James H. Quillen VA celebrates its centennial anniversary: 1903-2003.

The James H. Quillen Veterans Affairs Medical Center is very different from its modest beginnings 100 years ago. Today the medical center stands as a visionary and leader in the health care industry. This comprehensive care medical facility serves more than 25,000 veterans in its four-state service area. Since 1995, the VA has moved to an outpatient model of care and increased its patient load by 109% while decreasing the cost per patient and the number of employees providing these services. The quality of VA health care compared with private sector best practices far exceeds the norm while the VA provides care to an older and more medically complex population.

The institution, known today as the James H. Quillen VA Medical Center at Mountain Home (Johnson City, TN) has a history that dates back to the Lincoln administration. On March 16, 1865, President Abraham Lincoln authorized the construction of 10 homes and medical facilities for Union veterans of the Civil War. One of the identified facilities was 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. The mission was later expanded to include veterans of the Spanish-American War. Thirty-six years later, on January 28, 1901, Congress appropriated the funds to construct the National Home, which was established in 1903.

During the period 1918-1919, large numbers of veterans poured back into this country from Europe with lung scarring as a result of gas attacks, tuberculosis outbreaks, and the worldwide spread of influenza. Mountain Home was redesignated from a Soldiers' Home Branch to a National Sanitarium.

In 1930, by Act of Congress, all agencies administering services to veterans were consolidated under the Veterans Administration. The hospital was enlarged to 605 beds, and the domiciliary (ie, the original Soldiers' Home) had 2,000 beds. By the end of World War II, there was a surge in the demand for medical services, and the medical center's hospital gradually changed essentially from that of a long-term care institution to that of a smaller, acute care hospital.

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 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, the Mountain Home VA Medical Center has continued to support, expand, and strengthen its affiliation with East Tennessee State University's James H. Quillen College of Medicine. Expanding the partnership between the two entities, a new basic science building was constructed and dedicated in 2001 as the Stanton-Gerber Hall, which allowed the medical school to move its entire operation onto the VA campus. Dr. Carl J. Gerber, medical center director, stated, "With the establishment of the medical school in conjunction with the VA, a new era of quality health care was begun. That has continued until the present and in the future will continue to influence the quality of care available, not only to veterans, but the community at large."

The medical center's gradual change to a smaller, acute care hospital has led it to an emphasis on primary care outpatient services. The number of domiciliary beds also has been reduced steadily, largely due to lack of demand. From an overcrowded high of 2,000, the number of beds has been reduced to the present operating capacity of 350. The present objective of the VA domiciliary, built in 1992, is to direct services more toward outpatient rehabilitation and restoration to community living for veterans.

Today the James H. Quillen VA Medical Center is a model for the provision of primary care services. In 1994, the VA had approximately 2,500 patients enrolled in its Primary Care Service; today, more than 25,000 patients receive care in this program. The Primary Care Service is a leader and model for the implementation of same-day clinic access for patients.

The Geriatric and Extended Care Service of the James H. Quillen VA Medical Center provides a broad range of assessments and recommendations as well as a comprehensive treatment plan to all geriatric patients. Health problems in the elderly are often atypical and/or nonspecific in presentation and compounded by multiple pathologies. The Geriatric and Extended Care Service is cognizant of this fact and is very thorough in workups, placing a high value on patient safety.

The Patient Safety Program at the Mountain Home VA Medical Center has been recognized nationally for its success. It was one of four medical centers involved in a research trial using hip protectors in patients at high risk for falls. These hip protectors are an evidence-based practice for use, along with other measures, in preventing major injuries due to falls. Thus, falls with major injury have decreased.

Medical research in the VA system is focused on finding better ways to diagnose and treat diseases that affect veterans. The James H. Quillen VA Medical Center has a long tradition of supporting such research. One area in which our medical center has contributed important results is cardiovascular research. Our first cardiovascular VA merit review grant was awarded in 1991. This project involved an innovative system using isolated single heart cells to study the mechanism by which ischemia (lack of blood/oxygen) damages the heart. Three of our current projects continue to address the problem of heart disease. One project involves the study of chemicals that can protect the heart from damage caused by drugs used to treat cancer. In the second project, investigators are examining the possibility of treating heart damage by transplanting cells from other muscles, which then can grow into new, functional heart cells. The third project concerns a protein involved in heart failure and scarring of the heart. Mountain Home's Audiology Service has developed a research program that has established our institution as one of the foremost centers in the country for studying problems related to hearing and balance.

The Surgery Service at the VA has followed the national trend of performing most operations on an outpatient basis. Seventy-six percent of all operations performed fall into the ambulatory surgery category. In addition to general surgery, urology, orthopedics, thoracic/vascular, otolaryngology, and podiatry, there are now more subspecialties, such as plastic surgery, gynecology, and pain management.

The James H. Quillen VA Medical Center is a state-of-the-art, comprehensive health care facility today compared with the humble beginnings of the "old Soldiers' Home" in 1903. The facility is a leader in innovations and is often first in testing new ways of doing business in health care.

Today, when one looks at the James H. Quillen VA Medical Center, one sees the evolution of a National Soldiers' Home into a premier health care institution that takes pride in its centennial slogan: "A century of serving ... a lifetime of caring."

RELATED ARTICLE: Director's Biography: Carl J. Gerber, MD, PhD

The Secretary of Veterans Affairs appointed Dr. Gerber medical center director of the James H. Quillen Veterans Affairs Medical Center at Mountain Home, TN, on November 29, 1992.

Dr. Gerber started his career with the VA as chief of neurology at the Durham, NC, VA Medical Center. After serving as chief of staff at the Tacoma, WA, and Des Moines, IA, VA medical centers, he served as medical center director at the Fort Meade, SD, and Cleveland, OH, VA medical centers.

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After completing the requirement for the bachelor of science degree at the University of Detroit, Dr. Gerber attended Washington University in St. Louis, where he earned his doctoral degree in neurophysiology. He then earned his medical degree at Duke University School of Medicine. He completed postgraduate training in psychiatry and neurology and is board-certified in psychiatry.

He has held academic appointments at Duke University, the University of Washington, and the University of South Dakota. He holds appointments as professor of hospital administration and professor of psychiatry at the James H. Quillen College of Medicine at East Tennessee State University.

Dr. Gerber also has been awarded an honorary doctor of humane letters degree from the Ohio College of Podiatric Medicine.

Judy C. Fowler-Argo, James H. Quillen VA Public Affairs Officer