Chattanooga is home to Tennessee's biggest health insurer, the world's biggest disability insurer, a half dozen nursing and medical colleges and three healthy, competitive hospital systems with differing investor-owned, nonprofit and government ownership models.
Collectively, more than 25,000 persons in Chattanooga work in some means of delivering, insuring and supporting health care.
But health care is far more than just a major employer in town. For most of us at some point in our lives, health care becomes very personal and those who deliver and support it essential to our well being.
So for the past three years, Edge magazine, in partnership with the Chattanooga-Hamilton County Medical Society and BlueCross BlueShield of Tennessee, has recognized those who put the "care" in health care.
From nearly 200 nominations received from the public about health care providers, administrators and volunteers who have made health care better in Chattanooga, a panel of judges comprised of top leaders from the medical society and each of Chattanooga's three major hospital systems picked this year's Champions of Health Care.
Across an array of volunteer and professional jobs, the nine award winners have tackled major community health problems, starting programs to tackle obesity and smoking, adding physical therapy training in Chattanooga, and bringing needed medical services to those without health insurance. Others are recognized for new approaches, strong leadership and simple acts of kindness during their lifetimes of achievement and service.
In our third year of the awards, we have quickly discovered the rich talent and commitment from those who work every day to keep us healthy.
This year's Champions of Health Care, who will be honored at an awards luncheon Wednesday, are:
Carrying on the family legacy of health care started by his father, Dr. Walter Boehm, Dr. Peter Boehm Sr. is one of Chattanooga's most experienced neurosurgeons.
For decades, Dr. Peter Boehm Sr. has brought a consistent calm to high-stakes operations involving the brain and spine in Chattanooga.
Five years ago, Dr. Boehm, one of the city's most experienced neurosurgeons, retired from Chattanooga Neurosurgery and Spine Group. Yet even though he isn't on-call on nights and weekends anymore, his schedule is still packed with surgeries.
The 70-year-old scrubs in as a first assistant most days of the week, especially when his son, Dr. Peter Boehm Jr., is the primary neurosurgeon working. Those who work beside him say Dr. Boehm is a soothing and comforting presence in life-or-death situations when choices are critical.
"Not only does he think about the patient first, he thinks about the team working with him," said Donna Henderson, a certified surgical technologist at Erlanger Hospital who has worked with Dr. Boehm in countless surgeries over the years..
Dr. Boehm says he keeps working because he loves the work and the people the work serves.
"A lot of this is the satisfaction of dealing with people and getting to know them and getting them better," he said. "The thought that you have to be cold and calculated to deal with some of the bad results, that is foolish. I get to know families well and suffer with them ... It has been a satisfying, fun life and it continues. I don't know what I would do if I retire."
Dr. Boehm's father, Dr. Walter E. Boehm, was one of Chattanooga's first neurosurgeons. In 1947, Dr. Walter E. Boehm founded the Neurosurgical Group of Chattanooga and in 1963 founded the Walter E. Boehm Birth Defect Center — where Dr. Boehm later worked as president and co-medical director for 35 years. The Center, a non-profit located at Children's Hospital at Erlanger, provides care to children born with neural tube defects such as spina bifida and hydrocephalus.
Dr. Boehm's brother, Dr. Walter M. Boehm, also became a leading, area neurosurgeon and headed the Birth Defect Center their father started. The two worked side by side until his brother passed away in 2013.
Nearly a half century ago, a pair of Indiana University-trained physicians, who had completed their residency together in head and neck surgery in Indianapolis, headed south for a weekend trip to consider joining a surgical practice in Chattanooga.
Dr. John Boxell and his partner, Dr. Hathaway Harvey, were immediately impressed by the community and joined what was then already a 59-year-old medical practice in Chattanooga known as the Associates in Ear, Nose, Throat/Head & Neck Surgery. Their arrival added new expertise and procedures to the market in neurosurgery and head and neck cancer treatments.
Boxell has rotated his surgeries and his civic contributions among Chattanooga's hospitals. He practiced surgery on the the first day when Parkridge hospital opened in 1971 and was board certified at nine area hospitals, including Children's Hospital at Erlanger where he was a frequent Ear, Nose and Throat (E.N.T.) specialist for young children. Boxell was first vice-chief and then chief of the Memorial hospital staff in the early 1980s and chairman of Memorial's board a decade later. He later served as chairman of the Siskin Hospital for Physical Rehabilitation as well as president of the Chattanooga-Hamilton County Medical Society and the Chattanooga Surgical Foundation.
"Dr. Boxell is not a Memorial, Erlanger or Parkridge doctor. His service always transcended these limiting descriptions," says George "Chip" Faircloth, a hospital administrator who worked with Boxell at both Erlanger and Memorial. "He is egalitarian in his service, devoted to many of our fine facilities and local programs, and a great example to many."
Boxell, who is 78 years old, retired from his active medical practice in 2005 but he remains a physician advisor for cancer services at Memorial hospital.
During his practice, Boxell provided free clinic service and surgical services for the underserved and uninsured population for 35 years. He was the only physician in the area to provide free otolaryngology services to what is now Siskin Children's Institute. He has also been a leader or board member for the Tennessee Valley Medical Assembly, the Chattanooga Science Fair and the United Way and remains on the Chattanooga Tumor board and the Hurlbut Cancer Fund.
Boxell's service also was exemplified every Tuesday night during the last decade of his medical practice when he would take his wife and employees from the office, have a bag supper in the car, and seeing patients in cities like South Pittsburg who wouldn't otherwise have access or be able to afford such care.
"It was something I enjoyed because there was no scheduling and I got the chance to see a variety of patients," Boxell recalls. "Chattanooga is a community with a rich tradition of volunteer service and I've been blessed to be a part of that."
Someone once told Dr. Melanie Blake that the truest test of a doctor-in-the-making is: "If you can't imagine doing anything else."
The daughter of a cardiovascular nurse and a dentist, Dr. Blake, 39, has become the embodiment of that theory. She is this year's recipient in the "Innovation in Health Care" category for her work advancing a patient-centered approach to primary care.
In her spare time, Dr. Blake, a native of Birmingham and a former college athlete at Florida State University, is a national champion Masters sprint hurdler — which is an apt metaphor for her work at Erlanger, clearing hurdles through grit and focus.
Blake, who spends half her time in her medical practice and half her time on administrative duties, has been instrumental in helping retool many of the practices in Erlanger Medical Group. A new model, called Patient-Centered Medical Homes (or PCMH, for short) emphasizes improving patient outcomes and giving physicians more time for patient care by lifting some of their administrative duties.
The PCMH care model aims to consolidate health care functions under one delivery system, hence the "home" analogy. Such a practice combines traditional doctors and nurses along with pharmacists, nutritionists, social workers and care coordinators. It's multi-faceted care that takes into account the "whole person," experts say.
This team approach means that patients aren't left on their own to navigate the sometimes confusing and overlapping health-care system. Instead, patients are led down a path to better follow-ups and outcomes.
"For example, we have a social worker and a pharmacist and a care coordinator," Dr. Blake explains. "If (a patient) misses their cardiologist appointment (and needs to reschedule), we can facilitate that. Or if they go in the hospital we call them to follow up on how they are doing."
Part of the transition is building a system of integrated medicine to improve outcomes, says Dr. Blake, who also has a master's degree in business. At one point the Erlanger team converted 15 practices in 18 months, a herculean task.
"We started looking at quality measures," Dr. Blake says of the Erlanger PCMH model. "Some (practices) were doing really well on diabetic control and blood pressure, and some weren't doing well at all. It had a lot to do with geography and resources. It also had to do with communicating with patients and getting them in more often."
Dr. Kelly Rodney Arnold's Italian grandfather, Rocco, came to the United States as a young immigrant child who didn't speak a word of English.
So whenever Rodney Arnold hears the stories of her non-English speaking patients at Clinica Medicos, she says it makes her even more proud of her grandfather for overcoming some of the barriers in his way.
The fourth-generation, bilingual physician said the decision to open Clinica Medicos to serve the city's Latino population was equally fueled by passion and naivety. When Rodney Arnold and her partners opened Clinica Medicos on March 1, 2015, they had one patient walk through the door that day. Now, the clinic sees roughly 1,200 patients a month, has delivered about 500 babies and grown to a staff of 25.
"When we first started it, you don't think it's anything that's going to gain praise," she says. "You are just guided by believing it's the right thing to do. And come success or failure, you know that you took care of human beings that needed it."
With the county's Hispanic population expected to grow to more than 15 percent, or 40,000 residents, by 2020, Rodney Arnold said she and her partners opened Clinica Medicos with a "sense of urgency." The clinic was built on the belief that a more transparent, accessible community clinic for the underserved population was something Chattanooga needed as soon as possible.
Everyone on staff at Clinica Medicos speaks Spanish, which makes patients feel more respected and heard, Rodney Arnold said. The clinic is also open seven days a week for those that work during the day and can't adjust their own schedules to fit the traditional 9 a.m.-to-5 p.m. model that most doctor offices operate under. Perhaps the most important and unique aspect of the clinic is that they are as upfront about prices as they can be — reducing many of the expensive health care and imaging costs for patients that can't afford it.
Clinica Medicos is modeled after Rodney Arnold's family's clinic in Memphis that started out serving a mostly Hispanic population 20 years ago.
"Viewing their success in it gave me much more confidence to venture into something that is so risky," says Rodney Arnold about Clinica Medicos' sister clinic. "For me, the pain of not fulfilling that vision I knew would be much more painful [than] having done it and failed."
Dr. Davey Daniel started at the University of Georgia pursuing a political science degree. But he soon discovered he didn't like the gray areas "and I really was much better suited to the sciences."
His thirst for facts and scientific knowledge led him to Johns Hopkins Medical School and a residency and a fellowship at Duke University and to become one of the city's premier medical oncology and hematology specialists with Tennessee Oncology.
Daniel deals in death, plain and simple. Sure, he does everything his extensive and impressive training allows. He is willing to fight to the end or hold hands with a patient to the finish line.
"Your patient's goals always guide you in treatment decisions," Daniel says.
Making a patient comfortable after a cancer diagnosis, he said, is the first step toward alleviating the anxiety that comes with the countless doctor visits and sometimes long odds against a cure.
"Our goal is to cure if possible, but in the event that the cancer is not curable, we must preserve the quality of life as much as possible," Daniel says. "We face failure every day, but you must figure out what that patient's goals are — maybe an extra year, maybe maintaining some activity that is important to that person. Aim for that and you will have smaller successes every day."
Aside from the connection, maybe there's a utilitarian need for Daniel to be called by his first name. He's not the only cancer fighting Dr. Daniel in the family. His wife Brooke is one of the area's most-respected champions leading the fight against breast cancer.
"We joke with some patients that if you are seen by one of us, then you get an automatic second opinion by the other," he says.
Deseret Ward, whose husband was treated by Dr. Daniel for colon cancer, said Davey Daniel is not a normal doctor.
"He is one of the most humble individuals I have ever met. ... We are very fortunate to have had the pleasure to have Davey Daniel as our doctor through the most difficult challenge of our life."
The entire family tries to schedule regular getaways to a family farm in the no-traffic-lights town of Rentz, Georgia. There are no TVs. Little connectivity. Complete reconnection to family is the goal.
Dr. Marshall Horton, in his fourth decade as a gastroenterologist, says that screening for colon cancer is going up with an estimated two-thirds of the population current in their tests.
But, he says, it's that other third which is difficult to reach, noting they're resistant to endoscopy or don't want to deal with the prep necessary for the procedure. That's one reason why Horton, 64, keeps sounding the call for screening even after retiring from his day-to-day practice.
"Some don't understand the importance," says the Chattanooga physician who is the winner of the Champion of Healthcare's Volunteer Award for 2018. "If you identify the polyps, you dramatically decrease your risk."
The Mississippi native splits his volunteer time among organizations such as Volunteers in Medicine, Hamilton County Project Access and the Greater Chattanooga Colon Cancer Foundation.
He says he has been on the foundation's board for at least four years and is its current vice president. The last couple of years he has coordinated involvement in local health fairs, where Horton quips that a big draw is a 12-foot inflatable colon which is used to woo attention to proper screening.
The goal, the physician says, is to heighten colon cancer awareness and the importance of screening. Colon cancer, Horton says, is the second leading cause of cancer deaths, though the incidence is heading downward. Still, the 50,000 deaths a year due to the disease trails only fatalities caused by lung cancer, he says.
The University of Mississippi medical school graduate says he felt the need to give back to the Chattanooga area after he retired from Galen Medical Group five years ago after 25 years.
At Volunteers in Medicine, he and some two dozen other physicians and nurse practitioners donate their time at the clinic for the indigent and uninsured, many of whom work but don't have health care benefits, he says.
The clinic receives about 5,000 visitors a year and provides some $8 million in care, Horton says.
At Hamilton County Project Access, which is run by the Chattanooga-Hamilton County Medical Society, Horton facilitates colonoscopies and keeps up with the number performed. At Project Access, services are donated by hospitals and physicians to help people in need, Horton says.
"When you establish a relationship and help someone out, there's a sense of fulfillment," he said.
When Kevin Spiegel arrived at Erlanger in 2013, the area's largest hospital was struggling.
Over the past five years, the turnaround has been well-documented and the expansion and new direction of Erlanger has caught the attention of the medical industry around the country.
As with all changes in leadership, the new regime came in with new ideas. And new names and faces to fill a variety of spots.
A key cog in the new direction under Spiegel has been Gregg Gentry, the chief administrative officer and Spiegel's chief of staff.
New direction aside, Gentry is a familiar face among those at Erlanger Health System. He's been with the hospital since 1989, and has been a steady bridge from the recovery to the steam-rolling success under Spiegel.
"Both professionally and personally, Kevin Spiegel has been the ultimate mentor for me," Gentry said. "Since arriving in Chattanooga, Kevin has created an environment encouraging all team members to live up to their potential."
For those that know him, the credit-deflection is common for Gentry, who has worn a variety of hats at Erlanger in his 29 years with the hospital and continues to be involved in an array of duties. He works closely with Spiegel on strategy and direction for the organization and is directly responsible for a number of business arms at Erlanger including human resources, marketing, public relations and development.
"Health care is a highly regulated industry that is rapidly changing," he says. "This ever-changing landscape of regulations is challenging and difficult, and at times distracting from improving patient care and the overall patient experience."
The business of medicine has been a lifetime work for Gentry, and it's one that has — like the industry's regulations — continued to change. And with that change has come a realization that helping others get better has become a two-way exchange.
Gentry grew up in a small town in Alabama and earned both his undergraduate and Master of Business Administration degrees at the University of Alabama.
"Initially (coming to Erlanger) was the next step in my career," he recalls. "Today, it is much more than a career; it is a passion.
After working 20-plus years at some of the most impoverished health clinics in the city, Family Nurse Practitioner Judy Buhrman has witnessed things no one wants to see. But she has also seen selfless love, undying gratitude and immeasurable sacrifice.
She recalls a woman in her exam room cradling her newborn grandson, who cried inconsolably as his little body detoxed from numerous substances he was exposed to in-utero.
"I will never forget the pride she felt for that child and the love in her eyes – she only saw the good," she recalls. "That's the beauty of working here."
Buhrman's nursing career began in 1990 — 25 years after graduating from Duke University with a degree in chemistry. Her first job was working as an organic chemist in North Carolina's Research Triangle Institute, helping put her husband, Richard, through law school. When her kids became teenagers she went back to school, graduating from the University of Tennessee at Chattanooga in 1990 with her nursing degree. Her first job was at Memorial Hospital in the surgical intensive care unit, where she earned numerous certifications including Critical Care Registered Nurse. She later headed back to UTC's campus, this time graduating as a Family Nurse Practitioner in 1997. Buhrman's heart for the less fortunate has been a constant theme in her career. In nursing school, when asked to write a paper on a disease she chose poverty.
"The professor was a little miffed," she says. "But I truly believe it's a disease. It affects everything."
If it were a clinically accepted diagnosis, then Buhrman would be a specialist. Her first job as a Nurse Practitioner was at Erlanger's Alton Park Community Health Center. A few years later she learned CHI Memorial was opening the Westside Health Clinic in the former James A. Henry Elementary School building on Grove Street.
It had four exam rooms, a minuscule lab and infestations of all sorts of things that crawl and fly. The 100-year-old building had cleaning, plumbing and heating issues and dust that flared allergies for patients and staff. Nonetheless, she leapt at the chance to work there.
Last August, the Westside clinic closed its doors, consolidating with Memorial's other community health facility in Hixson. The move was bittersweet. On one hand the new facility has 14 exam rooms, six nurse practitioners, a full-time social worker, a lab and on-site x-ray, serving almost 10,000 patients each year. But the new location means some of her Westside patients now have to travel an hour by bus for their medical care.
"We're still serving the same population, but for some the travel is tough," she says. "Even so they're happy to be here and grateful for the care. And I'm grateful that Memorial put this clinic here and subsidizes it."
Designated as a charity clinic, roughly half of the clinic's patients are uninsured. The remaining are either on TennCare or Medicare. In addition to money set aside by the Memorial Health Partners Foundation, the clinic operates on grants to help with hardships beyond the exam room. Many patients can't afford their medications; some don't even have a refrigerator for storing insulin even if they could buy it.
The clinic staff does everything they can to help, including bus passes and pharmacy assistance.
"Judy truly has a heart for helping people who can't always help themselves," says office manager Connie Love. "She always looks out for people who are less fortunate, and she treats every patient like family."
Dr. Eugene Ryan describes himself as "just an average Joe," but in an era where the art of medicine is often lost in electronic frenzy, he's more akin to an Irish Rembrandt, who also happens to love Star Trek.
"He's personable and very interested in who you are ... not just your health, which is very important as a primary care physician," says Dr. Kellie Jolley, a fellow internal medicine physician who's shared the halls of Parkridge Health System with Ryan for 20 years.
The son of Irish immigrants, Ryan grew up in Columbus, Georgia, and earned a doctor of pharmacy degree from the University of Georgia before completing med school at the Medical College of Georgia. He served in the U.S. Army for six years, as a resident at Eisenhower Medical Center in Augusta, Georgia, and chief of medical service at the Army hospital in Fort Rucker, Alabama, before moving to Chattanooga in 1996.
Ryan, who is board certified in internal medicine, said the joy of primary care is fostering long-term relationships with patients and their families.
"We're not an episodic physician, so we get to know them very well. They know us, we know them," he says. "Taking care of patients is the ultimate puzzle in trying to figure people out and get the best treatment for them."
Although his patients always come first, for Ryan, it's not enough to "just go to work and come home."
His diverse knowledge and experience — medicine, pharmacy, research — and volunteer attitude set Ryan apart from the "average" doctor. Some of his leadership roles include two terms as chief of staff at Parkridge Medical Center, chair of the hospital's medical executive committee and member of the Chattanooga-Hamilton County Medical Society board of directors.
For more than a decade, Ryan mentored youth through local Scouts programs and served five years as adviser for Venturing Crew 2172, a Boy Scouts of America program for males and females age 14 to 21 focused on adventure, leadership, personal growth and service.
Ryan led the crew on lengthy expeditions that include camping in Savage Gulf, hiking in New Mexico and sailing off the Florida coast.
"When we started going out on these adventures, I realized that my internal medicine skill set here was not the best thing for the woods. ... You're out there hiking for like 55 miles for over 10 days," he says.
Venturing prompted him to complete an extra 200 hours of continuing medical education and become a fellow of the Wilderness Medical Society. Not only is Ryan attuned to the medical needs of everyone from scuba divers to astronauts, he taught wilderness first aid to crew members.
"Putting on a Band-Aid and calling 911 doesn't work in the middle of nowhere," Ryan says. "It's more of the fun aspects of medicine. You get to talk about snake bites, spider bites, altitude sickness."
The skills fostered early in his career as a pharmacist have not only served Ryan well as a doctor, but allowed him to conduct pharmaceutical research on the side.
"I enjoy the intricacies, nuances of new medications," he says. "It helps stimulate a different aspect of medicine. When you do a drug study for the patients, it costs the patients nothing, and they get the benefit of trying a new therapy."