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December 26, 2006 > The Palo Alto connection

The Palo Alto connection

A history of the City of Fremont1 notes that the Warm Springs Hotel and spa, damaged in the great earthquake of 1868, was repaired and sold to Leland Stanford with its adjacent vineyards in 1870. The book notes that Leland's brother, Josiah Stanford, managed the vineyards and winery adding the comment: "In fact, some say that if a coin had turned another way, Leland Stanford might have founded the university that now bears his name on the east side of the bay rather than in Palo Alto."

Although the vineyards and hotel, subsequently sold to the Weibel family, have now receded into historical archives in favor of residential development, strong ties forged between the peninsula and east bay remain in a variety of ways. In the area of medicine, hospital and clinic communications are evident as expertise is shared and some local clinics even bear the names of Stanford and Palo Alto.

An example of shared information, acumen and technology is the Palo Alto Medical Foundation for Health Care, Research and Education. Prominent use of the Palo Alto name represents its beginnings when the Palo Alto Medical Clinic was founded after Dr. Russel Van Arsdale Lee, a Stanford-trained internist, joined the practice of Dr. Tom Williams in Palo Alto in 1924. Dr. Williams retired in 1929 and the next year, in 1930, Dr. Lee formed one of the first multi-specialty groups in the country with Drs. Fritz Roth (OBGyn & Orthopedics), Milton Saier (internist), Blake Wilbur (surgeon) and Esther Clark (Pediatrics).

Joined by Drs. H.L. Niebel, Harold Sox and Robert Dunn, this group of eight physicians is recognized as the "founding partners." The Palo Alto Clinic followed an example set by the Mayo Clinic. Dr. "Tony" Marzoni, of the Palo Alto Medical Foundation (PAMF) executive board says the Palo Alto clinic was drawn to a foundation model by the example of the Mayo Clinic, the "great granddaddy of multi-specialty clinics in this country." The Mayo Clinic developed a foundation model in 1938 to allow more concentration on the patient without profit motives and provide financial support through philanthropy.

As more physicians of differing specialties joined the Palo Alto Clinic, a foundation for basic research was created in 1950. It was at this time that Robert W. Jamplis, M.D., a surgeon who trained at the Mayo Clinic surgeon, joined the Palo Alto Clinic and played a major role developing the impetus to create a foundation in the Mayo model. Clinic physicians and the research foundation pioneered the use of lasers in the '60s, developing laser surgery of the eye.

Thirty years later, in 1981, the Palo Alto Medical Foundation (PAMF) was formed as a charitable non-profit organization to combine health care, education, and research within a single entity. The foundation is a separate organization that has contracts with the Palo Alto Medical Clinic, formed as a for-profit partnership. A satellite clinic opened in Fremont in 1984 and has now expanded to include an extensive myriad of specialties at its facility on Kearney Street in Fremont included in a new three-story, 74,000-square-foot building next door to the original 56,000 square foot facility. Fremont's clinic offers primary care, cardiology, obstetrics and gynecology, laboratory and X-ray and imaging service plus many other specialties including psychiatry and behavioral health services. There are two other health divisions - medical clinics - that have professional services agreements with the foundation, the Camino Medical Group and Santa Cruz Medical Group.

Unlike closed, membership organizations such as Kaiser, PAMF does not offer a health insurance plan that requires treatment at member offices and hospitals. Over 30 health insurance plans recognize PAMF as well as Medicare. Qualified low-income patients are eligible for free health care. Although PAMF can usually provide primary and specialty care, some patients prefer and use outside physician services in conjunction with clinic care.

Dr. Marzoni notes that the focus of PAMF has not changed from its founding, community-based and community-delivered care by "a group of physicians dedicated to give the community what it needs in health care services from primary care to specialty services." Health care management has been evolving, according to Dr. Marzoni, from a focus purely on a particular disease to the larger issue of "development and execution of best practices of care delivery systems and how to export these to the larger community." Recognizing the need to align with a larger health care system, Sutter Health was chosen as an affiliate network in 1992.

Fremont PAMF patients who require hospitalization are admitted to Washington Hospital; their care coordinated by a "hospitalist" physician. An "evolutionary" process created this role. In the 1990s, a patient access problem for primary care in Palo Alto created the development of a "rounder" hospital system by primary care physicians.  Instead of each physician trying to visit patients in the hospital and return in a timely manner for office appointments, a team of "rounding doctors" was developed, who specialized in hospital visitation and care management.

An outgrowth of this idea was the creation of a physician specialty, "hospitalist." From admission to discharge, the hospitalist coordinates all treatment with the primary care physician, serving as a communications link. For those transported to the hospital on an emergency basis, an on-call hospitalist is advised of admittance by emergency room personnel and becomes the admitting doctor. The hospitalist will see the patient during hospitalization and once after discharge to address any residual issues before care is resumed by the primary care physician.

Committed to all aspects of health care, PAMF provides health education classes and lectures open to the general public. Education can range from lectures by specialty physicians to discussions of pre-natal care by nurses, audiologist comments on hearing difficulties and nutritionists who speak about healthy eating. While most classes are free, some require a modest charge, but Dr. Marzoni notes that for those who want to attend and lack the resources, there is a mechanism to waive the charges.

A Community Health Resource Center is also open to the public from 8:30 a.m. to 4:30 p.m. every weekday. Operated by a registered nurse, the center is open to all community members providing an opportunity to browse through books, pamphlets and the internet with qualified assistance either on a drop-in basis or by appointment. Janet Lederer, R.N., vice president of PAMF's Education Division, notes that the presence of a registered nurse in the resource center helps visitors to "sift through all the information so they can make intelligent choices." She notes that there will be considerable outreach by Fremont center staff to ethnic communities and the inclusion of small, more intimate classes in the center for subjects such as CPR (cardio-pulmonary resuscitation) and breast self exams.

Voluminous information can sometimes present a significant problem for those interested in finding helpful and well-researched answers to medical questions. In some cases, a patient and his/her family may be searching form more information than has been presented by the physician at an office visit. The resource center can provide a solution. Lederer says that the resource center can be seen as "an extension of the physician office visit. If a physician visit is 10 - 15 minutes, the center represents an opportunity for patients and families to explore health care options and better understand the situation." Visits are kept on a confidential basis.

Director of Public Affairs, Jill Antonides, Ph.D., emphasizes that the use of electronic health records by PAMF is "significant." She notes that use of these systems enhances the ability of the Palo Alto Medical Clinic and Foundation to help its patients and develop viable approaches to health care and control. "This is health care of the future, today."

Palo Alto Medical Foundation
3200 Kearney St., Fremont
(510) 490-1222
1 City of Fremont - The First Thirty Years, The Mission Peak Heritage Foundation, 1989, p 138-139.

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