Twenty years ago, Health Center of Southeast Texas opened its first clinic inside a small former flower shop in Cleveland. The computer was donated by Walmart. The waiting room furniture came from a patient.
It wasn’t a large medical campus or a polished facility. It was a small staff who believed healthcare shouldn’t depend on whether you could afford it.
Today, that modest beginning has grown into a regional network of clinics serving thousands across Liberty County and surrounding communities in neighboring counties. In addition to its headquarters in Cleveland, HSET has clinics in Plum Grove/Colony Ridge, Shepherd, Liberty, Dayton, Livingston, and a mobile bus. In the near future, HSET will open a new clinic in Roman Forest.
What began as a response to a growing healthcare crisis has become one of the region’s most important safety nets.
In 2004, Cleveland Regional Medical Center was struggling with mounting losses in its emergency room. Under EMTALA (Emergency Medical Treatment and Labor Act of 1986), a federal law requiring hospitals to treat anyone who comes to the ER regardless of ability to pay, hospitals across the country were absorbing significant costs from uninsured patients who were using emergency rooms as their primary care providers.
celebrates the grand opening of HCSET’s new clinic in Colony Ridge.
“We were in the double-digit million-dollar loss range,” recalled Steve Racciatto, director of Health Centers of Southeast Texas. “They were looking for a way to divert some of those nonpaid patients away from the hospital into more appropriate care.”
The hospital’s leadership at the time — CFO Phil Hacker and CEO Ron McLaren — began exploring the possibility of creating a Federally Qualified Health Center (FQHC), a model established in 1965 to provide primary care services regardless of a patient’s ability to pay.
The Health Center of Texas organization was legally formed on March 14, 2005. Racciatto was hired to get it off the ground.
By 2007, during an expansion of the federal program under President George W. Bush, Health Center of Southeast Texas secured its federal grant and officially became part of a nationwide network of FQHCs.
From the beginning, the mission was simple: provide primary healthcare to anyone who walks through the door.
“There is no restriction on who we can see,” Racciatto said. “If someone is here visiting from Alaska and walks in, we’ll see them.”
The clinic serves insured, underinsured and uninsured patients. For those without coverage, fees are based on a sliding scale tied to federal poverty guidelines.
Closing the gap in rural healthcare
Access to healthcare remains one of the biggest challenges in rural and semi-rural communities.
“It’s difficult to recruit physicians to rural areas,” Racciatto explained. Nurse practitioners, physician assistants and midwives are often more willing to come, but they must practice under a physician’s supervision.
Medical Director Dr. Jasmine Sulaiman said recruitment continues to be one of their greatest hurdles.
“Nobody wants to come to this neck of the woods, especially youngsters, because they are looking for amenities,” she said. “Primary care is in such a shortage. There is no scarcity of jobs.”
Even with Houston’s medical center nearby, attracting providers to smaller communities can be difficult. Still, the organization has managed to build a strong team and expand services where they are most needed.
From a flower shop to a regional network
When the first clinic opened, the staff was small: Racciato, Estrada, Dr. Sulaiman and a person for billing. Estrada also was the bilingual translator. Within months, Estrada proved herself indispensable.
“She was like a sponge,” Dr. Sulaiman said. “She had that hunger and that passion and was willing to serve.”
Over the years, Estrada grew into leadership roles. She currently is the chief operating officer and now is poised to take the helm. Racciatto, who will turn 75 this year, plans to retire and transition into a board member or consulting role.
“She’s going to be the next CEO,” Dr. Sulaiman said. “She knows this organization like the back of her hand. This is a success story.”
From that small Cleveland location, the organization has expanded to clinics in Plum Grove, Dayton, Liberty, Cleveland, Shepherd and Livingston. It also operates a mobile unit and plans to open a clinic in Roman Forest once an adult provider is secured.
Expansion has been strategic and competitive. Federal grants for new clinic locations — called “new access points” — are awarded nationwide based on demonstrated need. Hundreds apply for each funding round.
“You have to show the government that your area has a greater need,” Racciatto said.
The region they serve now includes Eastern Montgomery County, Liberty County, San Jacinto County, Polk County and portions of Hardin County — nearly 250,000 people combined.
Reducing barriers to care has always been part of the strategy. Travel distance alone can prevent patients from seeking care, so adding clinics throughout the region became essential.
In addition to new clinic locations, the organization has secured expansion grants over the years to broaden services. Each year, Health Center of Southeast Texas must reapply for federal funding and demonstrate that it continues to meet strict performance and quality standards.
More than just primary care
What began as a primary care clinic has grown into a comprehensive healthcare system.
“We started just with primary care,” Dr. Sulaiman said. “As we grew, we added pediatrics, behavioral health, dental, radiology services like mammograms, counseling and pharmacy.”
There are misconceptions about Federally Qualified Health Centers, Estrada said.
“Some people have the wrong conception of what an FQHC is because we say that we will see anyone regardless of ability to pay,” she said. “But the reality is we have a lot of restrictions and regulatory measures we have to follow. We are high on quality, and our providers are very qualified.”
As a nonprofit, revenue is reinvested into expanding services and improving care. Grants have helped fund new clinics, behavioral health services and service expansions — but each grant requires strict accountability.
“We maximize every dollar to ensure that we can give back to the community,” Estrada said.
Racciatto has even earned a nickname in the community for his success in securing funding — “green thumb” or “green fingers,” Estrada said with a laugh — though she credits an ample portion of that success to grant writer Carmen Crawford and the leadership team and supervisory board’s long-term commitment.
“I really think the commitment of the leadership is what drives the success,” Estrada said. “The top really makes it or breaks it.”
Dr. Sulaiman agrees.
“We work as a family,” she said. “But more than that, the community support is so important.”
Over the years, patients have placed their trust in the health center — and that trust has fueled its growth.
“If they don’t come through the door, we’ll not have business,” Dr. Sulaiman said. “We’ve earned their trust.”
Looking ahead
What began as an effort to relieve pressure on a struggling emergency room has now grown into a regional network serving thousands.
The challenges facing healthcare haven’t disappeared. If anything, they have gotten tougher as the communities served by HSET have grown rapidly. Recruiting providers is just one challenge. Funding remains competitive and the need continues to grow.
But two decades later, Health Center of Southeast Texas is here — still expanding services and still helping anyone who walks through the door.