April 16, 2025
Sidney R. Garfield, MD: Pioneer of modern health care
Kaiser Permanente’s co-founding physician spread prepaid care and the idea that doctors should help keep people healthy — not just treat them when they’re sick.
Dr. Sidney R. Garfield and Henry J. Kaiser, co-founded Kaiser Permanente. They introduced the country to a revolutionary model for integrated care and coverage.
Sidney Roy Garfield, MD, was a health care pioneer.
He believed in healthier lifestyles with annual checkups and preventive measures. He also promoted the early use of electronic health records.
He and industrialist Henry J. Kaiser co-founded Kaiser Permanente. They aimed to create a health care model that kept people well.
1906 to 1932: Early life and education
Garfield was born on April 17, 1906, in Elizabeth, New Jersey. His parents, Issac and Bertha, were immigrants from Eastern Europe.
Issac ran a supply store for dock workers, sailors, and their families. Garfield, his mom, his dad, and his older sister Sally, lived above the store.
Dr. Garfield’s graduation portrait from the University of Iowa Medical School.
When he was in high school, Garfield wanted to be an architect. At his parents’ request, he chose to pursue medicine instead.
He got his undergraduate degree from the University of Southern California in Los Angeles. He went to medical school at the University of Iowa, and graduated in 1928.
Reflecting on the moment of deciding to study medicine, Garfield later remarked, “Something good comes out of everything.”
1933 to 1938: Providing care to builders of the Colorado River Aqueduct
In 1933, when Dr. Garfield was finishing up his hospital residency in Los Angeles, he learned about the Colorado River Aqueduct project. It aimed to bring water from the Colorado River to Los Angeles.
Dr. Garfield reached out to the contractors. He learned that the project required a large workforce of about 5,000 people in a remote desert in Southern California. The workers would need on-site medical care.
The contractors offered Dr. Garfield a contract to provide care. He accepted and moved out to the desert.
Dr. Garfield and nurse Elizabeth “Betty” Runyen in front of Contractors General Hospital in 1934.
He borrowed money to build and open a small hospital near the jobsite. The hospital was known as Contractors General Hospital. He also hired a nurse, Elizabeth “Betty” Runyen.
Dr. Garfield initially used a fee-for-service payment model at the hospital. In this model, doctors got paid for each service they provided. In the 1930s, nearly all doctors used this model.
Workers at the construction site faced many dangers and risks to health on the job. These included explosions, rock falls, nail punctures, and dehydration. Dr. Garfield and Runyen treated their injuries and prioritized workers’ wellness using preventive care methods not covered by insurance.
Dr. Garfield and his team also accepted sick or injured workers even when their insurance refused coverage. This put the hospital’s future at risk.
A new way of doing business
Dr. Garfield had become friends with Harold Hatch, an insurance agent. Hatch had an idea to help fix the hospital’s financial troubles. He suggested workers agree to voluntarily have a fixed amount deducted from their paycheck each week for all medical care. Since the care was prepaid, workers could receive all the care they needed.
The idea worked, and the hospital’s finances improved. Dr. Garfield and Runyen could now focus on preventive care. They taught workers about safety and hygiene. They encouraged workers to keep hard hats on and to stay hydrated. They also instructed workers to keep their area clear of nails and dangerous items.
Their efforts helped reduce injuries and costs. Dr. Garfield opened more hospitals and hired more staff. The growth reduced stress on the first hospital and helped workers receive more timely care.
“At the end of the 5-year contract, we had built and paid for 3 small hospitals and given those workers a lot of good medical care,” Dr. Garfield recalled later in life. “We were all better off if the workers remained well, and we were able to give them the services that they needed.”
1938 to 1941: The next experiment ― Grand Coulee Dam
As the aqueduct project was ending, Dr. Garfield got a call from Alonzo B. Ordway. Ordway was a construction manager for Henry J. Kaiser’s construction company, which was involved with the aqueduct project.
Ordway asked Dr. Garfield if he knew Kaiser. Dr. Garfield said he did not. Ordway explained that Kaiser wanted him to provide care for workers building the Grand Coulee Dam in Washington state.
When Dr. Garfield toured the jobsite in Mason City, Washington, with Kaiser’s son Edgar, he saw a community of 15,000 workers and their families. He understood the opportunity to deliver care for a community in one location. He accepted the contract and hired a team of doctors and nurses.
The surgery department team at Mason City Hospital in 1938.
Dr. Garfield and his team planned to work out of the Mason City Hospital. Henry J. Kaiser Co., Ltd. had received the hospital as part of the dam contract. However, the hospital was poorly designed. Union workers in the area cited poor care and had lost trust in any health plan. Dr. Garfield believed that renovating the Mason City Hospital and providing excellent care would help rebuild trust with workers.
The renovations were finished in the summer of 1938. The hospital featured an integrated design — putting specialty care, a pharmacy, a clinic, and other care departments in a single building. Learning from his experiences with the Colorado River Aqueduct project, Dr. Garfield introduced a prepayment family plan. Workers prepaid a small weekly fee to cover medical care for themselves and their family.
When Henry J. Kaiser arrived for a visit, the 2 men spent the whole day talking about the health plan. Kaiser showed a lot of interest in its potential. "If your plan achieves even half of what you claim, it should be available to every person in this country,” Kaiser remarked.
The health plan for workers and families was a success. It provided coverage for injuries, illnesses, and preventive care, ensuring workers and their families got the right care at the right time.
Like his previous job in the desert, the Grand Coulee job was also a temporary contract for Dr. Garfield. But he often discussed what could be possible for the health plan with colleagues.
“We’d get together at Coulee at nighttime and talk about what we could do in a permanent community where (the health plan continued),” Dr. Garfield recalled.
Dr. Garfield planned to continue practicing surgery but wanted to refresh his skills and training first. He returned to the University of Southern California Medical School and taught surgery at LA County Hospital.
1941 to 1945: A call to duty
On December 7, 1941, the Japanese military attacked Pearl Harbor, prompting America’s entry into World War II. Like many other people, Dr. Garfield was shocked.
Feeling a sense of duty and commitment to the cause, Dr. Garfield volunteered for the Army.
However, Kaiser had other plans for Dr. Garfield. He wanted him to create a health plan for the thousands of workers building wartime cargo ships at the Kaiser shipyards.
At Kaiser’s request, President Franklin D. Roosevelt released Dr. Garfield from his Army service. Dr. Garfield got to work creating a shipyard health plan.
The home front’s health plan
Thousands of workers arrived at Kaiser’s shipyards to be part of America’s defense industries. Thousands of women also joined the home front, which changed the American workforce. Dr. Garfield brought together a group of doctors and nurses to provide care for the shipyard workers and their families.
They called the plan the Permanente Health Plan and made it available at all of Kaiser’s shipyards. More than 200,000 people (workers and their family members) were plan members.
Like at the Grand Coulee Dam, members prepaid a weekly fee. In exchange, they received preventive care in addition to care for common illnesses and injuries.
Dr. Garfield speaks at the dedication ceremony of the Permanente Oakland Hospital on in 1942.
To support the health plan, Kaiser’s construction teams renovated the Fabiola Hospital in Oakland, California. It became the Permanente Oakland Hospital and opened in 1942 to care for the shipyards’ health plan members.
Dr. Garfield and Kaiser didn’t stop at one hospital. They also built a field hospital near the shipyard, and another hospital for shipyard workers in the Pacific Northwest. That hospital was named Northern Permanente Hospital.
While many hospitals around the country at that time cared for Black and white patients separately, the wards at all of Kaiser’s and Garfield’s hospitals were integrated from the moment the doors opened.
1945 to 1981: America’s new health plan
When World War II wound down in 1945, demand for ships slowed. Kaiser’s shipyards began closing, and health plan membership dropped.
And yet Dr. Garfield and Kaiser saw in their shipyard health plan a new vision for health care in America. They wanted to continue delivering care in this new way — using prepayment, group practice, and a focus on injury and illness prevention.
Together, Dr. Garfield and Kaiser opened the Permanente Health Plan to the public on July 21, 1945.
In 1953, the Permanente Health Plan adopted a new name: Kaiser Permanente.
Dr. Garfield (left) and Kaiser review hospital plans in 1953. On the table is a model of the innovative Walnut Creek Hospital, which featured bedside push-button consoles for patients and an advanced surgical suite.
1981 to present: Dr. Garfield’s legacy of total health
In 1981, Dr. Garfield launched a new project with strong ties to the fundamental idea that helped launch Kaiser Permanente ― the belief that health care should keep people healthy and not just treat them when they’re sick or injured. His new endeavor became known as the Total Health Care Project.
The project addressed a mismatch in the health care system. More people were becoming health-conscious, but the health care system still focused primarily on illness. Dr. Garfield’s project was a long-term study using information gathered by his team.
The team asked health plan members to volunteer for a health assessment. By gathering answers to health questions over each member’s lifetime, Dr. Garfield hoped to develop a balanced spectrum of health care services.
Dr. Garfield died in 1984 before the Total Health Care Project finished. But his bold ideas would take another form at Kaiser Permanente decades later.
Our 2004 ad campaign focused on the term “total health,” evolving it further from Dr. Garfield’s original vision. Total health now included care that considers all aspects of a person's state of being — body, mind, and spirit.
Dr. Garfield at the Kaiser Permanente Health Education and Research Center in 1981.
That same year, we launched our Total Health programs. The programs encouraged members to walk daily and be active. They also asked members to take health assessments and join health education classes.
Dr. Garfield’s lifetime dedication to improving health care in America had lasting impacts on the total health of Kaiser Permanente members and the people in our communities. His efforts continue to influence our work and support our mission today.
