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.