Honoring a giant of 20th century health care.

fter almost ten years of being regaled by Kaiser Permanente (KP) historian Steve Gilford’s wonderful stories about Sidney Garfield, MD’s four-year sojourn in the Mojave Desert (1933-38), where the young surgeon literally laid the foundation of what would become KP, I was well primed for the long-delayed pilgrimage. Finally, last November, I at last had a legitimate excuse to fly down to Anaheim and drive more than 100 miles east, past the rich oases of Palm Desert and Palm Springs and into the empty, awesome wastes of the Mojave, in search of KP’s birthplace. The excuse was the forthcoming centennial year of Garfield’s birth in April 1906, which we celebrate in a special section in this issue of The Per manente Jour nal (TPJ). In preparation for this issue, as well a series of other centennial-year events and memorials, a small group of hard-core KP history buffs finally arranged with the Bureau of Land Management (BLM) and the Ragsdale family, owners of the site of Dr Garfield’s old Contractors General Hospital, to make a carefully escorted pilgrimage to a spot almost completely lost to 70 years of desert winds and sand. We included Jeff Selevan, MD; Linda Tolbert, MD; and Paul Bernstein, MD, from Southern California Permanente Medical Group; Suzanne Ragsdale, The Permanente Medical Group nurse practitioner whose family owns much of the site (as well as the nearby “town” of Desert Center); KP history consultant Steve Gilford; Tom Debley, KP Director of Heritage Management; an archeologist from the BLM, and myself. As it turned out, even Mr Gilford and the BLM guide, who had visited the site on several occasions, had to wander the rugged landscape a bit before re-locating what’s left of Dr Garfield’s 12-bed hospital— a vague, crumbling outline of the perimeter walls surrounded, at a short distance, (see page 58) by waste pits full of broken crockery and shards of bottles of IV fluid, medicines, and Coca-Cola (the archeologist showed us how to date the Coke bottles to the 1930s). For all of us, the humble nature of the ruins in no way detracted from the excitement we felt at being there in this almost-legendary place we had so long heard, read, written, and talked about. The place where it all began. Even the BLM official expressed hopes that the ruins may eventually be officially surveyed, catalogued, and protected as a point of historical significance. Of course, Dr Garfield’s significance to KP and to American health care does not depend on protecting a pile of fascinating rubble in the desert. But it does depend on the ability of those who know his story and understand the great importance of it to document and communicate it—to bring him out of the desert legends and into the legitimate annals of medical history, where he should be widely recognized as one of the truly great physicians and health care innovators of the 20th century. The special Garfield Centennial section in this issue of TPJ, which I have been honored to guest edit (with the able help of Arthur Klatsky, MD), is a small gesture in an ongoing campaign to win for Dr Garfield the enduring recognition that he is due. We hope the commentaries, reminiscences, photos—and especially the reprint of Dr Garfield’s own seminal 1970 Scientific American article on the “Total Health Care” system he envisioned and pursued—will provide at least a hint of the inspiration and gratitude that we felt out there in the humble birthplace of KP. ❖ Jon Stewart Communications Practice Leader, Government Relations and Health Policy, Kaiser Foundation Health Plan editorial comments