Dr. Walter Puckett doesn't hesitate when asked about the most dramatic change he has seen during his more than half a century as a doctor.
"When I was an intern in 1955, if you had a heart attack you were in the hospital for six weeks, and they had a 30 percent mortality," he said in a recent interview. "Now, you will be in the hospital for 48 hours and they have a 5 percent mortality rate."
Puckett was a heart doctor before that was even a medical specialty.
"When I trained in '57, the cardiac fellowship programs were just beginning," he said. "The American College of Cardiology didn't come along until the late 50s. I went to its first meeting in Washington, D.C., and became a full-fledged specialist in 1950s."
Prior to that time, if a doctor owned an electrocardiogram (EKG) machine, he or she could say they were a heart specialist, Puckett said, with a smile. But while Puckett was developing his specialty as a heart doctor, he also was building a reputation as a doctor with a heart.
"All my training was in charity hospitals that took care of the poor, so I always had an interest in that element of the population," he said.
In the early days of his practice, every doctor provided charity care. "Before Medicare, 20 percent of the average doctor's practice was charity care—older people without insurance, for example," he said.
Medicare changed that, paying physicians for some care they had previously provided for free. "Every doctor in the country's salary went up 30 percent when Medicare came in," he said. "Now you got paid for what you didn't get paid for before."
But Medicare only supplied care for the elderly, leaving many people facing bankruptcy if they required major surgery.
When Dr. Joe Cofer, then president of the Medical Society of Chattanooga and Hamilton County, first asked local doctors to provide free medical care for those who could not afford it, Dr. Puckett was among the first to volunteer.
Cofer, cardiologist Dr. Mitch Mutter, Dr. Robert Bowers, and several other doctors started Project Access (see related story), with initial donations from Erlanger, CHI Memorial, and Parkridge hospitals, and from the Medical Society—a total of about $200,000 in startup funds.
Project Access hired Rae Bond as its executive director, she wrote a successful grant application that won $1.9 million in funding, and the project was off to a fast start. Twelve years later, some 700 doctors donate their time, providing specialty care to patients who have first been screened by Project Access. Over 12 years, that's $144 million in care to more than 12,000 patients, according to executive director Bond.
Puckett has been medical director for Project Access since its beginning. "He's an icon in the practice of medicine," said Cofer, who is now the chief quality officer at Erlanger. "He was the cardiologist of choice when I was here as a med student in the 1980s. Just an excellent physician, great bedside manner, everybody loved him."
"He reviews charts and can tell us 'this test needs to be done,'" said Bond.
Prior to Project Access, even if a doctor provided free care, he or she had nowhere to turn if a patient needed a specialist. "There was an informal network," Puckett said, but obtaining care depending on what specialists a doctor knew.
He's pleased at how well Project Access has worked. "I think the program is pretty complete, I can't think of anything I would monkey with," Puckett said. "The key thing I would say is that it is the first time all three hospitals have worked together on a project sustained over 13 years—without any push back."
Puckett is now semi-retired, but that doesn't mean he sits at home relaxing. "My wife has a rule that I have to leave the house at 8 in the morning, and I can't come back until 5," he said, smiling. He's given up his passion for gliding, where he accumulated more than 1,500 hours aloft, and now keeps his feet on the ground, although they are also often underwater, preferably fly-fishing in a fast-moving stream.
While he has many memories of treating patients throughout his long career, he says his poorer patients are his favorites.
"They are always some of your best patients," Puckett said, "because they are the most grateful."
But Mutter said he thinks his long-time friend got as much from his patients as he gave them. He remembered when the two doctors went to Haiti together to do volunteer work, at a time when Puckett was not in the best of health.
"He trudged along in the rain and the mud, saw patients, and did a great job," Mutter said.
"If you worry about yourself too much, you get sick," he said. "If you worry about other people, you stay healthy. He still thinks about other people and not himself."