The average cost of hernia repair surgery in the United States runs into the thousands, with insured patients often paying $750 to $1,000 out of pocket— if they’ve met their deductible. But at the Lestonnac Free Clinic in Orange County, Calif., the cost for a hernia repair, along with other life-changing surgeries, will be zero.

In early 2025, the clinic will open the nation’s first surgery center operated by a free clinic, a groundbreaking initiative to provide life-changing procedures, including hernia repairs, cataract removals, colonoscopies, and more, to those who cannot afford them. Already, over 3,000 patients are on the waiting list.

For Ed Gerber, executive director of the Lestonnac Free Clinic, and a former patient, the implications are profound, having once had to balance imaging costs with eating dinner, he recalled. Gerber dreams of the surgery center becoming a national model, a goal that seemed out of reach until a $3.5 million donation from philanthropist Bill Thompson.

The creation of the surgery center, a 4,000-square-foot facility with two state-of-the-art operating rooms, five pre- and post-operative beds, and sterilization units, represents both a solution to a pervasive nationwide problem and a model for the future.

For nearly a decade, Lestonnac Free Clinic, founded by Sister Marie Therese in 1979, saw about 17,000 patients across 30,000 visits last year, and has been striving to offer surgical procedures to its uninsured patients. In one instance, the clinic borrowed operating rooms at a hospital for a single “surgery day,” completing a dozen cases— hernia repairs, carpal tunnel releases— with undeniable success. Yet no hospital agreed to repeat the program.

Eventually, through partnerships with organizations like the American Association of Physicians of Indian Origin, or AAPIO, Lestonnac secured occasional access to a Beverly Hills surgical center, performing surgeries twice monthly. It was during this period that early-stage cancers were detected in several colonoscopy patients— cases that could have turned fatal without intervention.

“That was eye-opening,” said Gerber. “We saved those lives, but the frustration was realizing how unsustainable it all was. We realized couldn’t rely on hospitals long-term. We had to build this ourselves.”

The Lestonnac surgery center is, in part, a response to the systemic challenges of U.S. healthcare. While hospitals are legally required to stabilize emergency cases, they are not obligated to treat conditions like hernias or cataracts, which can profoundly impact quality of life. “Emergency rooms stabilize and release patients. After that, you fall into a rabbit hole trying to find care,” said Gerber.

At Lestonnac, care is free, provided through a network of volunteer doctors, surgeons, and anesthesiologists. Free clinics do not receive any state or federal government reimbursements for care they provide. Addressing common perceptions about free clinics, Gerber said the volunteers are doctors with deep experience.

“They’re doctors you wish you could get. They’re well-seasoned surgeons who want to make a difference,” he said, adding that instead of doing medical missions internationally, they’re able to provide services locally.

 Courtney Harrison, the clinic’s Director of Surgical Services, envisions a ripple effect from the free surgery center. “The evolution of this is going to be fantastic. If a surgeon is willing to volunteer, I know we’ll find the patients,” she said.

Already, the clinic coordinates with 16 federally qualified health centers and other clinics, which refer uninsured and underinsured patients. “A $2,000 co-pay might as well be no insurance at all,” Gerber said, referring to private insurance plans that have high deductibles, which are out-of-pocket costs that a patient must pay before insurance begins to cover costs.

The types of procedures planned are considered routine, yet are potentially transformative: cataract surgeries that restore sight, hernia repairs that allow patients to work again, colonoscopies that prevent advanced cancer, and minor orthopedic procedures like ankle stabilizations.

“These are surgeries that don’t take much time, some are 15 minutes, but they change lives,” Harrison explained. “One hernia patient couldn’t work for two years. After the surgery, he was back on his feet.”

Bringing the surgery center to life has required a delicate balance of donations and partnerships. Kaiser Permanente has donated critical supplies, while hospitals have offered pathology services free of charge. Specialized equipment, such as colonoscopy scopes and anesthesia machines, are among the project’s major expenses, along with construction costs.

“Collaboration is what’s making this a reality,” Gerber said. The free clinic also benefits from owning the building in which the surgery clinic will be housed. “If you’re renting, you’re back to relying on someone else,” Gerber said.

Once operational, the center will prioritize patients based on severity and urgency according to Mary Baker, director of quality. Cases will be sent to volunteer surgeons, who select those they are most comfortable performing. Already, some patients are willing to drive from as far as Arizona.

The Lestonnac team hopes the center serves as a national model for other free clinics, showcasing how communities can bypass a complex, costly healthcare system to provide vital care for those who do not have another option due to cost.

“This is what free clinics are about,” Gerber said.

“Saving lives is first and foremost for all of us. But quality of life matters too. If we can do one cataract, we’ve made a difference, it’s huge for patients,” he said about the procedure, which can restore sight.