Hospital experiment putting locally grown produce on patients' plates

A cherry tomato seems hardly the stuff of revolution.

But Tuesday, if everything goes right, patients at 19 hospitals in Northern California will find cherry tomatoes with their chicken sandwiches and dinner salads, and will unwittingly take part in a small but potentially profound shift in institutional food systems.

The ripe red tomatoes are fresh from Hmong farmer Choua Vang's 9-acre plot near Sanger in Fresno County -- and they're the first items to roll onto Kaiser meal trays through a new pilot program that buys produce from small California farms instead of from the large, more industrial farms that typically supply hospitals and other large institutions.

Strawberries grown on Amparo and Aurelia Martinez's 23-acre Santa Rosa Farm in Salinas will sweeten patients' fruit cups on Wednesday. Soon, it will be plums and melons from Paul Buxman's 30-acre Sweet Home Ranch outside the Central Valley town of Dinuba, near Fresno. Later, it will be sweet potato sticks from an African American-run farm nearby.

About 10 farmers, with a focus on ethnic minorities, will send about a half-dozen crops straight to Kaiser's central kitchen over the next six months. Their names won't appear on Kaiser patients' menu cards, a la Chez Panisse -- at least not yet -- but that's in the works if the plan takes off.

The results of Kaiser's experiment will answer a question vital to the future of sustainable agriculture, and to the livelihood of small farmers in California and across America:

Can an institution the size of Kaiser Permanente adopt the Chez Panisse model of buying locally and from many smaller sustainable farms -- without busting the budget or bogging down its production of 5,000 to 6,000 inpatient meals every day for 19 Northern California hospitals?

If the pilot program works, Kaiser plans to expand it systemwide and also put it into place in its staff and visitor cafeterias.

Other large institutions eager to catch the sustainable wave are watching closely, including Stanford University, UCSF Medical Center and UC Berkeley, as well as food service outfits like Bon Appetit, which feeds Google and other companies.

"It's a baby step, but it feels to me like a big step," said Dr. Preston Maring, a Kaiser-Oakland gynecologist and administrator who started what he says was the first hospital-based farmers' market in 2003 (Kaiser now has 30) and is responsible for initiating the small-farm pilot program.

"We're big enough, and we order enough food" that Kaiser can make a difference, Maring said.

To understand what makes Vang's cherry tomatoes a big deal to Kaiser requires a plunge into the global produce economy and the modern wholesaling system that delivers most tomatoes, broccoli and carrots to consumers.

Whether their clients are Safeway or Kaiser Permanente, wholesalers want to buy from growers who can deliver lots of one crop, cheaply. Quality needs to be consistent, and ideally the supply should be year-round. The system favors large agricultural operations -- organic or not -- that grow crops up and down the state as well as in Mexico and Chile.

Smaller farmers have been aced out, especially nonorganic ones, according to Anya Fernald of Community Alliance With Family Farmers, the Davis-based nonprofit that works to preserve family farms and is developing Kaiser's pilot program.

Farmers too small or poor to own their own land often don't have the resources to go organic, which means they have fewer outlets like farmers' markets, subscription box sales and specialty wholesalers catering to high-end restaurants and markets, Fernald says.

The result: The number of small and medium-size California farms with annual sales up to $1 million dropped between 1997 and 2002. At the same time, farms with annual sales over $5 million grew 18.3 percent, according to U.S. Census of Agriculture figures compiled by Fernald for Kaiser.

Not coincidentally, she said, Fresno County has the most farmers, the most big farms and the most cropland of any county in the country -- but its biggest city, Fresno, has the highest density of urban poverty of any U.S. city, according to a 2005 Brookings Institution report.

To help keep small farmers from disappearing, the community alliance is trying to open new markets by working with large institutions like Kaiser. The trick is figuring out how to get produce from many small farms to one big kitchen, in this case Kaiser's central commissary, Food Service Partners in South San Francisco.

The alliance solution is to create a small, alternative distribution network.

Working mainly through Hmong, African American and Latino farmers' groups, the alliance has lined up small producers in the Fresno, Santa Cruz and Ventura areas who contract directly with Kaiser at prices slightly above wholesale.

They deliver their crops to big packers in their areas where Kaiser's wholesaler, Sysco-owned Lee-Ray Tarantino of South San Francisco, picks them up, along with all the other fruits and vegetables bound for Kaiser. Tarantino then delivers the produce to Food Service Partners, which has made most of Kaiser's patient meals for 31 years and will make the chicken salad sandwiches and dinner salads that will get Vang's tomatoes.

Tarantino's customers include big food service companies that cater to universities and high-tech companies. Over the past few years, company President Paul Tarantino says his clients have become more interested in produce that's organic and seasonal, and recently, buying locally has become hot.

Tarantino has mainly purchased from big growers. The focus on small farmers is new -- and, he said, has the potential to be huge.

"Santa Clara and USF want to piggyback similar ideas to what's going on at Kaiser," he said. "I'm excited. I was supposed to be on vacation (this week), but I put it off so I can be here for the first month."

Everyone involved is both amped up and aware of the pitfalls. So the pilot program is starting very small -- Vang will provide only 80 of the 1,200 boxes of cherry tomatoes Kaiser will use in August, for example. The plan is to see how things go for six months and then take stock.

"My fear is that there are very good reasons people got out of the system of buying from small farms," Fernald said on a recent trip to Fresno County to lay final plans with farmers. "It's less efficient."

But the alliance has a track record, with an alternative distribution hub called the Growers Collaborative it set up in 2004 to funnel small farmers' crops to public schools in Ventura. It follows a different model from the Kaiser program, but works with the same kinds of farmers.

Started with grant money, Growers Collaborative is now self-supporting and has expanded to 35 farmers serving schools in Ojai (Ventura County), plus the Getty Museum and Bon Appetit clients like Dream Works and Sony.

Kaiser's Maring said the hospital doesn't know yet what the costs might be.

Buying Central Valley broccoli instead of South American asparagus in December could be a cost-saver. But both the packers and Tarantino charge small fees to handle the produce.

"There may be an increased cost overall to do this, or there may be a decrease," Maring said. "We don't know."

For the farmers, working with Kaiser is a no-brainer.

Vang's 9 acres of cherry tomatoes, chile peppers and green beans provide the sole income for his family, including five kids from 14 to 21, living in Clovis.

His wife, Chong Yang, and children all farm with him at the height of the season. They pick 1,000 boxes a week and stack them in a rudimentary shed fashioned from tattered plywood and blue plastic tarps alongside his neatly trellised cherry tomatoes.

"The market is saturated now, so any new market is a plus," he said through translator Blong Lee of the Fresno-based Economic Opportunities Council, which works with many Southeast Asian family farmers.

Vang generally gets about $9 from wholesalers for a 16-pound box. But being paid directly by Kaiser will net him about 20 percent more, because the wholesaler's markup is cut out. And a contract with Kaiser would ensure him steady business, not subject to wholesale market volatility.

Earning more might let Vang eventually buy his land. In the short term, it will help support his family.

The community alliance's Ventura program kept a strawberry farm owned by a pair of Mexican American brothers in business, according to Fernald. With 20 acres, the brothers didn't grow enough to make it in the wholesale market, but grew too much to sell all their berries at farmers' markets, she said.

With Kaiser, she said, "We're starting with small volume. We're not changing farmers' lives yet. But a year from now we hope to see the same thing that's going on in Ventura." If it succeeds, she'd like to see Kaiser's model replicated all over California.

The advantages to Kaiser from buying from small farmers are more than just better-tasting, fresher cherry tomatoes to pique the appetites of sick patients.

It's also a good fit with the HMO's "Thrive" marketing campaign, with billboards linking healthy communities to eating things like fresh blueberries or broccoli, according to Kaiser's national nutrition director, Jan Sanders, who is a registered dietitian.

And, eventually, if the program grows, it will help Kaiser cut the amount of fuel it's using to transport grapes from Chile and kiwis from New Zealand. Of the 200 to 250 tons of fruits and vegetables Kaiser Northern California uses annually, about 100 tons come from outside California, according to a analysis by the alliance.

"I'm not saying that what Kaiser Permanente is doing will affect the rate of global warming," Maring said. "And I'm not saying that a post-hip-replacement patient who eats a local tomato wedge is going to go home healthier. And I'm not I'm not saying that we're changing the world.

"But we're changing our system -- and this can grow from here."

E-mail Carol Ness at [email protected].

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URL: http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/08/06/MNG43KC7751.DTL

Source San Francisco Chronicle