VA Virtual Museum

VA Medical Center, Mountain Home, TN

The historic institution known as the Veterans Affairs Medical Center, Mountain Home, (Johnson City), Tennessee, was founded in 1903 and has been under three different federal agencies. On March 15, 1989, under legislation signed by former President Reagan, the Veterans Administration attained Cabinet status as the U.S. Department of Veterans Affairs.

THE NATIONAL HOME
After being authorized by President Lincoln on March 16, 1865, an act of Congress, dated January 28, 1901, authorized the Mountain Home Branch of the National Home for Disabled Volunteer Soldiers. Its mission was to provide a domicile and medical care facility for Southern Union veterans and later expanded to include veterans of the Spanish-American War. The majority of the buildings on this Beaux Arts design campus were constructed between 1901 and 1905. Veterans of World War 1 were given admission to this National Home by an act of Congress on October 6, 1917.

Mountain Home, currently situated on 204 acres, was originally built on a 450-acre site because of the altitude (1700 feet),the inspiring views, and the abundant nearby mountain water. The act authorizing the Home appropriated $2,100,000 for its construction. The National Homes in that era were designed primarily as domiciles rather than hospitals, which were intended primarily as "infirmaries" for the care of those members of the Home who became acutely ill. Very few veterans were admitted directly to the hospital since the modern concept of veteran hospitalization had not been developed. This Home had a large farm which grew its own produce and raised livestock. It contained a greenhouse, laundry, power plant, various shops, fire department and security force. Veteran members furnished most of the labor for all these activities with the Home employing relatively few full time employees. Organization was essentially military in nature, the veterans being organized into "companies" with Captains and Sergeants. Even the full-time staff was semi-military in nature and title. This organization persisted until the close of World War II.

Like most of the National Homes, Mountain Home had its own beautifully landscaped cemetery. The cemetery now has nearly 30 acres and about 9,300 graves, with ample area remaining for expansion and is under the National Cemetery System Director. Among the original buildings was a beautiful chapel, built in two separate wings for Protestant and Catholic services.

Also included in the original construction was a beautifully designed theater, completely equipped for stage productions. The theater was restored in 1981. A baseball field with bleachers provided entertainment and recreation, and for many years was the finest baseball park in this area, used by the best amateur and semi-pro teams. Andrew Carnegie donated $15,000 for a library which served the patients for many years and is now used as a continuing education complex for the VA Medical Center and East Tennessee State University. The Library hall was dedicated in January 1998 as the Carl J. Gerber Lecture Hall honoring the current Medical Center Director, Dr. Carl J. Gerber. The Home also had a beer hall, which was closed in 1906.

THE NATIONAL SANITARIUM
In September 1920, Congress provided authority to change the "home" into a sanitarium or hospital for the treatment of disabled World War I veterans. By 1921, the "National Sanitarium" had a capacity of 1,000 beds and became one of the largest hospitals in the United States opened for disabled World War I veterans. Casualties from World War I, the influenza epidemic, and a national concern about tuberculosis (TB) combined to place emphasis on the hospital needs of veterans rather than the domiciliary needs. Accordingly, Mountain Home was redesigned from a Soldiers Home to a National Sanitarium. Money was appropriated to add sleeping porches (then the approved fresh air treatment for tuberculosis), to enlarge nurses' quarters, to add more staff quarters, and to purchase new medical equipment. In 1923 an isolation building, a laboratory, and a clinical wing were added at a cost of $150,000. With these alterations and additions, the National Sanitorium at that time represented a most complete and modern institution for the treatment of tuberculosis and its complications.

Among the additions of the 1920s was an enlarged surgical suite with modern operating rooms; a recovery room; cystoscopy rooms; an eye, ear, nose, and throat clinic; a modern dental clinic; a clinical laboratory; and a new radiology department with the latest equipment. More space was provided on the wards for doctors' offices and examining rooms.

As in most TB hospitals of the day, therapeutic "workshops" for both diversion and rehabilitation were established for the convalescent patients. Cabinet and other woodworking, reedwork, weaving, leather tooling, metal fabrication, and ceramics were among the crafts used. Educational courses were offered for those who wanted to complete grammar and high school certification. A portion of the extensive farmland was set aside for patients and members who wanted to garden as a means of therapy or diversion. During this period (1918-1930), the institution remained under the central authority of the National Homes.

THE VETERANS ADMINISTRATION
By Act of Congress and Executive Order of the President, dated July 21,1930, all agencies concerned with administering benefits for veterans were consolidated in an independent agency, the Veterans Administration. When Mountain Home became a field station of the new agency, the hospital capacity was listed at 605 beds and the domiciliary at 2,000 beds, both very overcrowded by modern bed-spacing standards. The domiciliary was virtually self operated in terms of supervision and support, and the largely tuberculosis nature of the hospital required rather light staffing. There were less than 200 full-time employees at this time. The newly appointed manager, Colonel Lee B. Harr, was given a free hand to reorganize and restaff the center. Colonel Harr served as manager (later center director) for 32 years, guiding the center through much of its development into the present day medical facility.

In keeping with its new designation as a Veterans Administration general hospital and domiciliary center additional physicians were recruited and a survey of the physical plant was requested. An architect and a Superintendent of Construction were sent to Johnson City to supervise an extensive program of rebuilding, renovation and modernization. Wooden floors in many areas were replaced with terrazzo, modern toilet and bath facilities installed, many new elevators were added, the heating system was completely updated, miles of roads were paved, all wiring was placed underground, and kitchens were modernized.

General Frank Hines, Director of Veterans Bureau, was largely responsible for a change in veteran legislation which was to involve millions of dollars in construction and services for he introduced the concept that "all honorably discharged veterans of any war, in need of hospitalization, should be authorized hospital care wherever facilities were available and sufficient therefore." This became law in June 1924, and greatly affected the future of the Veterans Administration hospital program.

THE MODERN ERA
With the end of World War II came an end to the Hines administration and a period of frustrating struggle for the Veterans Administration Medical Service. Before leaving office, General Hines had appointed in 1944 a Special Medical Advisory Group of outstanding physicians who recommended creation of a Department of Medicine and Surgery, with teaching and research activities as an integrated responsibility. This report led to the modern era in Veterans Administration medicine. In August 1945, President Truman appointed General Omar Bradley as Administrator of Veterans Affairs. By September 1945, General Bradley had announced a sweeping reorganization of the Veterans Administration, with thirteen branch offices similar to the military's regional "Armies." Each branch had a Branch Medical Director under a Deputy Administrator, who reported directly to General Bradley. The hospital and other field stations reported to these branch officials, with Atlanta being Mountain Home's "branch."

The Veterans Administration embarked on a major construction program which laid heavy emphasis on building veterans hospitals in urban centers where the veterans were concentrating, and particularly in urban centers where there was a medical school in existence or planned. All Veterans Administration hospitals located in cities with existing medical schools were assisted in affiliating with the schools as teaching hospitals.

Mountain Home had shared with most Veterans Administration hospitals the vexing problem of retaining adequate staff during the war years. During the great resurgence that followed World War II, Mountain Home was somewhat handicapped by being isolated in a small East Tennessee community, remote from the medical school contacts. In spite of this, vigorous efforts were made to improve the old physical plant, and the professional staff was substantially enlarged.

In 1953 a space survey team from Veterans Administration headquarters spent several weeks at Mountain Home studying the needs for major repair, modernization, and new construction. As a result of this study, work was initiated in 1957 on projects worth $1 million dollars which included a new surgical suite, a laboratory, expanded x-ray facilities, a central sterile supply service, physical medicine clinics, and other alterations and improvements.

In 1972, Congress enacted the "Veterans Administration Medical School Assistance and Health Manpower Training Act". This act provided the necessary financial impetus for five VA Medical Centers nationwide to assist in the development of medical schools in order to train physicians, improve health care delivery and promote medical research. Mountain Home VA Medical Center was selected as one of those sites. Since the enactment of this statute, known as the Teague-Cranston Bill, VA has continued to support, expand and strengthen its affiliation with East Tennessee State University’s James H. Quillen College of Medicine. The medical school accepted its first student and residents in 1978. Through this endeavor, funding was obtained for a Clinical Support Building built in 1984 at a cost of $11 million to expand services in medicine, surgery and ancillary services.

The medical center's operations have gradually changed from an essentially long-term care institution to a smaller more acute hospital care with an emphasis on primary care outpatient services. Beds in the hospital have been reduced in several stages from 605 to 202 at present. A new Bed Tower project which replaced 457 hospital beds at a cost of $62 million was completed in 1989, and occupied on August 25,1990. A shift to outpatient care has resulted in a reduction in beds to the present level of 202. This has permitted much better bed spacing and the provision of much needed offices and treatment rooms. At the same time, better staffing has greatly increased turnover and reduced the average length of patient stay.

A Nursing Home Care Unit (NHCU) of 58 beds was activated in 1965. This facility made available some needed beds in the hospital that were occupied by long-term patients. A 120-bed Nursing Home Care Unit, costing $7.6 million, was opened in October 1991, replacing the 58-bed NHCU in Building 93. An Alcohol Treatment Unit was established in 1971. A 10-bed Intensive Care Unit for medicine_, surgery, and coronary cases opened in 1975.

Domiciliary beds have also steadily reduced, largely due to lack of demand. From a very over-crowded high of 2,000, beds have been reduced to the present operating capacity of 350. As a result, domiciliary patient-members have much better living conditions. At the same time, the staff can direct more effort toward outpatient rehabilitation of the veteran and his restoration to community living, the present objective of the VA Domiciliary. The new Domiciliary, costing $32 million, was opened September 1992.

The James H. Quillen College of Medicine is scheduled to complete its move to the VA grounds in the near future into the buildings which were formerly occupied by the Domiciliary. Funding for the renovation of these buildings will be shared by the Department of Veterans Affairs and the State of Tennessee.

Teaching and training affiliations have developed rapidly in recent years, and include the East Tennessee State University School of Nursing and School of Public Health (Dental Hygiene and Environmental Health), and Paramedical School (Radiology). Field experience is provided for graduate students in Audiology and Speech Pathology, Social Work, Psychology, and Pharmacy.

A concerted effort has been made by the VA Medical Center and VA Headquarters officials to update the technical and medical equipment Since 1978, nearly $10 million has been expended for new and replacement equipment to bring "state of the art" health care facilities to Mountain Home and enhance its function as an affiliated, progressive, and modern medical center.

Mountain Home VA has embarked on a major capital improvement program. A new $9 million Laundry/Warehouse facility is presently underway with a completion date slated for 1999. A joint venture between the State of Tennessee and VA will see the completion of a $36 million Basic Science building on the campus of our VA in 2000. Also a $15 million clinical addition is projected for completion in 2001. An additional $11 million has been earmarked for renovation of three former domiciliary buildings (bldg. 2,3 & 5).

The Mountain Home VA Medical Center is a large comprehensive care medical facility serving more than 18,300 veterans in its four-state catchment area. There were 213,225 outpatient visits in FY 97. It is a major factor in the economy of Johnson City with a staff of over 1,300 and a budget of over $95 million for fiscal year 1998.

###

"The Mountain Home Story" submitted by Nancy Dougherty, Mountain Home VAMC, VISN9. Revised February 1998.