The Legacy of the Petros (Tenn.) Health Clinic

In the 1970s, Petros was a small community of 1400 on the eastern border of Morgan County.  Unemployment in the county was high, in part because there were only 3 manufacturing firms that did not provide enough jobs to replace those lost as strip mining replaced deep mining.  In 1972, there was no practicing physician in the county to serve the 14,000 residents.

Petros was just a tiny place until the State of Tennessee decided in 1896 to open a maximum security prison there and to have the prisoners mine coal in Brushy Mountain.  The community began to expand and continued growing when the railroad put a new line through Petros.  During the first half of the century, Petros was a fine place with stores, banks, churches, deep mining, and the prison.  Then slowly things fell apart.  First the deep mining disintegrated.  Strip mining came in and the roads began to deteriorate and the creeks to fill with silt.

Then some real animosities emerged between Petros and the county seat, Wartburg.  The county officials had always seen Petros as the “bad end of the county.”  The local folks say they have never gotten their fair share of road and school money and that they have never gotten fair representation.

In mid-1972, a devasting blow hit Petros.  The 180 prison guards tried to form a union, the governor of Tennessee disagreed, and then crushed their efforts by suddenly closing the prison and moving the prisoners to Nashville.  Legal battles followed but the prison remained closed, and the men remained out of work.

Petros sits on Rt. 116, just off Route 62.  The houses spread out on hills along the road and back down the hollows.  In the early 1970s, the school was rundown and in need of repairs.  Repairs weren’t made because the community had been promised a new school, but that was delayed.  There was a small post office and several stores near the railroad tracks which had not been used in four years.  At one end of town, tucked up against the mountains, sat the white walls of Brushy Mountain Prison but with no prisoners, no guards and no jobs.

Two community workers and one law student from the Student Health Coalition spent the summer of 1972 in Petros to prepare for the initial health fair and the follow-up event several weeks later.  There were 750 people seen at the first health fair in June.  Another 400 adults and 60 children were seen a month later.  The health fair was held in the Petros School.  There were Mennonite families that came from as far away as Monterrey.

One of the SHC workers, Perry Steele, remembers his experience in Petros:

We had a big turnout for the health fair. The doctors did a lot of good work. We could have used a dentist too because several little children had black teeth rotten from being allowed to drink Pepsi Cola every day. I slept in the school during the fair to protect the equipment and to kill the bats that would get into the school. I began to see that I was not far removed from the people I was trying to help. I was lower middle class at best, and I was the first in my family to be able, eventually, to finish college and to go on and get a Ph.D. and then a J.D., but that was later.

When Kathy and I finished our community organizing” work for the day, wed go down the creek behind Kate and JWs house and catch crawdads with their youngest daughter, Mary Faith. Mary Faith had a pitifully sad looking red hound dog named Redbone” who would sun himself in the road and only move when a coal truck came barreling down the mountain at him. Sometimes Redbone would stay out all night and in the morning Mary Faith would hug him and then say, Oh, Redbone, you stink, you been out rolling in an old dead snake again.” My co-worker Kathy was a such a strong person she could handle anything and not flinch.

Read Perry’s full story here.

In a 2018 interview, Wanda Gould, a nursing student worker who worked in Petros, remembered  her experience:

I returned for follow up to Petros, TN and remember staying a lot of the time with Kate and J.W. Bradley and their children, Connie, Chip, and Mary Faith.  Their house was always ready to expand to include more people needing a bed or a meal.  They were active in the community and wanted better for their small town and for their kids.

 

One memory of J.W. was walking with him on a Sunday morning down the main road to a church in Petros.  It was locked and he unlocked it.  No one was there but us.  We stayed in the empty quiet church for a little while and then got up and left.  He told me that he had vowed that as long as he could, that church would always be open on Sundays.  He was a man of strong principles.

 

At the time of the two SHC health fairs in Petros, there were other health care developments in Morgan County.  The Morgan-Scott Project for Cooperative  Christian Concerns (MSP) was founded in 1972.  MSP was organized by executives of the United Methodist Church and the United Church of Christ.  MSP functioned as both a social services agency and as a community development organization.  Their efforts were soon supported by representatives of the Presbyterian, Roman Catholic, Lutheran, Baptist, and Episcopal Churches.

In 1973, the National Health Service Corps (NHSC) placed a healthcare clinic in Wartburg, the county seat for Morgan County, staffed by two NHSC physicians and a NHSC dentist.  Another facility, created in 1974 in Elgin after a SHC health fair (also in Morgan County) was staffed by a NHSC physician.  MSP opened the Deer Lodge Clinic in 1975, staffed by a nurse practitioner.

The health fair in Petros in 1972 identified many unmet health needs in the community.  That motivated community members to start a clinic. The Petros Health Council was formed shortly after the SHC health fair in 1972 and was incorporated on November 15, 1972, with the help of Irwin Venick, one of the SHC law students who worked in Petros the summer before.   The officers were J.W. Bradley, President; George Koontz, Vice President; and Emma Bradley Secretary/Treasurer.  Other members of the Health Council were Jack Chamblee, Don Cox, Barbara Hobbs, Joyce Brown and Billy Christopher.

Check out this clip from a 2017 interview with Kate and JW about their motivation to organize a community clinic in Petros.

One of the first things that the Health Council did was to ask the SHC to return for another health fair in 1973.  At this time the Council was trying to raise money and was making initial plans for construction of a clinic building.  The response in 1972 was so overwhelming the SHC agreed to go to Petros again the following summer.

Obtaining funds became the most difficult task.  Since Petros was not a wealthy community, the Health Council tried to use local initiative and hard work to pull in funding from outside the community.  Initially, there were rummage sales in both Petros and Oak Ridge.  Then there was a large Thanksgiving turkey dinner at the Petros School with most of the supplies donated by Oak Ridge and Oliver Springs merchants.  Movies were shown at the school, and in January a Gospel Sing at the school netted $400.  In February, the Petros Health Council (PHC) joined with the Stoney Fork Health Council to hold an Appalachian Weekend on the campus of Vanderbilt University in Nashville.  The New River Boys, a local bluegrass group from Stoney Fork, performed before two standing-room only audiences at a campus coffeehouse.  The PHC sold quilts and other homemade items and baked goods.  On Sunday morning, the weekend was closed out with a gospel sing in the campus chapel.  The PHC netted $1000 and lots of good publicity from the weekend.  By early spring the Council had raised $4,000.

All during this time the PHC, mostly through the dedication of Secretary Kate Bradley, had been making themselves know both locally and nationally.  Kate and her husband, JW, plus Bob Hartmann, the new Director of the Coalition, were on local radio shows, Oak Ridge television, and in several newspapers in East Tennessee.  WDCN-TV in Nashville came to Petros to make a 5-minute segment for a national televised show, “Patients Without Doctors”, that was shown in March.  After the segment was aired, the PHC received donations in the mail from places as far away as New York, Indiana, Ohio, and Florida.

The Health Council decided to try to buy a small 1/3 acre plot of land in the middle of town for the clinic.  The land was owned by the railroad.  Randy Hodges, the SHC worker who was helping to build the Petros Clinic, knew the President of the Southern Railroad.  He arranged an appointment for Kate with the President in Nashville. As of the beginning of the summer, the railroad company had agreed to sell PHC the land, even though people from Wartburg were opposed to Petros getting the land.

The Petros Health Council asked for an engineering study to help with the construction of the clinic in Petros.  A Vanderbilt engineering graduate, Gary Lang, had developed the plans and supervised the construction of a clinic in another community the previous year.  He felt that another engineering student could adapt his building plans to the situation in Petros.  Randy Hodges was a Vanderbilt engineering student who worked on construction of the clinic in 1973. Randy found that his responsibilities ranged from providing manual labor to overseeing the actual construction of the clinic.  Not only was he able to transfer some of his engineering skills to others, but he was also able to organize the community to take an active role in building the clinic and planning for its future operation. Randy left Petros at the end of the summer, confident that the clinic would be completed and his involvement was no longer necessary.

Click here to listen to a 2017 interview with Kate and JW talk about fundraising for the clinic, “working with one hand and fighting with the other!”.

The large turnout at the first health fairs and the plan to have another SHC  health fair in 1973, were helpful facts for the Health Council to use as they faced opposition in the county seat.  Officials in Wartburg considered Petros the “rough end” of the county and the people of Petros felt that the county seat had never given them their fair share of county services.  The Health Council represented a strong local group that would show others that people at that end of the county were sincerely interested in solving their own problems.

In early spring, PHC members appeared before the Morgan County Council and asked for $5,000 in revenue-sharing funds to help build and operate the clinic.  The County Court approved the request,  but when Kate Bradley and John Williams (a lawyer for the Center for Health Services at Vanderbilt) appeared before the judge to collect the check, the judge refused, giving PHC a series of requirements that had to be met first (i.e. letters from the Tennessee Attorney General, the Governor’s Office and so forth).  PHC fulfilled these requirements, but the judge still refused to sign over the funds.  This experience was typical of the harassment the people of Petros had experienced from the county seat for years.

Unlike some other communities where the SHC had health fairs, there was a history of community activism in Petros that the Health Council could build on.  For example, the Petros Action Club had been working to get a new school built in Petros.  JW Bradley was one of the founders and the president of Save Our Cumberland Mountains, a community organization initially developed to fight strip mining in Eastern Tennessee.   See more on this history in the UNC archival collection of Kate and JW’s papers, online  finding aid located here.

The SHC returned to Petros in the summer of 1973. The second health fair, like the first, was well-attended.  People were very understanding about waiting for hours to get a physical.  All said it was worth the wait because it was the best exam they had had in years. There were 433 adults and 310 children seen at the ’73 health fair. Of those seen, 46 percent had not seen a doctor for more than 10 years.   Of the 72 adults who received chest x-rays, 16 had abnormal findings.  Of the 62 adults who received an EKG, 18 were abnormal.  Most of the adults with abnormal results were referred to local physicians. (Dr. Thomas John, Vanderbilt resident in Internal Medicine, contacted most of the physicians in Oak Ridge to determine who would be willing to see people from Petros who might need follow-up care.)

Dental caries was the most frequent diagnosis among the children seen at the ‘73 health fair, followed by obesity and parasites.  The vast majority of the children were up-to-date on their immunizations, ranging from 60 percent for tetanus to 84 percent for polio and rubeola.  However, many children had poor vision and hearing.

In a 2017 interview, Kate Bradley explained why there had been such a good turnout at the health fairs.  Approximately 20 percent of the population in the area had no car, so access to care, even in fairly close locations like Oak Ridge, was almost impossible.  Many people just didn’t go to a doctor at all.  The fact that the health fair was free also eliminated any financial barrier to access care.

Another part of the Student Health Coalition efforts in Petros was the work of law students from Vanderbilt.  One of those students, Irwin Venick, helped to organize the Black Lung Association.  Working primarily with retired miners, the SHC workers helped 100s of people become eligible for black lung benefits.

Given the challenges of raising funds, the members of the Petros Health Council concluded it would be difficult to operate as a solo clinic in a small town.  The PHC decided to join with health councils in Norma (Scott County) and Stoney Fork (Campbell County) to form Mountain People’s Health Councils.  They decided to use the model developed by United Health Services in Campbell County of a circuit-riding physician who regularly visited small clinics that were staffed by nurse practitioners.  The National Health Service Corps agreed to place nurse practitioners in each Mountain People’s community, along with a full-time physician who would visit each clinic at least twice a week.  Mountain People’s also received Federal funds from the Rural Health Initiative Program to cover operating expenses for the three clinics.  The MPHC Board also hired a full-time administrator, Duane Sexton, and a secretary, Janice Laxton, to provide administrative services to the three clinics.

Kate and JW were asked why they didn’t want to affiliate with the National Health Service Corps site in Wartburg.  They said there was very little trust in Petros of county government in Wartburg.  They believed they could maintain more independence within Mountain People’s than they would have if they were affiliated with the clinic in Wartburg.  Independence was an expectation of all three communities that joined together to form Mountain People’s.  Each clinic had its own health council and made its own hiring decisions.  Each clinic had its own fee schedule and operating hours. There was also some distrust within Mountain People’s about whether each community was getting its fair share of Federal funding.

The Petros Clinic opened in 1974.  The first nurse practitioner was Wanda Gould who had worked in the 1972 and 1973 health fairs while a nursing student at Vanderbilt.  Wanda came to Petros after completing the Primex Program at Vanderbilt School of Nursing.  Wanda, like all of the first nurse practitioners at Mountain People’s, was a pioneer who brought a new clinical role to Petros that was unfamiliar to the community.

I felt that the Petros Health Council was very supportive of me as a nurse practitioner. I only recall one disagreement with the Health Council.  It concerned the issue of providing contraception to single women.  I considered this a patient/nurse decision and not a council decision.

Some patients were comfortable with the idea of a nurse practitioner; some were not.  In general, those who had been to one of the health fairs in Petros were more accepting of my role.  If anyone wished to see a doctor, we scheduled them on a day when Rick (the NHSC physician) was there.”

Rick Davidson, also a SHC worker, came to Mountain People’s in July of 1974 to serve as a circuit-riding physician who visited Norma and Petros two days a week and Stoney Fork one day a week.

The second nurse practitioner at Petros was Lucy Freytag who was from the area.  When Lucy left, Mountain People’s hired Janie Hiserote to be the nurse practitioner for Petros.  Janie was a Master’s graduate of the nurse practitioner program at the University of Rochester, one of the pioneering NP programs in the country. Before Petros, Janie had worked at the Briceville Clinic.

Like Wanda before her, Janie felt the community was very accepting of her role as a provider of health care services.  In a 2017 interview, Janie talks about being a nurse practitioner providing family and community care in the communities of Petros and Coalfield, Tennessee. She shares a touching story about attending to a dying man in the middle of the night and the “incredible connection” it forged with the man’s family and the rest of the community who learned about it.

Click here to watch excerpt from the 2017 interview with Janie Hiserote.

When Rick Davidson left to finish his residency at Vanderbilt, the National Health Service Corps recruited Alan Miller to be the circuit-riding physician for Norma, Petros and Stoney Fork.  Two years later, Mountain People’s had to look for a physician to replace Dr. Miller.  Caryl Carpenter, the MPHC administrator at the time, and Bill Dow reached out to Bob Hartmann who was an SHC alum just finishing his residency in internal medicine, also at UNC-Chapel Hill.  Bob was looking forward to returning to the communities where he had worked with the SHC, serving as SHC Director in the summer of 1973.

Bill Dow, Bob Hartmann, Pat Kalmans, Caryl Carpenter visiting Bob in Chapel Hill.

At the same time, another physician, Chet Caster, expressed interest in coming to practice in Morgan County.  Dr. Caster was a graduate of the University of Michigan Medical School and had just finished his residency in family medicine in South Bend, IN.  Dr. Caster was a member of the Brothers of the Holy Cross. He and fellow members of the order hoped to move to Morgan County together to work in the community.

All of the communities in Mountain People’s were familiar with Bob Hartmann because of his work with the Student Health Coalition.  Dr. Caster was not familiar to them.  Board members from Norma and Stoney Fork wanted Dr. Hartmann to be their next physician.  Board members in Petros were happy to have Dr. Caster work exclusively for them.  So for the first time, Mountain People’s had two physicians.

Because Dr. Hartmann now had extra time, Caryl Carpenter, the administrator at MPHC at the time, arranged for Dr. Hartmann to spend some of his time at the Black Lung Clinic in Jacksboro and then with Valley Health Services in LaFollette when the National Health Service Corps physicians at the Black Lung Clinic left to start the clinic in LaFollette.

In the summer of 1978, Dr. Chet Caster came to work at the Petros Clinic, alongside Janie Hiserote, their nurse practitioner.  This was the first time there was a full-time physician at the Petros Clinic, as well as a full-time NP.  Unlike the previous physicians at Mountain People’s, Dr. Caster had been trained to deliver babies.  The first certified residencies in family medicine emerged in the early 1970s.  The residents were trained to provide a broad spectrum of family health care services, including adult and pediatric medicine, as well as obstetrics and gynecology.  Most hospitals were still not familiar with the training and skill sets of board-certified family medicine physicians.  It was not unusual for hospitals to exclude obstetrics when granting admitting privileges to family medicine physicians.  Fortunately, that’s not what happened to Dr. Caster.  He eventually had admitting privileges for obstetrics at Oak Ridge Hospital.

When Brushy Mountain Prison re-opened, Dr. Caster spent one day a week seeing inmates.  The prison’s most famous inmate at the time was James Earl Ray who assassinated Martin Luther King, Jr.  Ray escaped from the prison and spent several months hiding in the mountains behind the clinic.  In a 2017 interview, Janie Hiserote, the third nurse practitioner at Petros Clinic, told about coming to work every day while Ray was on the loose.  She and the staff would enter cautiously, look in every corner, and still worry that he might be hiding out under the floor boards.

Click here to listen to Janie reminisce about the Ray escape from Brushy Mountain Prison.

Not long after his arrival, conflicts developed between Dr. Caster and the Petros Health Council.  The Council was accustomed to making many decisions about the running of the clinic.  This was not the first time there had been disagreements about who was authorized to establish policy at the clinic.  In her 2018 interview, Wanda Gould Lang mentioned that there had been a disagreement between the Council and the clinicians at Petros about whether single women could receive birth control at the clinic. Wanda felt that was a clinical issue that should be established by the clinicians, not the Council.  The same issue came up with Dr. Caster.

The conflicts drew attention from local media, including a television station in Knoxville.  Despite the conflicts, Dr. Caster had become very popular in Petros and Morgan County, in part because of his obstetrical practice.

Eventually, the Petros Health Council fired Dr. Caster.  Then representatives from the National Health Service Corps came to Petros to investigate the conflict.  The Health Council was told they did not have the authority to fire Dr. Caster because he was an employee of the National Health Service Corps (NHSC) who had been assigned to Mount People’s, not Petros.  If they had a problem with Dr. Caster, their complaints should be addressed to the HNSC through Mountain People’s.

At the same time, Dr. Caster was approached by community members from Coalfield, another nearby community in Morgan County.  They offered to build and equip a clinic in Coalfield if Dr. Caster would move his practice there.  Given the tensions with the Petros Health Council, Dr. Caster decided to accept their offer.  Dr. Caster left Petros in November of 1979, less than 18 months after he arrived.  Janie Hiserote followed soon after.  Janie and Chet were well-regarded in the county and had a thriving practice for more than 10 years.

The administrator at Mountain People’s at the time was Cade Sexton.  He recruited a physician’s assistant to work at the Petros Clinic.  However, utilization of the clinic dropped off as many patients transferred to the practice in Coalfield.  Eventually the clinic closed.  Sometime later the clinic burned to the ground, a victim of arson.

In 2017, Kate Bradley looked back on the experience of starting a clinic in Petros. She reflected on the “ignorance and jealousy” that developed in the community.  For example, when people in the community heard about the Federal grants that came to the clinic through Mountain People’s, they thought the money went directly to Kate and JW, she said.  This is probably not an unusual experience when a small community with few resources is suddenly infused with Federal funds.  “I feel like we failed, said Kate, when I look at what’s happening today”.  Many of the same health problems remain unaddressed and are even more challenging in an era of opioid addiction that plagues communities throughout Appalachia.

Although the clinic experience had been a disappointment, that did not stop Kate from finding other unmet needs that needed to be addressed.  Kate organized volunteers to help inmates at the prison.  They organized educational services that helped some inmates earn their high school equivalency.  In a 2017 interview, Kate explained how rewarding the work at the prison was.

This story about the clinic in Petros draws on the Vanderbilt Center for Health Services Annual Reports for 1972 and 1973 and interviews with Kate and JW Bradey, Janie Hiserote, and Wanda Lang.