By Kim Krisberg and David Leffler, Public Health Watch Juanita Franklin, 58, the woman who had seen the clinic’s sign on her way to volunteer at church, was among the clinic’s first patients. She and her husband, Kevin, had spent eight years trying to find consistent care for his prostate cancer.
In 2019, when Kevin became too sick to work, he finally qualified for Social Security disability benefits and Medicare. But when his new benefits were added to their household income, Franklin lost the disability assistance that had made her eligible for Texas Medicaid. She’s been uninsured ever since.
“It was very scary,” she said. “I didn’t know what else to do but pray.”
Franklin now considers ETCC her medical home.
While Curran and Mettetal were treating the first patients, Robison was running the business side of the clinic. They couldn’t survive on donations. They needed the steady stream of funding that the Health Resources and Services Administration offers clinics deemed “federally qualified health centers,” or FQHCs.
Becoming an FQHC is such a grueling process that many groups hire consultants to do the paperwork for them. To save money, Robison took on the job himself.
The clinic had to be up and running six months before he could even submit an application. During that period, it had to abide by strict FQHC rules to prove it was worthy of the special designation. It couldn’t refuse care to anyone. It had to make its services easily accessible. And most of the people on its board of directors had to be patients at the clinic.
The application also required extensive data to prove that the clinic’s service area — which stretched over three counties and included more than 47,000 low-income residents — actually needed an FQHC.
“It’s easy to understand why there’s not one of these on every corner,” Mettetal said.
Robison’s life took on a new rhythm: Build the clinic by day, then write about it in the application that night. He said it felt a bit like walking across a bridge as it was being built.
In January 2021, Robison submitted the 234-page application.
In just seven months, the Gun Barrel City clinic had tallied roughly 7,000 patient visits, and its benefits were already being felt in the emergency room at a nearby University of Texas outpatient facility, which often serves as a safety net for people without health coverage.
Wes Knight, chief financial officer at UT Health East Texas-Athens, said that during the first year of the COVID-19 pandemic, when the ER would have expected an upturn, uninsured visits dropped about 3 percentage points.
The UT facility saw another benefit: It could refer its uninsured ER patients to Gun Barrel City for follow- up care. Curran and Mettetal think the clinic has saved the local hospital system hundreds of thousands of dollars in uncompensated care.
Robison thought details like these would prove that the clinic deserved FQHC status. People familiar with the process told him he’d probably hear back from the Health Resources and Services Administration in about 30 days — although he figured it might be a bit longer, given that the nation was in the midst of another COVID-19 surge.
A month ticked by and there was still no word.
In March 2021, Robison sent the Health Resources and Services Administration an email asking about the status of the application.
He got the bad news in a form letter that same day.
Their application had been denied because it hadn’t proved they were eligible for FQHC status. The letter didn’t specify what needed to be fixed, but suggested that they apply again. Robison would have to start from scratch.
But they never considered giving up. Too many people already depended on ETCC to let it fail. In fact, they were getting ready to open a second clinic, this one in Athens. They needed the space to serve their growing list of patients and to train their first four family- medicine residents, who would be arriving that summer.
“I figured it wouldn’t be the last time we’d get rejected,” Curran said.
Curran and Mettetal were accustomed to the ups and downs that come with big, complicated projects. In 2010, Mettetal had founded another nonprofit, Hope Springs Water, which drills clean water wells around the world. Curran owns and helps work the ranch where he lives with his wife, Sandy, and tends more than 250 head of cattle. Both Curran and Mettetal helped start their former private practice in Athens.
They have some of their best ideas — including ETCC and Hope Springs Water — during their ritual, early-morning walks on a quiet road that runs past Curran’s ranch and the small cemetery where he has plots for himself and his wife.
But getting the clinics on stable footing was turning out to be much more difficult than they had anticipated.
Their three core donors had committed to keep them afloat until they got through the FQHC application process, but they couldn’t depend on charity forever. If they didn’t qualify as an official FQHC, their plan would be unsustainable in the long term.
They opened the Athens clinic in June 2021, a couple of months after their FQHC application was rejected. It sits in the center of Athens’ medical district, next door to the 127-bed University of Texas Health hospital.
“You put it right in the middle of all the health care services so that (patients) realize they get the same care that everybody else gets,” Curran said.
Ardent Health, one of their primary funders, owned the medical plaza and donated the space, which had just been vacated. It was a bit of luck — “kind of a God thing, if you will,” Robison said.
The 7,000-square-foot facility was more than three times as big as the Gun Barrel City clinic, and furnishing it on a tight budget was no easy task. The previous practice had left behind some exam beds and desks, but other than that, the rooms were bare.
Robison searched everywhere for good deals. He bought an 18-foot conference table and a hutch for $400 from an attorney who was closing her office in Houston, nearly 200 miles away. He found 14 matching upholstered chairs for the waiting room — $86 for the lot — from a seller in Cedar Hill, 100 miles to the northwest. He roped the seats to the bed of his truck and drove them home.
“I looked like Jed Clampett,” said Robison, who keeps a sign on his desk that reminds him to keep “hustlin’.”
Appointments filled up fast in Athens, just as they had in Gun Barrel City. By the end of 2021, the two clinics had logged about 15,000 patient visits and had become local points of pride.
Continued next week, in the October 27th issue.
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