On a Tuesday evening in October 1974, a few dedicated medical volunteers stood in anticipation as they opened the doors to welcome their first patients to the Free Clinic of the Roanoke Valley, the second free clinic in Virginia. Decades later, the clinic is still operating, but now residents know it as the Bradley Free Clinic.
This year marks the 50th year of the free clinic, and its leaders through the decades gathered this spring to celebrate at an anniversary gala. Janine Underwood, the current executive director, attributes its success to its original leader, Estelle Avner.
“This is really Estelle’s legacy,” Underwood said, smiling at Avner sitting across the table from her in her clinic office.
Avner served as executive director for 40 years before passing the baton to Underwood. Even though Avner has been retired for a decade, she still takes calls from Underwood to give advice, introduce her to people in the community or just provide moral support.
Warmhearted and well loved at the clinic, Avner talked about the modest beginnings of the free clinic, always giving credit to the volunteers who helped make the dream of accessible free health care a reality.
“We had a volunteer put wire across the rooms and we hung bed sheets from the ceilings, and those were the exam rooms,” Avner said. “When we moved buildings, one of the physicians came up to me. He said, ‘This place is great. We can close the door to the exam room and hear the heartbeats.’”
The first free clinic in Virginia was the Fan Free Clinic in Richmond, which opened in 1970. It served as a model for the Free Clinic of Roanoke Valley, which became the second no-cost health clinic in the state.
At the time, the idea of free medical care delivered by volunteer nurses and physicians was just a budding trend across the country — and a controversial one when the idea came to the Roanoke Valley.
It was the brainchild of Roanoke resident Henry Bell, who was a conscientious objector during the Vietnam War. The 25-year-old Bell had a government job and was studying philosophy and political science at Virginia Commonwealth University, and he spent some time working at the Fan Free Clinic in Richmond before he brought the idea to Roanoke.
“Some people called me a communist and a radical. That was a big deal at the time,” Bell said.
But he found support through the Council of Community Services and the church he attended most of his life, St. Mark’s Lutheran.
The first clinic appointments were held on the first floor of the Way Inn, an old house on Third Street owned by the church. The space was offered up for the clinic site by its pastor, George Bowers, who served as the president of the clinic’s board of directors.
Bell’s father, Dr. Houston Bell, was a well-known ear, nose and throat surgeon in the Roanoke Valley and helped recruit the first team of volunteers. In the early days of the free clinic, local physicians were slow to offer their services, but Dr. Bell’s recruitment proved instrumental for getting other providers on board, according to a Roanoke Times article published in 1974.
Clinic hours were held twice weekly from 5:30 p.m. to 9:30 p.m., or later to accommodate the patients who lined up on the sidewalk. The evening hours were intended to accommodate the population the free clinic aimed to serve: employed Roanoke Valley residents who earned too much to qualify for Medicaid but still couldn’t afford health care at the hospital.
At first, only about six or seven patients came to the walk-in sessions, but within months the Free Clinic of Roanoke Valley hit 100 patients, then 200, according to an article published in The Roanoke World-News in 1975. To date, the clinic has served at least 150,000 patients over the course of its 50-year history.
The clinic drew families with children as well as adults who suffered from acute illness due to the lack of accessible preventative care. Patients who had gone to the emergency room with an injury would receive follow-up care at the free clinic. And seniors who couldn’t afford medications would come to the clinic for help.
Making do with donated drug samples from local pharmacies, the volunteer physicians cobbled together prescriptions to help patients get by until pharmacy services were established at the free clinic in 1976.
That same year, dental services were added, making it the first free clinic in the country to incorporate dental services, according to the clinic’s 2023 impact report.
Dentists would bring their own tools from their practices and sterilize them at the small clinic at the Way Inn to use on dental nights, Avner said. At the time, very few if any dentists accepted Medicaid.
Dr. Dick Surrusco, one of the first volunteer doctors to provide services, said he’d expected that the clinic would operate until Congress passed national universal health care. He said he never dreamed that a half-century later there would still be a need for a free clinic for what he called the working and retired poor.
“I never thought it would go this far. I thought the government would come around, that there would be other programs that would eventually lead to affordable health care. I never dreamed it would be 40 years later,” Surrusco said.
Surrusco worked as an emergency room physician at Roanoke Memorial Hospital, where he saw patients every day who could not afford the medications they needed. The effects of their disease or illness would escalate until they were brought into the ER. Once stabilized, they would be sent home with two days’ worth of medicine and instructions to fill their prescriptions at the pharmacy. But without any means to pay for medications, they’d arrive back in the ER days later, only to be sent home again with another two days’ worth of meds and directions to the pharmacy.
Seeing these types of patients every day made Surrusco and his wife, Barbara Surrusco, a registered nurse, eager to help get the free clinic up and running.
News of the clinic spread through word of mouth, and soon, patient volume swelled.
“I remember people sitting on the front porch. The waiting room simply was not big enough to accommodate everyone who came,” Barbara Surrusco said.
Eventually, the clinic created a program called Project Access, which allowed doctors to see free clinic patients in their own practices instead of at the clinic, she said. The program became known as the clinic without walls.
The model not only helped the clinic serve more people, but also restored dignity for some patients.
“It’s hard sitting under a sign that says ‘free clinic.’ They felt diminished,” Barbara Surrusco said.
Moving upward
When Roanoke Memorial started sending over residents enrolled in its family medicine program in the 1980s, the free clinic became a center of education. With more volunteers and an ever-growing patient load, it became clear that a larger space was needed.
In 1990, local philanthropist Marion Bradley Via gave an undisclosed donation to the free clinic that allowed it to move to a larger facility, the former home of Roanoke Orthopedic Clinic, located just blocks away from the Way Inn.
The clinic was renamed the Bradley Free Clinic in memory of Via’s father, Harry Lynde Bradley. First lady Barbara Bush visited Roanoke to dedicate the new building. Later that year, then-President George Bush honored the clinic with the Presidential Points of Light designation, which acknowledges those who demonstrate the transformative power of service in their communities.
The Bradley Free Clinic became a model for the creation of other no-cost clinics. Today, there are about 70 free clinics across Virginia.
Avner, the first director of the clinic, traveled around the state and the country to help others build sustainable no-cost health services. Now, her correspondence with other clinics is stored in binders that line the director’s office at the Bradley Free Clinic.
“It’s a well-oiled machine,” Avner said. “But I never had a problem finding volunteers. That was the biggest shock. The biggest surprise.”
Underwood teased Avner from across the table where they sat talking.
“She definitely wasn’t shy to ask,” Underwood said, spurring a knowing laugh from both women.
A new era
Over the following decades, specialty services were added, and the clinic continued to adapt.
“If I had to summarize it, those next couple decades, we were filling in the gaps. We’ve become the safety net in the community for health care needs,” said Underwood, who became executive director in 2014. “Health care changes, and it has changed in 50 years, and that’s the beauty of free clinics is that they adapt and they’re quick to change to whatever the need is.”
As the clinic expanded, it became a one-stop shop for its patients.
One of the biggest developments Underwood spearheaded was the expansion of behavioral health services, from adding psychiatric services to making the clinic a home for the HOPE Initiative, a nonprofit that supports people in addiction recovery using peer support specialists, to building a new behavioral health wing.
“I think whether it was mental health or mental health and substance use … there’s a stigma behind them. It’s really about keeping what’s in your heart and what’s important to the patients and knowing that there’s a huge need. That was probably the biggest challenge because of all the stigma,” Underwood said.
Today, the clinic operates on a $4.9 million budget, with the majority of its funding coming from grants and large gifts, according to its most recent tax documents. Federal grants make up about $700,000 of its budget, and contributions including medical equipment total $1.9 million. Underwood’s most recent compensation was $129,514.
The budget has grown modestly over the last 20 years, with revenues totaling $2.1 million in 2004.
Despite the hurdles, there’s a saying that Underwood has become known for within the walls of the free clinic. The staff even had a sign made with Underwood’s name printed below. It says: “We’ll figure it out.”
When patients found it difficult to find providers who accepted Medicaid after it was expanded in Virginia in 2019, the Bradley Free Clinic decided to accept the public insurance to help fill the gaps.
Over the last 10 years, the clinic has made significant strides in reaching the community’s Hispanic and immigrant populations and established specialized clinics to support these communities. More interpreters and providers have been brought into the fold to facilitate care for this underserved population.
And as its next decade starts, Underwood says the clinic will continue to adapt.
“I’ll go back in history, or I’ll see the letters Estelle sent to legislators 30 years ago, and the need for dental or medical, and I’ll realize that’s still what I’m working on or dealing with today. I’ve seen how it’s adapted over the last 40 years before I came and how it’s affected the community and the country,” Underwood said. “There’s this magic about the Bradley Free Clinic. We’re just carrying on its purpose and the legacy.”
