners. Photo taken in the early 1970s by a co-worker.

First of a series

It’s 1970 and Kaiser Foundation Health Plan's operation in Sacramento is just five years old. The state of California and the federal government have both recently set up health benefits for their employees with Kaiser Permanente as a popular option.

The Northern California Health Plan is quickly approaching its million members mark, and the Sacramento facility is overflowing with patients.

Meanwhile, Mildred “Millie” Kahane, BS, MS, a New York transplant teaching nursing at California State University, Sacramento, thinks her students are bright enough to contribute more in the burgeoning field of health care. The destiny of nurses, she believes, is to rise above the traditional hospital bedside role and to take on more responsibility in an outpatient setting.

She believes her students can learn new skills that could eventually be included in a bachelor of science nursing program and that these advanced nursing capabilities would provide the core content upon which to build clinical specialties.

John Mott, MD, physician-in-chief at Kaiser Permanente Sacramento, is facing increasing pressure to welcome and serve new members. His resources for providing primary care and new member health assessments can’t keep up with the demand. What is he to do?

Fortuitously, Mott and Mrs. Kahane have occasion to meet — through her husband Kaiser Permanente Sacramento chief of OB-GYN Albert Kahane — and their collaboration sets in motion a revolutionary program to elevate the nursing role and to solve Mott’s shortage of primary care providers.

Some of Millie Kahane’s students will become “nurse practitioners,” a title unheard of at the time in Sacramento County, and Kaiser Permanente members will get comprehensive evaluations in what will become known as the Department of Preventive Medicine.

Origin of advanced practice nursing

The story of Mrs. Kahane and her hand-picked nurse practitioner pioneers was not unique in the 1970s health care landscape. Indeed, medical providers throughout the United States were looking for solutions to a manpower shortage. In that era, the federal government provided special funding to identify ways to maximize health care dollars.

Within Kaiser Permanente in particular, physicians in Southern California, Oregon and Hawaii began to train nurses to examine seemingly well patients and identify any abnormalities for follow up with a physician.

Eileen O’Hagan McCauley followed Millie Kahane in 1975 as the leader of the Sacramento preventive care nurse practitioners group. Photo taken in late 1970s by a co-worker.

Pediatrician Sam Sapin, MD, in Panorama City worked with Southern California Permanente Medical Group Director Raymond Kay, MD, to train nurse practitioners to provide well-child check-ups, along with physicians.

In Oakland in the early 1970s, Drs. Morris Collen and Robert Feldman employed NPs in the “Multiphasic,” an annual physical program originally set up for the longshoremen’s union in 1951.

After nurse practitioner programs were well established in Northern California, The Permanente Medical Group developed a certification process for those who were to work as nurse practitioners within the organization. This process later helped Kaiser Permanente nurses meet California nurse practitioner requirements.

The first formally educated Kaiser Permanente nurse practitioner was Linda Lee, who was one of Mrs. Kahane's students at Sacramento State. Upon graduation, she attended the nurse practitioner program established by Henry Silver, MD, at the University of Colorado in 1965.

Silver's program was the first university-based pediatric nurse practitioner program in the United States. After completing the program, Lee came back to California and worked with Sacramento Kaiser Permanente Chief of Pediatrics Clifford Skinner, MD.

Synergistic forces converge in Sacramento

Why is the story of the Sacramento Kaiser Permanente Nurse Practitioner and Preventive Medicine Program of the 1970s remarkable? Looking back after 40 years, the program’s pioneers — many still working for Kaiser Permanente — marvel at the phenomenon of a close-knit group of advanced practice nurses who loved their mentors and their patients and whose lives were marked indelibly by the experience.

Nurse educator Mildred Kahane and Physician-in-Chief John Mott’s alliance to develop a nurse practitioner program found fertile ground in the hearts and minds of certain of Mrs. Kahane’s graduates. In 1970, Mrs. Kahane set completion of a bachelor of science degree as the basic program requirement and recruited four candidates to begin work (and training) in the Health Appraisal Evaluation center to be located in an older Kaiser Permanente building at 3240 Arden Way, Sacramento.

Kaiser Permanente allergist Carl Henriques, MD, formerly a general practitioner in Susanville, Calif., became the center’s physician leader and primary teacher. As the program progressed, the University of California at Davis Medical School was developing a mid-level practitioner master’s in Health Services program for nurses.

UCD lacked clinical facilities, which Kaiser Permanente had. Eventually KP and UC partnered, and UC students were able to enhance their clinical experiences at Kaiser Permanente with Mrs. Kahane and Dr. Henriques as members of the UC clinical faculty. Kaiser Permanente nurses were given the opportunity to apply their education and training toward the master’s degree.

Next time: Kaiser Permanente preventive care patients benefit from more time with their provider.

This blog is dedicated to the memory of Eileen O’Hagan McCauley and Linda Lee (both deceased), two of the first NPs at KP Sacramento, and the late Carl Henriques, MD.