Bradley Free Clinic

The Bradley Free Clinic is a long-running, volunteer-staffed clinic for Roanoke’s working poor. In the book, its importance extends beyond medical care: located in Old Southwest, an area emerging as a heroin hot spot, it became the home of the Hope Initiative, a treatment-referral project that tried to turn local concern into practical help. The clinic offered a place to seek assistance, but the effort based there repeatedly encountered a gap between wanting treatment and being able to obtain it.

Clinic and Community Setting

The clinic served people with limited resources and relied on volunteer physicians. Its location in Old Southwest placed it within a neighborhood increasingly affected by heroin use, making the site a practical base for a local response as well as a medical facility. The Hope Initiative was designed as a public-private partnership operating from the clinic, with trained volunteers helping people navigate treatment and related services.

The clinic’s executive director, Janine Underwood, was not a doctor. She attended the first Hope Initiative meeting in fall 2015 because her son, Bobby Baylis, had died that June after using fentanyl-laced heroin. His history included addiction that began after OxyContin was prescribed following knee surgery, repeated movement between rehabilitation and jail, and a period of stability after prison. His death gave Underwood a personal stake in the work, even as she entered it without a background as a clinician or treatment specialist.

The Hope Initiative at the Clinic

The clinic became the project’s regular point of access. Participants could drop in on the second Monday of each month and, if they had no outstanding warrants, be paired with trained volunteer mentors, called angels, who helped troubleshoot care. Social-service workers were available to assist people who qualified in applying for Medicaid. Volunteers had spent months assembling a five-page spreadsheet listing thirty-six rehabilitation and aftercare providers in the southeastern United States; where they could refer someone depended on that person’s finances and on whether a facility had an available bed.

Some volunteers also helped arrange outpatient medication-assisted treatment, but the angels were divided over its value. Many regarded treating addiction with another medication as wrong, despite scientific evidence supporting the approach. That disagreement mattered in practice: the clinic’s referral work was not simply a matter of locating a provider, but of navigating competing views about treatment alongside eligibility, cost, and scarce capacity.

The clinic also became a place where the tension between access and enforcement was visible. People sometimes injected drugs in its parking lot. Police chose not to intervene because they believed enforcement would discourage people from coming to the program. The decision reflected the Hope Initiative’s effort to keep the clinic available as a point of contact, even when people arrived while still using drugs.

Limits of Referral and Support

Underwood and other angels made themselves personally available to participants, with many allowing people to contact them on their own cellphones. Underwood received calls and messages from grieving parents and people seeking help, including Matthew, a young heroin user who said he was suicidal and spoke with her several times over several days. He died by suicide the day before he was scheduled to come to the clinic. The episode showed how the project’s personal, flexible approach could expose volunteers to needs far beyond the formal task of arranging referrals.

In its first month, twenty-two people came to the Hope Initiative. Volunteers saw signs of progress among people who repeatedly expressed interest and stayed in contact, but none had entered residential treatment, and only a handful had obtained outpatient medication-assisted treatment. The mismatch between the spreadsheet’s thirty-six listed providers and the absence of residential placements made the limits of referral stark: information and encouragement could not create beds or remove other barriers to care. Underwood became so exhausted that colleagues called emergency medical services after she passed out at work from stress-related vertigo.

A Link in a Fragmented Care System

The clinic’s work intersected with efforts to improve the transition from emergency care to ongoing treatment. Roanoke emergency physician Karen Kuehl and Hope Initiative coordinator Cheri Hartman tried to develop a smoother handoff for people revived after an overdose, drawing on a model in which emergency departments connect patients directly to outpatient medication-assisted treatment and counseling. Their effort faced bureaucratic, financial, and legal obstacles, including too few treatment providers and insufficient detoxification and treatment beds. Hospital social workers referred some revived patients to Hope while the proposed handoff remained out of reach; the women later learned that the grant they had sought to support it had not been awarded.

The Bradley Free Clinic thus served as more than a location for the Hope Initiative. It was a neighborhood access point where people could ask for help, volunteers could make referrals, and social-service assistance could be offered, but its experience also exposed how little a local program could accomplish when treatment capacity and coordinated follow-up were missing. The clinic’s promise lay in keeping a door open; the story’s harder conclusion is that an open door did not ensure that treatment was available on the other side.