Clinic Chief Provides Health Care to Poor, but Leaves a Few Bruises

When tough-talking Roberto Juarez was recruited to run a struggling Ventura County farm worker clinic in 1978, it operated out of two rooms in an old Santa Paula motel and used a coffee can to stash the cash paid by a trickle of poor patients.

Today, Clinicas del Camino Real stands as an example of how far a rural health clinic can come in California if it is headed by a savvy high school dropout with a knack for gaining government grants and a give-’em-heck attitude toward local bureaucrats.

“There is something in my character: I fight for the underdog,” said Juarez, 54, a square-jawed farm worker’s son who fought in Vietnam and marched with Cesar Chavez. “I grew up reading the Lone Ranger and Batman and Superman comic books. And that must have stuck.”

In Juarez’s 24 years as boss, Clinicas has grown from one clinic with six employees and an annual budget of $60,000 to a flourishing health-care system with seven clinics, 220 employees, a $15-million budget and assets of $18 million.

It operates out of a 50,000-square-foot headquarters in east Ventura with palm-lined walkways and state-of-the-art treatment rooms.

Its 17 doctors and 50 nurses see thousands of patients a year in Ventura County’s poorest communities. And it provides care and counseling to students at 22 schools and five group homes across the county.

Two years ago, Clinicas received a rare honor for a rural health clinic -- accreditation by a national commission that evaluates the quality of hospitals and health-care organizations nationwide.

“That clinic was just two little rooms. Nobody would have envisioned what it has become,” said Diana Bonta, director of the state Department of Health Services, who recruited Juarez, then a young hospital administrator.

“Roberto was able to take his skills and make that clinic function through sheer determination and build a whole system that was ahead of its time,” she said.

Three years after he came to Clinicas, Juarez helped write the state law that set up California’s farm worker health program in 1981. He has held state and federal leadership advisory positions, including the chairmanship of the Clinton administration’s committee on migrant health issues.

Santa Paula Memorial Hospital, the only medical center in the agricultural Santa Clara Valley, is negotiating a potential partnership with Juarez’s clinics to keep that struggling facility afloat.

“They’ve got experience and relationships with patients throughout this valley,” said Santa Paula hospital administrator Mark Gregson.

From the start, a Clinicas strength has been reaching impoverished Spanish-speaking patients who for generations received medical care only in emergency rooms or as they delivered babies.

“We go out to the fields where they are picking and pruning,” Juarez said. “We go where they live and where they congregate. We go to the bars, and give them information. We don’t wait for them to come to us.”

But as Juarez -- a child of a broken home in Oxnard’s Colonia barrio -- has climbed an unlikely ladder to success, his confrontational personality has also made enemies every step of the way.

He fired doctors en masse when he concluded they were trying to organize a union. He dismissed another in a dispute over whether money the doctor was receiving for delivering babies on his own should be shared with the clinic.

And Juarez has reported Ventura County health agencies to federal authorities for allegedly dumping uninsured patients in his clinics instead of treating them in the county’s public health-care safety net.

“He seems to have a chip on his shoulder,” said Dr. Samuel Edwards, recently retired administrator of Ventura County’s public hospital. “He strikes me as having a perception that everybody’s against him and that everything he tries is against all odds.”

Dr. Martha Gonzalez was one of the doctors fired by Juarez more than 20 years ago.

“Now he’s built this palace out of taxpayer money,” Gonzalez said. “And he drives expensive cars to take care of sick people. These are your taxpayer dollars at work.”

Juarez said he has heard it all before -- that he has been called a “poverty pimp” who drives a luxury car, lives in a fine house and has used taxpayers’ money to build a small empire of clinics far more opulent than his patients need.

“Well, people deserve the best we can afford,” Juarez said. “And we’re going to provide quality care in the best facilities by the best physicians with the best equipment we can afford.”

But the facts are, Juarez said, that his luxury car is actually a 1993 BMW, his fine home is really a 2,300-square-foot house in a middle-class tract two miles from his office. And that his opulent corporate headquarters is a high-quality structure that cost $105 a square foot to build, well below the industry standard.

The building is large enough to accommodate years of growth, he said. And its $49,000-a-month payment toward a 30-year construction bond will result in Clinicas owning it. By comparison, the clinics had paid $30,000 a month in rent to house services now in the headquarters building, he said.

And despite his long years of service, his salary was just $95,000 annually until six months ago, when he received a substantial raise, Juarez said. “The doctors make more than I do.”

Yet, criticism often comes from Ventura County officials, Juarez said.

“They don’t want this agency to exist,” he said. “They were supposed to be the providers of last resort. But they weren’t doing their jobs ....My personal comment is that the plantation mentality is alive and well in Ventura County.”

Pierre Durand, director of the county Health Care Agency, did not return phone calls about Clinicas and Juarez.

County Supervisor Kathy Long, whose district includes Santa Paula, said the chilly relationship between Juarez and the county results from his allegations of patient dumping and from competition to treat low-income pregnant women since Medi-Cal payments made such care profitable in the 1990s.

“There’s been some bad feelings,” Long said.

But for all the controversy, even some of his critics say Juarez has been good for patients as his clinics have expanded from Santa Paula to Oxnard, Ventura, Fillmore and Ojai.

Dr. Stanley Frochtzwajg, a Ventura family physician, said he was fired by Juarez in 1980 when he refused to split fees he earned on his own time, while Juarez said the dismissal also resulted from a dispute over the number of patients the doctor should see a day.

“But I think Roberto has provided an important service to the area,” Frochtzwajg said. “Clinicas provides good medical care and their presence caused the county medical center to build up a clinic system.”

Mike Murray, president of the St. John’s hospitals in Oxnard and Camarillo, said Juarez is an excellent businessman and his doctors are first rate.

“He’s got a wonderful connection to the Latino community,” said Murray, whose hospitals receive dozens of Clinicas patients a month. “And to be honest, his clinics are nicer and better positioned than the county’s or Community Memorial [Hospital’s].”

That Juarez today leads a large nonprofit agency is testament both to the force of his will and to the era in which he matured as a professional.

In foster homes at age 10, he ran the meanest streets of Oxnard before joining the Army at age 17. After Vietnam, he was hired as a community worker by the Ventura County Public Health Department in 1970.

He helped get toilets in the fields for farm workers. He mapped drinking water wells. And he filed grievances with the Civil Service Commission, contending he had been passed for promotion because he was Latino.

He got his promotions. And within four years, Juarez became the top aide to the head of the 1,100-employee Health Care Agency, then an assistant administrator at the county hospital.

Off the job, he also became a leading Latino activist, working political campaigns and helping start the county’s main Latino social service agency.

But he wasn’t a popular guy at work. His bosses considered him too pushy and inflexible. Minority workers thought he didn’t do enough for them.

“Folks hated my guts,” he said. “So I asked for a sabbatical [to work at Clinicas]. And they said, ‘When you go, we want you gone.’ ”

Attorney Victor Salas Jr. remembers keenly Juarez’s arrival at Clinicas, where Salas was still a teenage volunteer, because the new boss fired everybody with a salary.

“He came in and wrote some grants and all of a sudden we were seeing 30 patients a day,” Salas said. “Before, we’d be lucky to see 30 patients a week.”

Juarez fired and rehired Salas four times. Finally, he encouraged the youngster to finish his college education. Two months ago, he hired Salas back, this time as Clinicas’ corporate legal counsel.

But Juarez was also loyal to those who worked hard. And today, many employees have been there for years. Some administrators started there as teenage clerks and worked their way up, earning college degrees along the way, just as Juarez did a few years ago.