Doug Curran on his ranch outside of Athens, Texas. Credit: Blaine Young

In June 2021, reporters Kim Krisberg and David Leffler traveled to Gun Barrel City, Texas, to meet two doctors who had opened a clinic for low-income, uninsured residents. The physicians’ efforts underscored a larger issue: Because state leaders had refused to expand Medicaid, more than a million Texans, many of whom lived in rural communities, were struggling to access critical health-care services. 

An ongoing series on the states that refuse to expand Medicaid. Read other project stories.

What follows is Krisberg and Leffler’s account of what they saw during their trips to East Texas and the impacts of their investigation.

Earlier this month, Public Health Watch published an investigative narrative about health-care access in rural Texas: “A Free Clinic Opened in Rural East Texas. Thousands Poured in for Help.” The story describes how Doug Curran and Ted Mettetal, best friends and longtime doctors, opened East Texas Community Clinic to serve their area’s most vulnerable residents. It’s a story about compassion, care and perseverance. It’s also about institutional failure in a state that has the nation’s highest proportion of uninsured residents — 18 percent. 

In the two weeks since its publication, the story has caught the attention of policymakers and audiences around the country. It has been shared on social media by Texas lawmakers of both parties, including U.S. Sen. John Cornyn, a Republican, and U.S. Rep. Lloyd Doggett, a Democrat. It has been published by The Texas Tribune, The Daily Yonder and the Forney (Texas) Messenger. It has also inspired follow-up stories, including this broadcast from an ABC affiliate in Tyler, Texas. People from around the country sent words of support and small donations.

The story’s impacts went beyond shares, likes and page views.

One of the problems Curran and Mettetal face is getting the U.S. Health Resources and Services Administration to approve East Texas Community Clinic as a federally qualified health center, or FQHC. That designation allows safety-net clinics to receive enhanced Medicaid and Medicare reimbursements and gives them access to millions of dollars in federal grants. The doctors had expected to receive the designation by the end of 2021. But when our story was published, the crucial last step in that process — a site visit by federal inspectors — wasn’t scheduled until March 2023. That meant the clinic would have to continue relying on donations to stay afloat. 

After reading the story, staff from Cornyn’s office contacted Curran, who had been trying to secure the senator’s help in moving up the visit. Just days after publication, Glen Robison, the clinic’s operations manager, got an email from the Health Resources and Services Administration saying it would reschedule the visit for mid-December. 

That means Robison should be able to meet the end-of-year deadline to apply for $3 million in federal funds to support the clinic’s medical residency program. 

Another chunk of money that the clinic has been waiting for — a $1 million grant promised to it by the state of Texas — still hasn’t materialized. That money has been sitting unused since October 2021, when Gov. Greg Abbott made it available by signing a state spending bill. Robison said he hopes to receive the first $50,000 by the end of this month. 

Reporter Kim Krisberg interviews Dr. Doug Curran in the Gun Barrel City clinic. Credit: David Leffler

Public Health Watch took on this project because we wanted to show how Texas’ decision not to expand Medicaid has affected the lives of its most vulnerable residents.

What kept us going during the many months of research wasn’t interviews with experts or hours spent poring over health-care data — though there was plenty of that. It was our trips to Gun Barrel City and nearby Athens, where both East Texas Community Clinic branches are located. It was our time with Curran, Mettetal, Robison and the big-hearted people who fill their communities.

We visited the East Texas towns on six occasions. We’d hit the road before sunrise and use the three-hour drive from Austin, where we both live, as our prep time, listening to previous interviews and talking strategy. We knew we were approaching our destination when the piney woods and grazing cattle came into view. These trips, we soon realized, were as much about this place, Henderson County, as they were about the people.

As the months passed, Curran and his team became more than sources to us. We met their families, saw their homes, asked them questions about their religious faith and deepest fears. We met their patients, too, many of whom hadn’t seen a doctor for years because they couldn’t afford to. 

Reporter David Leffler records notes outside the Gun Barrel City clinic. Credit: Kim Krisberg

Of all those days, Sept. 23, 2021, stands out. It started with the buzz of an alarm clock at 5 a.m. and a short drive from our Super 8 motel to Curran’s ranch. He and Mettetal were standing on the front porch, coffee in hand, when we pulled up. Over the next hour and a half, we joined them on one of their morning walks, where they had come up with the idea for their clinic. As we strode past farms, barking dogs and bleating goats, the friends discussed everything from politics to happy memories from their decades as small-town doctors. They even pointed out the modest cemetery where Curran and his wife plan to be buried someday.

Later that day, after we’d toured the clinic, we returned to Curran’s ranch. He introduced us to his ranch hands, who described the various injuries and ailments he’d treated. He drove us across his pastures, pointing out the cows that would soon go to market. With crickets chirping behind him, Curran told us that the first surgery he ever performed was on a cow’s cancerous tumor. He was only 15 at the time, and had used his grandfather’s pocket knife and some fishing line for the procedure. 

Here’s an audio clip from that conversation:

Those experiences stuck with us as we wrote this story. They still do. That’s why we’re so encouraged by the attention the clinic has drawn in recent weeks. From the first time we interviewed him, Curran’s goal was to show us that a small group of dedicated people could make a big difference.

“People will see that you can change something that seems unfixable,” he said. “It’ll encourage people to get a gun and get in the fight.”

more stories from ‘the holdouts’

Medicaid and the Public Health Emergency

Enrollment in Medicaid programs has reached an all-time high, but millions of low-income people are likely to lose coverage unless states conduct aggressive outreach.

Learn more about reporters Kim Krisberg, David Leffler and other contributing writers and editors for Public Health Watch.