MOUNTAIN PEOPLE’S THEN AND NOW

A comprehensive history (1974-2023) of a vibrant community-owned and community-operated clinic network in East Tennessee

composed by Caryl Carpenter 2024

 

I came to East Tennessee in December of 1975. The Board of Directors of Mountain People’s Health Councils (MPHC) had hired me to be their administrator. MPHC was founded in 1974. The first administrator, Duane Sexton, had resigned. I moved to Tennessee from Massachusetts.
I found out about the job from a college roommate, Betsey Remage, who was working as a health careers counselor at Harvard. She visited East Tennessee to see a student she had worked with who was doing a year of service between undergrad and medical school, Ellen Williams. Ellen was working with the East Tennessee Research Corporation.
Betsey found out that MPHC was looking for an administrator and told me about it. Betsey didn’t even finish her sentence and I was in the car headed for Tennessee. I don’t know why I responded so quickly. I think it was a fascination with the mountains. Maybe it was because I spent many summers at the other end of the Appalachian chain in the Adirondack Mountains of New York. Some people in the East are mountain people; some people are ocean people. I was a mountain person.
I had worked for the Providence Community Health Centers in Rhode Island and been the Executive Director of a family planning project in Brockton, Massachusetts. I was also 9 months into a 24-month Master of Public Health program at the University of Michigan. The program was for working health care professionals. We came to Ann Arbor once a month, for 24 months, for a 4-day weekend of classes. This was before the days of personal computers and studying on-line.
I was the youngest person in the class (turned 30 about halfway through) and had the least experience. My classmates were my professors, along with the Michigan faculty. My commute from Massachusetts was not the longest. I had classmates from as far away as Arizona, Maine and Mississippi. Many of them were administrators or medical directors in community health centers.
I’m not sure why the board at Mountain People’s hired this Yankee woman. I suspect Bill Dow and Pat Kalmans were my advocates. I did know how to write federal grants. That might have sealed the deal. I discovered later that I had one other valuable skill. At that time, Mountain People’s ordered their drugs from a pharmaceutical wholesaler on Long Island, NY. I was the only person at Mountain People’s who could understand their accents.
My office at Mountain People’s was on the second floor of the Norma School, across the road from the Norma Clinic. The clinic in Norma was housed in the office of Norma’s only physician, Dr. Divine Truth Chambers, who was murdered in his home. That was a comforting thought for the physicians who eventually worked for Mountain People’s.
There was no heat in the office when school was closed, which happened quite often in the winter. I learned the hard way that the school and almost everything else closed when there was a slight skim of snow on the winding Norma Road. Not long after I started at MPHC, I headed for work from my house in Lake City. There was that skim of snow which I thought nothing of since I had lived in Upstate New York and New England all of my life to that point. As I headed up the Norma Road, I realized there was a glaze of ice under the snow and I started sliding backwards. I managed to get a rear tire jammed into a gully along the edge of the road, right before a drop-off into a hollow.
A board member, Quentin Sharpe, came by and informed me this was no weather to be out on the Norma Road, and besides the school was closed. He helped me get my car turned around and I headed home. Along the way I started to slide again. I had a choice between sliding into a coal truck or going over the edge. I opted for the coal truck. The damage wasn’t too bad. The front of my car was smashed and so was my nose, but I was able to drive home and I was able to breath. Odes McKamey from Stoney Fork helped me find someone to repair my car. A kindly ENT physician in Oak Ridge, eager to bill my insurance, repaired my nose. He even offered to take a little off the end of my nose while he was at it. I declined because my nose was proof that I was the daughter of Leonard Carpenter.
In 1979, two National Health Service Corps (NHSC) physicians who were assigned to the Black Lung Clinic in Jacksboro, Dr. Bob Firestone and Dr. Peter Haroff, were having conflicts with the board. They wanted to leave the clinic but not the area. I offered to help them set up a not-for-profit clinic to which they could be assigned by the Corps. Thus was born Valley Health Services. The physicians moved into the medical office building attached to Lafollette Hospital.
Eventually, two Corps clinicians from Mountain People’s, Kaye Bultemeier and Bob Hartmann, spent part of their time with Mountain People’s and part with Valley Health.
I worked out an agreement with the Mountain People’s board to work part-time for them and part-time for Valley Health. Eventually I helped MPHC recruit a new, full time administrator, Cade Sexton. I continued to work part-time for Valley Health until I left in November of 1980 to become an Instructor at the University of Missouri-Columbia. I remember my farewell party was at a Chinese restaurant in Oak Ridge the night of the 1980 election. As we gathered, it was clear that Reagan had beat our guy, Jimmy Carter. It was a rather somber event.
Fast forward to 2016. I was invited to a gathering of alumni from the Vanderbilt Student Health Coalition (SHC) in Chapel Hill. They were in the process of developing an archive and website about the work of the SHC. I was invited because I had been part of two legacy organizations – Mountain People’s Health Councils and the Tennessee Primary Care Association (TPCA). I was one of the organizers and the first President of TPCA.
After the gathering, I decided to go on-line to see what had become of Mountain People’s. I was amazed. MPHC had become a significant provider of health services in Scott County and was a thriving organization. Two of the three original Mountain People’s clinics had closed – Petros and Stoney Fork – but the organization now had five sites, all in Scott County, including the original clinic in Norma.
I was especially shocked to learn that the headquarters and one clinic were located in Oneida, the largest town in the county, and the location of the only hospital in the county. I remember that the work of MPHC in my day was not welcomed by the private practice physicians in Oneida. (I admit that might have been because one of the MPHC physicians said a primary health problem in Scott County was iatrogenic disease, i.e. disease caused by physicians.)
How could the atmosphere have changed so radically? I had to know. So I arranged a field trip to East Tennessee to interview people associated with Mountain People’s, both past and present. There were four of us on this mission: Rick Davidson, a SHC alum and the first National Health Service Corps physician to work at Mountain People’s; Irwin Venick, another SHC alum and an attorney in Nashville; Biff Hollingsworth, an archivist from the University of North Carolina library; and yours truly. I documented this visit in an article on the SHC website,
Notes from the Road. https://studenthealthcoalition.org/?s=notes+from+the+road
In this article, I will compare Mountain People’s in the late 70s with Mountain People’s in 2023. How did it change? What changes account for its current success?
Mountain People’s Then
There were three communities that incorporated health councils and built facilities after hosting a Student Health Coalition (SHC) health fair. Each community concluded that they were too small to operate independently. With the help of Bill Dow and Pat Kalmans, the three communities decided to create an umbrella organization they named Mountain People’s Health Councils (MPHC). MPHC was incorporated on September 26, 1973. The articles of incorporation were signed by Raymond Jeffers (Norma), Emma Kate Bradley (Petros), and Odes McKamey (Stoney Fork).
The articles of incorporation specified a number of purposes for Mountain People’s: 1) to increase the health services available to the people in the geographical areas served by the following three non-profit community health organizations:
Area Health Center, Inc.
Norma, Tennessee

Petros Health Council, Inc.
Petros, Tennessee

Stoney Fork Health Council, Inc.
Caryville, Tennessee

2) to provide health services in other geographical areas if the Board of Directors of this corporation so decides (leaving open the possibility of adding other clinics such as the one developing in Robbins, Tennessee);
3) to provide overall administration and aid in financing, to coordinate the delivery of health services and health education, and to provide health services directly, as requested by the participating non-profit community health organizations through their representatives on the Board of Directors;
4) to help the participating community health organizations to procure and train medical and other necessary personnel; 5) to promote better environmental and occupational health conditions, as requested by the community health organizations through their representatives on the Board of Directors; 6) to encourage and participate in any activity designed to promote the general health of the areas served by the participating community health organizations…7) to operate exclusively for charitable and educational purposes, to lessen the burdens of government, to promote social welfare of the area, and to encourage local initiative in solving health problems and relieving the poor and distressed and underprivileged residents of these communities.
It is interesting for me to look at the purposes delineated in the articles of incorporation. They suggest a broad, public health approach to health care that included occupational and environmental health, for example. However, these broader activities were not part of the work of Mountain People’s or the clinics. There were no environmental and occupational health activities included in the federal grant. The only community that was active in environmental health issues was Petros. Kate and JW Bradley, and other members of the Petros Health Council, were active in Save Our Cumberland Mountains (SOCM), an organization committed to challenging the coal companies whose work created major environmental degradation and threats to individuals’ health. The work of SOCM was not linked to the Petros Clinic. It was not part of the work of the clinicians assigned to the clinic. The connection was only through the dual roles played by the Bradleys.
I think at the time of the incorporation, Bill Dow and Pat Kalmans tried to get the Briceville Clinic to join Mountain People’s, but Byrd Duncan wanted no part of it. The people in Robbins, in contrast, were interested in joining MPHC once they were ready to open their clinic. Their health fair was not until 1974.
The original three communities were each in a different county: Norma in Scott County; Petros in Morgan County; and Stoney Fork in Campbell County. The three communities had little if anything in common other than their participation in MPHC and their shared origins in SHC health fairs.
The Mountain People’s Board of Directors had three representatives from each of the three communities. Each clinic had a separate health council. It was not clear what the duties of local health councils were compared to those of the Mountain People’s board. The National Health Service Corps (NHSC) placed three nurse practitioners and one physician with MPHC, not with the individual clinics, but the understanding was that each clinic would have a full-time nurse practitioner and the physician would circuit-ride among the clinics throughout the week.
MPHC had a federal grant through the Rural Health Initiative, Section 330 of the Public Health Service Act. This grant paid for everything but the NHSC clinicians’ salaries. Mountain People’s also had some funding from the Appalachian Regional Commission. The individual clinics had small grants from private foundations, including the Catholic church’s Campaign for Human Development. These funds were used primarily for building maintenance.
The support staff (receptionists, lab assistants, and outreach workers) were hired by the local health councils, although they worked for Mountain People’s. The MPHC secretary/bookkeeper and administrator were hired by the Mountain People’s Board. Support staff in the clinics and administration were paid through the MPHC federal grant.
When I arrived in 1975 to replace Duane Sexton as the MPHC administrator, I reported to the Mountain People’s Board of Directors. However, I also met with the health councils in Norma and Stoney Fork on a regular basis. I don’t remember meeting with the Petros Health Council, at least not regularly.
It took me a while to figure out what issues I should take to the local councils vs. the MPHC Board.
My primary responsibility was to write the grant applications to the Feds and the foundations, whether MPHC or an individual clinic was the grantee. Jan Laxton, the secretary/bookkeeper, handled payroll, kept the books, and did the billing to Medicare, Medicaid and private insurance.
After I had been at MPHC for a while, I did an analysis of each clinic’s prospects for achieving self-sufficiency, i.e. being able to function without a federal grant. Given low utilization at Petros and Stoney Fork compared to Norma, I concluded the only clinic that might achieve self-sufficiency was Norma. I thought all three clinics could improve their financial position by raising fees. Each clinic had developed its own fee schedule, so I had to meet with each local health council to get approval to raise fees. I could not have taken that issue to the MPHC Board. The video below shows me presenting at one of the SHC alumni events, talking about my experience discussing the issue of fees with the Stoney Fork Health Council:

Caryl Carpenter on community leader Odes McKamey


It turned out I did not encounter any resistance from the Stoney Fork Health Council, or any other health council, to the idea of raising fees. Council members in all three communities felt that low fees might suggest the care in the clinics was inferior to private practice, so they were supportive of my proposals to increase fees. (Many years later, I told my students that the highlight of my management career was when Henry Tackett of Stoney Fork said, “Caryl tells it like a mountain man likes to hear it,” after a meeting of the Stoney Fork Health Council.)
I think the three communities agreed to form Mountain People’s because they thought they could retain a fair amount of independence, while accessing the Federal resources that would not have come to them individually. This example about raising fees illustrates the somewhat confusing separation of powers between MPHC and the local health councils. Looking back on those days, I realize that locally Mountain People’s had no identity of its own, whereas the local councils did not exist from the point of view of the National Health Service Corps or the Federal bureau that funded the Rural Health Initiative grant. (As you will see when I write about MPHC today, this governance problem no longer exists.)
One job I did not have was personnel management. The clinicians worked for the Corps, although we could call on the regional office of the NHSC if there were problems with the performance of any of the clinicians. The support staff worked for the local health councils, even though they were paid by Mountain People’s.
To be honest, I was just as glad to defer to the local councils because each council had hired one or more people as support staff who were related to someone on the health council. I don’t know if any of the people who helped organize the clinics and Mountain People’s ever pointed out that nepotism was not a good practice. On the other hand, I can easily understand how this happened. Other than the coal companies, there were very few employers in these communities that paid a decent wage plus benefits. The council members who had family members working in the clinics were also leaders who played essential roles in the development of the clinics.
What I don’t know is whether hiring relatives of the health council members created any problems for the clinics. If there had been a problem with any of these employees, I did not have the authority to do anything about it. I did have a sense that there were resentments in Petros about the health council hiring the daughter of Kate and JW Bradley. However, those resentments also might have been about the work the Bradleys did to challenge local authorities and the coal companies. As Kate said, in a 2017 interview, many people in the community thought the federal money came directly to the Bradleys.
At the time of Mountain People’s founding, nurse practitioners (NPs) were a fairly new concept. The NPs at MPHC were pioneers in a new field. Most were graduates of some of the first, well-regarded MSN programs in the country – Vanderbilt, U of Rochester, U of Pennsylvania and Frontier Nursing Service in Kentucky.
One interesting part of my job at Mountain People’s involved advocating for public policies at the state and Federal level that were supportive of NP practice. Many states, including Tennessee, had not adapted their practice acts to cover the full scope of practice that was required of the NPs at Mountain People’s. As Rick Davidson said during a panel discussion at Vanderbilt, we were practicing at the edge of the law.
A good example was the issue of prescribing and dispensing medications by nurse practitioners. Each clinic at Mountain People’s had a pharmacy from which the NPs dispensed medications that they prescribed or were prescribed by the physicians. After I came to MPHC, a PharmD from the University of Tennessee School of Pharmacy, Glen Farr, arranged to visit the clinics regularly and package the most frequently used medications. Not every clinic staffed by an NP in Tennessee had a dispensing pharmacy, but most of them had NPs writing prescriptions that were typically co-signed by a physician. The issue came to a head when the Tennessee Board of Pharmacy charged a nurse practitioner at the Crab Orchard clinic of illegally prescribing medications.
That event prompted Bill Corr to call a meeting of administrators and nurses from the various clinics in East Tennessee. I attended that meeting on behalf of MPHC. There was clearly a need to represent the interests of the clinics with the legislature, the Board of Medicine, the Board of Nursing and the Board of Pharmacy.
Bill proposed forming an association of clinics. Thus, was born what eventually became known as the Tennessee Primary Care Association. I was one of the founders, along with clinicians, administrators and academics from across the state, and was the first president. In that role, I made many trips to Nashville to meet with legislators and government regulators. I’m quite sure most of the legislators thought I was a nurse, since what else would a woman in health care be.
A breakthrough came when the MPHC physician, Bob Hartmann, was accidentally invited to a meeting of the Tennessee Family Practice Association. The family practice physicians were up in arms about the clinics that they considered to be their direct competitors who had the advantage of Federal grants to subsidize their operations. They were meeting with Ned McWherter, then Speaker of the Tennessee House of Representatives.
Bob lived in one of two houses in Lake City that were home to physicians and nurse practitioners who worked at Mountain People’s. These included Rick Davidson, Bill Dow, Kathy Bowman, Bob Hartmann, and Kaye Bultemeier. Any mail addressed to a physician in Lake City was typically delivered to one of the two houses. That’s how Bob found out about the meeting with McWherter. He attended the meeting and stood up to explain how the clinics in East Tennessee were structured, and what the need was for primary care services in that area. That got McWherter’s attention and eventually his support.
Eventually changes were made to the Nurse Practice Act to permit prescribing by NPs under certain circumstances, without a physician being on-site to co-sign them. I don’t think we ever addressed the issue of dispensing by NPs, although the nurses at Mountain People’s and some other rural clinics continued to do so. When we visited MPHC in 2017, I found out there were no longer dispensing pharmacies in the clinics. Nurse practitioners and physician’s assistants can write prescriptions that they can be filled at retail pharmacies in the county. Mountain People’s also participates in the 340B discount drug program. MPHC serves as the pharmacy but they drop ship the 340B medications to the independent pharmacy partners who distribute the medications to MPHC patients.
Another policy issue related to Medicare and Medicaid reimbursement. It was common practice at Mountain People’s and other rural clinics to bill Medicare for services provided by an NP under the physician’s name, even though the physician was not always on site when the services were provided. Technically, this was illegal. I was invited to Washington to meet with the head of the bureau that housed the National Health Service Corps and the community health center programs, Ed Martin. The meeting had been arranged by Alice Hersh, who was the head of health programs at the National Rural Center. I talked to Martin about the model at MPHC of full-time nurse practitioners in the clinics with a circuit-riding physician who visited each clinic twice a week. It was not practical to only see Medicare and Medicaid patients when the physician was on site, which is why we were billing under his name, even though he did not always see the patients we were billing for.
Subsequently, Alice arranged to have Rep. Dan Rostenkowski (D. Ill) come to East Tennessee to see the clinics . At that time, Rostenkowski chaired the influential House Ways and Means Committee. I was not involved in the visit but I remember that Bill Dow and others took Rostenkowski on a tour of the clinics. They took him on the road between Stoney Fork and Norma that requires you to drive through a stream. (It really wasn’t a road that was used very much, but they didn’t tell Rostenkowski that.) Subsequently, some of the board members from MPHC went to Washington to meet with Congressmen to discuss the issue.
In this video, board member, Betty Anderson, talks about her experience lobbying on behalf of nurse practitioners.

Nurse Practitioners, in the beginning…


About the same time, Bill Corr told Rick Davidson that he was interested in going to work in Washington. Rick’s father was personal physician to Congressman Paul Rogers of Florida. Rick’s father contacted Rogers and asked him to meet with Bill. Bill must have made a good impression because after meeting Rogers, Bill was hired to serve as Counsel to the House Subcommittee on Health and the Environment, chaired by Rogers. (Bill went on to serve in a number of significant staff positions in Congress. In 2009 he became Deputy Secretary of Health and Human Serv ices in the Obama Administration.)
There was strong bi-partisan support for addressing the issue of Medicare and Medicaid reimbursement for nurse practitioners and physician assistants practicing in rural clinics. Rogers introduced the legislation that eventually became the Rural Health Clinic Act that made provisions for nurse practitioners and physician assistants in rural clinics to bill Medicare and Medicaid for their services, even if a physician was not on site when services were provided.
When I was in class at the University of Michigan one of the four-day weekends I attended as part of my Master of Public Health Program, a telegram arrived from the White House, inviting me to attend the signing of the Act at the White House. Needless to say, my classmates were quite impressed, including the head of the National Health Service Corps who was in my class. I attended the signing in the East Room of the White House, although Jimmy Carter wasn’t there. Vice President Mondale was there in his stead.
MPHC Now
I left East Tennessee in 1980. Mountain People’s went through expansion and contraction in the period from 1980 to our visit in 2017. In 1980, Cade Sexton was the administrator of Mountain People’s. Cade was there when the conflict between Dr. Caster and the Petros Health Council erupted and led to Dr. Caster and Janie Hiserote leaving Petros to start a clinic in Coalfield. There was a brief period when the Petros clinic was staffed by a physician’s assistant, but eventually it closed.
About the same time, the community in Elgin, Tennessee was ready to join MPHC. There had been a Student Health Coalition health fair in Robbins (also called Elgin) and the community had built a clinic, much like the other clinics in MPHC. The National Health Service Corps assigned husband-wife physicians to Scott County and MPHC in 1981. The wife worked at the Elgin clinic – Highland Health Center. Her husband was assigned to do what the Corps called the Private Practice Option. He opened a private practice in Oneida, the location of the only hospital in Scott County. His interactions with the local medical community were so negative, he and his wife left the area after one year.
In 1981, Jan Laxton became the administrator for Mountain People’s. She had served as the administrative assistant and bookkeeper from the beginning of MPHC in 1974. During Jan’s long tenure, MPHC expanded within Scott County. Clinics were opened in Huntsville, Winfield, and Oneida. Dental services and mental health services were added. When Kaye Bultemeier left Stoney Fork, MPHC tried to staff the clinic by having the NP at Norma go to Stoney Fork once a week. Demand had always been low at Stoney Fork. With Kaye’s departure, it dropped off even more. Eventually the clinic closed.
When I visited Mountain People’s in 2017, along with Irwin Venick, Rick Davidson and Biff Hollingsworth, Mountain People’s was alive and well. MPHC is now based entirely in Scott County. The five clinics provide a comprehensive range of services, including dental and mental health services (that were not part of MPHC in my time). The five locations are Norma, Elgin, Huntsville, Oneida and Winfield. They provide services on a sliding scale for those who do not have insurance, so no one is refused care because of an inability to pay. During that visit, Rick Davidson (the first NHSC physician at MPHC) said, “Mountain People’s today is exactly what those young medical, nursing and law students from Vanderbilt hoped it would be when they held health fairs in Norma, Petros and Stoney Fork more than 40 years ago.” Mountain People’s serves more than half the population of Scott County.
During our visit, we met with James Lovett, the current CEO of Mountain People’s and with the current MPHC Board of Directors. In 2005, Jan Laxton died of cancer. Mountain People’s struggled through a period without leadership, while the Board was interviewing candidates to be Executive Director. One of the candidates was James Lovett. James had grown up in Oneida and left to attend college at the University of Tennessee. James brought a lot of relevant experience to the position. He had worked for Blue Cross/Blue Shield of Tennessee and been the administrator of a rural health practice in Kentucky. James was excited about the fact that MPHC was a Federally-Qualified Health Center (FQHC). He thought the FQHC model had the potential to do a lot of good work in the community where he was working in Kentucky. James wasn’t sure he wanted the job at Mountain People’s but couldn’t say no when one of the board members said “why don’t you come back to do the same work for the people you grew up with.”
James also told us about his experience as a child when his mother brought him to the SHC health fair in Norma.

James Lovett’s childhood experience at the Norma Health Fair


What a great story. A 7-year-old who attended the Norma health fair comes back many years later to be the Executive Director (and eventually CEO) of Mountain People’s Health Councils.
There is much to be proud of at Mountain People’s. They provide a broad range of services including pediatrics and adult health, preventive medicine and disease management, women’s health, dental, behavioral health, vision and hearing screening, pharmacy, care coordination, and case management. They also have a certified program for treating people with opioid addiction, a program that is critical for serving the people of Appalachia today. MPHC offers on-site laboratory and x-ray services. The original Mountain People’s clinics offered lab services but no radiology. MPHC also has 24-hour call coverage, something that would have been logistically impossible with the one circuit-riding physician going to three counties in the original MPHC model.
As of 2023, MPHC is in the process of building a new center that will allow community members to better access diagnostic services such as MRI, CT, ultrasound, mammography, and bone density studies. MPHC was able to get their state representative to include this project in the federal budget as an appropriation. They were thrilled when the proposal advanced through the House Appropriations Committee and await the final decision about the federal budget. MPHC is also working towards building a new and larger health care facility in Huntsville.
Mountain People’s has made a strong commitment to assuring their patients receive high quality care. In 2019, two SHC alums – Diane Lauver and Anne Thomas – visited Mountain People’s and met with Sharon Neal, RN, the MPHC Quality Improvement Director. Sharon described their continuous improvement approach that utilizes cross-functional teams of providers and staff to develop and improve work flows and processes. As of 2023, MPHC has received the National Quality Award for four consecutive years. This award recognizes the top 1 percent of community health centers nationwide in terms of their quality-of-care scores. They are one of only two health centers to ever earn the award in Tennessee and the only health center in the state to win the award in 2022. MPHC has won many other quality-related awards from the federal Health Resources and Services Administration for reducing health disparities and increasing access to care, plus awards from the American Heart Association for their disease management work for patients with Type 2 diabetes and high cholesterol.

(This contrasts with my experience in the early days of Mountain People’s. I was in a course at the University of Michigan taught by the father of quality measurement in health care, Dr. Avedis Donabedian. The course inspired me to develop a system to monitor quality of care. I developed an encounter sheet that included a list of the most common diagnoses. The clinics sent their encounter forms to me and I sorted them manually by diagnosis. Then when the NPs decided they wanted to study patients with a particular diagnosis, I gave them a list of the patients’ names to draw for chart reviews. Quite primitive compared to what Mountain People’s can do today and totally in violation of today’s HIPPAA rules.)
MPHC is also stable financially, although they do depend on the same Federal grant that has funded Mountain People’s from the beginning. The grant makes it possible to see patients without insurance on a sliding fee scale and it supports some of the programs that are not revenue-generating. Under the leadership of James Lovett, MPHC managed to finance construction of another facility in Oneida out of operations. That never would have been possible in Mountain People’s early days. In 2023, Mountain People’s received a significant multi-million dollar donation from a wealthy philanthropist. That is almost unheard of in community health centers.
I was pleased to learn that staff from Mountain People’s continued to be leaders in the health care field. Both Jan Laxton and James Lovett served as Chair of the Tennessee Primary Care Association. Dr. Edward Capparelli, the Mountain People’s Medical Director, was appointed by the governor of Tennessee to chair the TennCare Pharmacy Advisory Committee. He has been active in the Tennessee Medical Association (TMA) where he has served on the board of trustees and chaired a number of TMA committees. In 2017, Dr. Capparelli was elected Speaker of the House of Delegates of the TMA. He was the first physician from a Tennessee Primary Care Association member health center to ever serve in that capacity. Quite a contrast with the opposition to the clinics from professional medical associations in the 1970s and 80s.
The question I asked myself was what differences between MPHC Then and MPHC Now explain the difference between what MPHC was in its early days and what it is now, some 40 years later.
The fact that all the sites are in one county is a distinct advantage for Mountain People’s today. Organizing Federally-Qualified Health Centers requires extensive coordination between the health centers and other health and social service agencies in the county. That would have been difficult to do in the early days of Mountain People’s, since each clinic was in a different county.
Mountain People’s also has a different governance structure from when it was first incorporated. The individual clinics no longer have separate councils. There is just one Board of Directors with nine members. There are members from each community served, but that is not a requirement. This structure makes for a more cohesive organization than the original MPHC model where the three communities wanted a fair amount of independence. However, MPHC does require that at least half of the board must be active patients of the organization. As of 2023, 66 percent of the board members are MPHC patients.
Another advantage Mountain People’s has today is that most of their health centers are located in areas that are more populous, so patient volumes are higher. The only site in an isolated area is Norma. In contrast, in the early days of MPHC, Norma had the highest patient volumes of the three original clinics.
Having adequate utilization at a site is not just a financial issue. It’s also important that clinicians see a sufficient volume of patients to maintain their clinical skills. This was a primary reason that I arranged for Kaye Bultemeier to divide her time between Stoney Fork and Valley Health Services in LaFollette. It gave her the opportunity to interact with more clinicians and see many more patients than she saw at Stoney Fork alone.
Having two health centers in Oneida today makes it possible to serve more people and to attract more people with private health insurance. (Even though the staff and board at MPHC are proud that all of the people in Scott County have access to care regardless of ability to pay, they are also proud that people who could afford to go elsewhere choose to get their care at MPHC.) The higher volumes at some of the health centers and the better payer mix is part of what accounts for the financial stability of Mountain People’s. In essence, the health centers in more populous areas subsidize the services provided in low-volume sites such as Norma.
Mountain People’s today is organized as a hub and spoke model, with two large facilities in Oneida as the hub and the other sites as spokes. (In the beginning, MPHC had no hub. It was a coalition of three small clinics.) Having a hub makes it possible to offer a broader range of services than was possible at MPHC in the 1970s.
Another key to Mountain People’s success today is that most of the staff, including physicians, nurse practitioners and physician’s assistants, have ties to the community and have longer tenures than was true of the physicians at MPHC. That makes it easier for patients to commit to the practice and trust the clinicians will be there when they need them. Dr. Capparelli is a good example. Although he is not from Scott County, he has worked with community health centers in Tennessee for 30 years, including two years at the National Health Service Corps site in Wartburg, Morgan County. He has been at MPHC since 2009.
There are many people who deserve recognition for their contribution to the successful community health organization that is now Mountain People’s Health Councils, beginning with the student workers in the Vanderbilt Student Health Coalition. The medical, nursing, and law students in the Coalition planted seeds in Norma and Robbins that started the gradual growth of services across Scott County. Lawyers like John Williams and Neil McBride helped the health councils incorporate, write by-laws and other legal documents. Staff at East Tennessee Research Corporation encouraged the creation of Mountain People’s, and secured the initial funding sources that made MPHC possible. Bill Corr brought clinics together from all across the state to form the Tennessee Primary Care Association (TPCA). TPCA became a vital advocate for public policies at the state and federal levels that made the nurse practitioner model at Mountain People’s possible.
Jan Laxton, the Executive Director at Mountain People’s from 1981 to 2005, oversaw the expansion of MPHC throughout Scott County, adding sites in Huntsville, Winfield and Oneida. Mountain People’s location in a single county proved to be a key element in MPHC’s success.
James Lovett, the current CEO, built on the foundation developed by Jan. He expanded services, recruited clinicians with ties to the community, strengthened the Mountain People’s financial position, developed teams of staff to do process improvement, and championed the organization’s commitment to quality of care.
The Board of Directors of Mountain People’s Health Council deserves credit for supporting the concept of a comprehensive community health organization. They also made two important hiring decisions – first of Jan Laxton and then James Lovett.
To fully appreciate what a remarkable organization Mountain People’s has become, I encourage people to check out their website @ mphci.com.

(On a personal note, I have many people to thank for their help with this story. My thanks to the SHC alumni who invited me to one of their first meetings. Thanks to Rick Davidson and Irwin Venick who joined me in 2017 to interview people from Mountain People’s past and present. Biff Hollingsworth from the UNC library also participated in the 2017 site visit. And he patiently fielded many emails and phone calls from me as I struggled to navigate the website and the Southern Historical Collection library. He gave great advice about how to interview people and document a history that spans several decades. I am especially grateful to all the people we interviewed: James Lovett, the MPHC Board, June Sharpe and Janet Chambers of Norma, Kate and JW Bradley of Petros, and Shelby McKamey of Stoney Fork, and the wonderful group of clinicians who worked with Mountain People’s during my tenure and long after – Kaye Bultemeier, Janie Hiserote, and Chuck Darling. There were others who were interviewed at other times, including Wanda Lang, Chet Caster, Sally Kimberly, and Bob Hartmann. Finally, a special thank you to James Lovett for arranging our visit in 2017 and the visit in 2019 by Diane Lauver and Anne Thomas. Like Biff, James was very patient with my many questions. I claim no credit for what MPHC became, but it has been a real treat to learn how they became such a remarkable organization.)

This article drew on interviews and conversations with James Lovett, Sharon Neal, Bill Corr, Irwin Venick, Rick Davidson, and the author’s personal experiences.