Permanente in the Northwest fills a large gap in the history of Kaiser Permanente — the unique contribution made by the Northwest region, especially in the early years. Author and retired Northwest internist Ian C. MacMillan, who served 14 years as chief of medicine at Kaiser Permanente Sunnyside Medical Center, demonstrates an insider’s insight and enviable access to details that thoroughly enrich this account.
Before there was a Kaiser Permanente, there was Permanente Metals, the division of Henry J. Kaiser’s construction consortium that built ships during World War II. The medical services offered to those civilian workers was the kernel of what would eventually grow to become one of the nation’s largest not-for-profit health plans, and with two vibrant shipyards in Portland, Oregon, and Vancouver, Washington, the Northwest was a key participant.
The prologue provides a history of the medical care options in the area before 1941 as well as the story of how Sidney Garfield, MD, and industrialist Henry J. Kaiser came to collaborate on their successful model of prepaid industrial medical care. This is followed by a detailed account of the wartime boom — shipyards, housing, and health care rolled into one.
Notable events include the then-new practice of treating civilian tuberculosis patients with streptomycin, the model day care program for workers’ children endorsed by Eleanor Roosevelt, and a rich art community.
The demand for medical facilities soon outstripped the capacity of the first aid stations in the yards, and the first Northern Permanente Foundation (NPF) Hospital was built in Vancouver, Washington, in 1942, followed by a second one across the Columbia River in Vanport, Oregon, a temporary community built for shipyard workers, the following year.
That hospital was kept out of the nearby metropolis of Portland through stiff resistance by the local medical establishment, an example of a contentious relationship that would last many years.
As happened in California, the exodus of shipyard workers after the war forced the Northwest medical care program to expand to the broader community. Ernest Saward, MD, who had administered the wartime health care plan for DuPont plutonium workers at Hanford, Washington, became the medical director of the physician group and the Northwest health plan in 1947.
Dr. MacMillan explores some of the fractious cold-war dynamics of the medical partnership at that time, including debates about how KP internist Charles Grossman's political activism was affecting the medical group's relationship with the community.* (See note below.)
By 1950 relationships had deteriorated to the point that Edgar Kaiser (Henry J. Kaiser’s son) fired them all and formed a new partnership. Dr. MacMillan details other challenges to the Northwest region, including its struggle for legitimacy with the American Medical Association and ostracism by private practitioners.
The first major postwar facility in the Northwest was the Bess Kaiser Hospital in Portland, completed July 7, 1959. (There would not be another until the 1975 Garfield-designed Sunnyside Medical Center at Clackamas, Oregon). Named for Henry Kaiser’s first wife, the state-of-the-art facility featured air conditioning, telephones and televisions in every room, pneumatic medical records delivery, and a drawer bassinet allowing newborns to slide through the wall between mother’s room and the nursery.
The Kaiser Permanente health plan expanded into Hawaii in 1958, and the Northwest physicians played a significant role in helping that region survive a rocky start. Dr. Saward was called out to apply his management skills when friction within the physicians group exploded. Dr. MacMillan explains some of the complex background that led to the struggle, and he chronicles the eventual maturation of the region.
A large portion of the book is devoted to the history of various medical specialties of the Northwest medical group, detailing medical arcana more likely to be of interest to practitioners than a lay audience. The last three chapters trace significant chronological events in the region from the 1970s to the present.
Among these topics are the challenges of recruiting and retaining good doctors (he outlines the need for robust medical infrastructure, clear work policies, and adequate pay), the deep impact of the 1988 nurses’ strike, and the erratic steps taken by KP to institutionalize an effective electronic medical record system.
In all, this is a much-needed historical survey of a major region in the Kaiser Permanente constellation. Dr. MacMillan does not shy away from exploring awkward and complicated events in the Northwest Permanente history, and he writes with an insider’s viewpoint that enriches the accounts.
Permanente in the Northwest should be of interest to anyone interested in modern American health care policy, health practice, and the broader history of medicine.
Permanente in the Northwest
Ian C. MacMillan, MD, The Permanente Press, 2010
313 pp, with illustrations, bibliography, and index
To order the book, go to permanentepress.com
Preservation of the rich history of Kaiser Permanente’s Northwest Region (KPNW) got a boost at the end of 2011 when staff of the national Heritage Resources department in Oakland packed up over 100 cartons of Northwest photographs, clippings, newsletters, and files to fold into the KP archives. These materials will be selectively processed over time and added to the existing collection, greatly enhancing our research capacity. The photographs accompanying this review were drawn from that collection.
Special thanks to KPNW Community Benefit and External Affairs staff Jim Gersbach and Mary Ann Schell for their help.
*After leaving Permanente in 1950 Dr. Grossman continued to practice medicine privately, and his political activism continued throughout his life (a path respectfully footnoted in MacMillan’s book in his Afterword titled “What Happened to the Pioneers?”). He was arrested in 1990 during a peaceful demonstration organized by Physicians for Social Responsibility, challenging the presence of a nuclear-armed battleship berthed near the Portland Rose Festival. His court testimony describes the scene:
“I was standing silently with several other doctors and a few others with a sign in my hand saying ‘Rose Festival is a fun time, we don't need nuclear weapons.’ About 2:30 p.m. three or four policemen approached and asked us to leave. I asked why and was told that we have no right to stand in a city park carrying a sign. . . I put my sign down and said ‘O.K. I am not carrying a sign.’ His response was that if I did not leave within 30 seconds I would be forcibly removed. I said we were creating no disturbance and again asked why such a confrontation was necessary. While I was writing [down his badge and name] my two arms were forcibly seized, forced behind my back and handcuffs were applied.”