Photo by Craig Carlson

Dorothy Reno. “I said, ‘You don’t want to go there. She’s going to chop your weenie off. You are going to be really unhappy.’ ”

Even the Methodist minister is irate. So are the Lions, the Soroptimists, the Optimists, the Kiwanis, members of the Borrego Springs Civic Foundation, the Women's Circle of the Borrego Springs Community Church, and scores of other benefactors of the now-defunct Borrego Springs Community Clinic On a particularly pleasant desert spring day last month, representatives of this unlikely band of civic malcontents gathered in a small reception area of the empty clinic quarters, where retired admirals once rubbed elbows with citrus pickers as they waited to see a doctor. This time, though, they had come to explain how the fruits of public charity had been lost to a multimillion-dollar corporation.

Beverly Kuhrts and others compiled an extensive list of equipment donated to the clinic.

Photo by Craig Carlson

For more than a decade, the citizens of Borrego Springs had been models of civic involvement, donating cash and equipment to a community health clinic that had, during that time, operated under various auspices. It never mattered who was running the place The clinic was one of those rare institutions that brought the whole town together.

Bill Long: “We could never get a decent answer from Reno."

Photo by Craig Carlson

The gift-giving went back as for as 1975, when two Sisters of the Blessed Lady came to Borrego Springs and opened a clinic called the Family Health Center. The center was affiliated with La Clinica de Salud del Pueblo in the Imperial County town of Brawley. Borrego Springs community groups were generous to the new clinic. In 1980 the Civic Foundation held bingo games to raise money for a centrifuge for the clinic’s lab, and a Soroptimists’ fashion show raised half the cost of a blood-testing device. The next year, the Civic Foundation also kicked in another big chunk of its bingo profits for a new clinic microscope.

Board chairman Dick Hedstrom: “Reno did not want advisory boards anymore because they were too demanding.”

Photo by Craig Carlson

In 1981 North County Health Services — a San Marcos-based, private, nonprofit corporation that operates similar clinics throughout North County — took over administration of the clinic. The two nuns, who had by then been running the clinic for six years, left their order but stayed on at the clinic under the new administration, one as a nurse practitioner, the other as clinic administrator and counselor.

Dr. Charles Maletz: “My record is impeccable. Yet this woman impugns my integrity and judgment.”

Photo by Craig Carlson

One reason North County Health Services agreed to take over the Borrego Springs Clinic was the community’s long record of financial support, which continued under North County Health Services management. A December 1982 fundraiser, just a year after the changeover, netted the clinic more than $6500. In appeals to the Borrego Springs community, clinic officials, including North County Health Services executive director Dorothy Reno, assured prospective donors they could earmark contributions for local use exclusively. Although cash would be deposited into a general corporate account, it could be requisitioned for use by the clinic director. Under those circumstances, people gave freely and without reservation — $1000 from the Church Circle, $1000 from the Soroptimists, tables, sofas, window blinds, waiting-room chairs.

Beverly Kuhrts, a forty-year resident of the area, and Bette Born, a member of the Borrego Springs Community Church Women’s Circle, along with others, have compiled an extensive list of equipment donated to the clinic over the years. They used old newspaper clips from The Borrego Sun, records of various civic clubs, and letters from donors they received after an appeal to the community for the information. The list is two pages long and includes a portable refrigerator, autoclaves, examination tables, microscopes, thermometers, pediatric medicine equipment, otoscopes, and EKG machinery. All told, she estimates the donated equipment is worth between $10,000 and $15,000.

But North County Health Services, citing state and federal funding cutbacks, * ordered the clinic closed last October, and | the equipment is gone, every last piece of it. The only thing left behind was a huge X-ray machine too heavy to move easily. Removal of the equipment from the Borrego Springs Community Clinic took place three months ago on a January day that will not be soon forgotten in Borrego Springs. “They moved in there between two suns and got with it,” says Bill Long, a retired liquid petroleum wholesaler, who served as chairman of the clinic’s local advisory board in 1985.

In February, Beverly Kuhrts, Bette Born, Bill Long, and Frank Matthews, pastor of the local Methodist Church, traveled to San Marcos to meet with the corporation’s board of directors. They said they wanted their equipment back, but they were told to produce proof of ownership and then were

mw asked to leave. Since then, PI North County Health Services executive director Dorothy Reno has decided to keep the _ equipment. “Everything that was in the * health center was the property of North County Health Services,” she insists. Her pronouncement, according to those familiar with the Borrego Springs Community Clinic, is a bunch of baloney. Long | and former North County Health Services board chairman Dick Hedstrom say they also believe North County Health Services stripped the clinic in retaliation for the trouble the determined locals had been causing. Her decision to keep the clinic equip-I ment, they say, is just the most recent in a long series of her edicts that have bred anger, disappointment, and cynicism among the citizens of Borrego Springs. During the six years that North County Health Services operated the Borrego Springs Clinic, the two former nuns quit and left the area, a popular physician was fired under suspicious circumstances, the local advisory committee rose in open revolt against North County Health Services over suspected corporate financial irregularities, and, ultimately, the community lost its clinic altogether.

IT WAS NOT, HOWEVER, AS IF A greedy North County Health Services stalked its prey and sprang upon it. The corporation was invited in by Rat Muro and Lois Chenier, the two former Sisters of the Blessed Lady who opened the Family Health Center in 1975. The two women were attracted to Dorothy Reno’s North County Health Services for a number of reasons, not the least of which were Dorothy Reno’s recognized political skills and grant-writing abilities. Fbr a while, the nuns believed they had made a smart move. For example, Borrego Springs had been used, along with other rural clinics, to qualify North County Health Services for federal grants to provide health care to mothers and children. Reno had told Pat Muro that the Borrego Springs Clinic had helped “legitimize” the operation.

But 1983, says Muro, was a year of dramatic, transmogrifying change. In that year, North County Health Services became one of a handful of agencies in San Diego County designated as a contractor for County Medical Services, a state-funded, county-administered medical-aid program for poor people. The change brought millions of dollars to North County Health Services, which in turn created a separate agency called Northeast San Diego Health Plan to administer the program. Between 1984 and 1986, the corporation received more than $17 million in County Medical Services. Projected revenues for this year alone are estimated at $7 million.

"The overhead and the expansion of the bureaucracy skyrocketed,” says Muro. "And it was at that point that services to the community got bogged down with bureaucratic red tape and paperwork. A lot of paper pushers began to run the organization.” Many of North County Health Services’ once-innovative programs collapsed under the weight of the new bureaucracy, she says. In Borrego Springs, for example, health education, mental-health services, and a child- and maternal-health program began to drown in a sea of government paper.

In 1984 an increasingly frustrated Pat Muro did little to help her worsening relations with the administration in San Marcos when she began to tell prospective donors they could no longer be certain their contributions would do anything to improve medical care in Borrego Springs. She took that unusual step, she says, because North County Health Services director Reno had reneged on an earlier pledge to an anonymous Los Angeles County philanthropist who had been funnel ing thousands of dollars into the Borrego Springs clinic on the condition that it be used solely to finance a mental-health counselor there. “I had gotten an assurance from Dorothy that this money would be used exactly as this donor had indicated ” recalls Muro. "But two to three weeks later, I was told that things had changed, that she wanted to take these funds and pay the psychologists at the other sites. I was so uncomfortable about what was happening with North County Health Services that I would tactfully turn things down. ‘No, I don’t really think we need a new carpet. I don't think we need a new counseling chair....’ [The people] believed things would stay in Borrego Springs, and they relied on Lois and me to safeguard their investments in the community.”

Despite their disagreements with Reno over the ultimate destination of the largesse of benefactors, Muro and Chenier tried to stay on at the clinic. But Reno was making their lives increasingly miserable, says Muro. It was becoming almost impossible to withdraw donated money from the general account in San Marcos for use in Borrego Springs; the clinic itself was becoming financially strapped, she maintains, while North County Health Services was burgeoning.

Muro says she and Chenier had already considered leaving the clinic before an incident in late 1985, when Dorothy Reno sought their help in an effort to fire Charles Maletz, a young, bilingual Harvard Medical School graduate who had recently gone to work for North County Health Services after completing his residency in Family Medicine at UCSD. Maletz himself had incurred Reno’s ire by refusing to move to Ramona and instead commuting from Rancho Penasquitos to the mountain and desert clinics where he worked. But it was not just the young doctor’s choice of residence that raised Reno’s hackles; he also challenged her authority in medical matters.

After Maletz suggested to a federal auditor, in Reno’s presence, that there were problems with the quality of health care delivered by North County Medical Services, an angry Dorothy Reno related the incident to Muro. “From that time forward, he was on her hit list,” says the former nun. Reno questioned Maletz’s judgment in staff meetings and discredited his proposals for change. Muro says Reno summoned her to a private meeting at the corporation’s San Marcos headquarters where the director had assembled her top administrators. “What she wanted me to do was to say that Dr. Maletz was not putting in his hours, that he was lying, that he was adding on extra hours, that he was not following personnel procedures.” Muro says she refused but that her refusal did not stop Reno. On February 28, 1986, Maletz was pulled from clinic duties in San Marcos, where he had been reassigned for “monitoring,” and was informed that he had been dismissed. (In an interview, Reno declined to discuss the Maletz dismissal, calling it “private information.” In addition, she refused to discuss the specifics of other complaints and allegations.)

Other professionals were also treated poorly, claims Muro, remembering a physician’s assistant who was “blackballed” by North County Health Services after a run-in with Reno. Maletz says that when he once came to the defense of an embattled nurse practitioner in Santa Ysabel who had the support of the entire clinic staff, he was told any interference would be regarded as “unprofessional conduct.”

In the midst of these disputes, according to Pat Muro, arose an even more alarming, Orwellian specter: corporation employees came to distrust even their co-workers. “People were spying on each other," she says. “You didn’t know who was around the corner listening.” Her suspicions about spying are confirmed by a May 1986 memo to North County Health Services board chairman Dick Hedstrom. In that memo, a health educator detailed a conversation she had had with a receptionist at the Santa Ysabel Clinic. The receptionist had become upset after being asked by a high-ranking North County Health Services administrator “to monitor all telephone calls that came in ...from Dick Hedstrom and Bill Long.” She was told “to note dates and times and report.” She also was told to tell no one of the request.

“We saw the handwriting on the wall,” says Muro. “We were right in line to be fired because we were opposing her vehemently. But we couldn’t do what she was asking us to do.”

Two months after Maletz’s firing, Chenier and Muro gave Reno three weeks’ notice, after which she never spoke to them again.

Although insiders knew it was coming, the departure of Chenier and Muro rocked the tiny desert community of Borrego Springs.

“Pat Muro was a stubborn little chili pepper,” recalls Bill Long, who had become chairman of the Borrego Springs Community Clinic Advisory Board the year before. “She would not give in just because Dorothy Reno said so.” Long had his own stormy year at the helm of the advisory board. “We could never get a decent answer from [Reno] ” says Long. “We were blocked by Dorothy every time we turned around.” What he and other advisory board members wanted was an accounting of some $36,000 they figured the community had donated to the clinic in cash. How much had been spent? On what? What would be the needs in future fundraising? But despite months of pleading, the North County Health Services administration never gave them a satisfactory answer. Finally, in December of 1985, the Borrego Springs advisory board voted to suspend future fundraising and to try to have all of the money transferred from North County Health Services to a local account in the name of “North County Health Services — Borrego." The local board would decide how the money would be spent.

A few weeks later, on December 13, 1985, the Borrego Springs advisory board issued a letter to make the request formal. Reno’s response came within a week. “Great care was taken to explain to your advisory board that it would be ‘advisory’ in nature and that our representative board is the ‘legal’ board of directors,” she wrote. “Therefore, since the Borrego Springs Advisory Board is not a legal entity, I will advise the board of directors not to honor your request to transfer funds to another account.”

Director Reno did not stop at the issue of transferring funds. She told them she was going to recommend to her own board that Long and his associates “be given the opportunity to incorporate [the Borrego Springs] advisory board and assume the legal and financial responsibility for the Borrego clinic.” As for the $36,000, she wrote, “all monies raised... have been used to subsidize the Borrego Springs clinic.” In other words, the money was gone. Bill Long says that’s when he and others on the advisory board realized the life of the clinic would soon be snuffed out. “They could all see what I saw,” he says. “One way or another, she was going to end it.” Less than a year later, in November of 1987, the local advisory board voted itself out of existence, turning over all of the clinic’s assets to Unicare Health Alliance.

Unicare is tiny in comparison to North County Health Services. It is funded by private donations and a small grant from the state division of rural health. Jim Howard, Ph.D., Unicare’s executive director, says his group looked forward to moving in, especially since the community had transferred its support from North County Health Services to Unicare. State health officials, he says, were also considering more funds for Unicare. But when Unicare moved to the old clinic in mid-February of this year, Howard was surprised by what he discovered. Instead of well-equipped quarters, “we found an empty house,” he says.

Perhaps no one in Borrego Springs is better situated to assess what has happened than Dick Hedstrom, a forty-nine-year-old swimming pool service operator who served on the North County Health Services board of directors for seven years before his controversial departure last spring. Until he was forced off the board a year ago, Hedstrom had rarely missing a meeting, despite the two-hour drive along tortuous mountain roads to the San Marcos headquarters, where the board usually met.

In April of 1986, even though Hedstrom was a partisan of the Borrego Springs advisory board, his colleagues on the North County Health Services board of directors elected him their chairman. But by this time, Hedstrom had begun to question more than what the corporation was doing to his hometown. He says he argued with Dorothy Reno over the very concept of local advisory boards. “She did not want advisory boards anymore because they were too demanding,” he says. “If their clinic is closed, they want to know why, and Dorothy figures it is nobody’s business but hers. I tried to tell her that advisory boards are the backbone of the clinic system. But she didn’t like them. They asked questions that she didn't want to answer.”

Hedstrom's final year at North County Health Services was a tempestuous one. Some of his colleagues on the board — among them treasurer Sarah Rosenfield of Encinitas and fellow board member Art Weller of Valley Center — also began to seek information about the financial health of the corporation. "There was something wrong in that corporation," says Hedstrom. His suspicions grew with the resistance and roadblocks director Reno threw in the way of financial disclosure to the board, which technically was her boss. "We kept asking for financial statements and we never got a one," he says.

Board member and treasurer Sarah Rosenfield took the lead in pressing for financial information from Reno. At one point, she refused to sign documents transferring funds needed to meet the corporation's payroll until she was provided with trial balance sheets attesting to the corporation's solvency. Her persistence was sometimes met with peculiar responses by Reno, who offered to meet privately with individual board members, instead of addressing the issue at full board meetings. In November of 1986, Reno wrote a memo to Rosenfield telling her that in the future, she would be charged to costs of "preparing and providing" any such "special reports."

Rosenfield's appetite for information still had not been satisfied by last December, when she wrote to Hedstrom that she found it "morally and legally necessary" to bring her problems to the attention of the full board. The administration, she said, was violating corporate by-laws by failing to provide information needed by the governing board "to make informed and prudent decisions." Rosenfield's exasperation was clear. Among other things, she wrote, a 1985 audit had revealed a corporate deficit of $910,000. The board needed comprehensive information immediately "to insure the corporation's liquidity." Although the administration did from time to time provide pieces of the financial puzzle, Rosenfield was not placated. Frustrated, she resigned two months ago from the board on which she had served since 1981.

Dorothy Reno says that Rosenfield and other board members who pressed for financial information do not recollect correctly. "None of that is true," she says. "Our board received — is receiving right now — complete financial statements, and they receive other statements and reports from other reporting agencies on a regular basis. The board has always known what the balance is."

Former North County Health Services board chairman Dick Hedstrom says he regrets never facing Reno head-on and demanding accountability. He blames himself and other board members for bing insufficiently strong willed to force the powerful woman to comply with their demands. “We should have kept after her,” he says. “What we should have done is fired her.” It was Hedstrom, not Reno, however, who lost his job with North County Health Services. The process that ended in Hedstrom’s departure was a peculiar one. At the April 1987 meeting of the corporation’s general membership, Hedstrom won re-election to the board by a five-vote margin of the thirty members present. Following the general election, the board of directors re-elected him as board chairman over Charles Marsh, a Reno partisan who had been suggested by the nominating committee. But Hedstrom was not to savor his victory for long.

Hedstrom believes that Reno went to work quickly to undermine him. He says that when all of the ballots were counted, two of the thirty were missing. However, because his margin of victory was five votes, the outcome of the election could not be changed by the missing ballots. As far as he was concerned, it was no big deal. According to Hedstrom, Reno, however, was said to have considered the missing ballots crucial. The corporation’s attorney agreed. In a conference call to the four-member executive committee, the attorney warned that the corporation could be taken to court over alleged election irregularities. As a consequence, the executive committee agreed to a second election, even though the proposed mail-in balloting was not provided for in the corporation’s by-laws.

In the meantime, Hedstrom contends, Dorothy Reno mounted an active campaign against him with the membership. “She told people that if I remained on the board, I was going to ruin the corporation,” he says. “She wanted to get rid of me ” When the results of the second election were announced, Hedstrom received only eight votes. Thirty corporate members voted against him. Shortly thereafter, Charles Marsh was named board chairman.

Reno says she did nothing to encourage members to oust Hedstrom and that the second election was not her idea. “I’m sorry he feels that way,” she says. “I didn’t have anything to do with that. That’s not something I have any influence over, but I’m sure it was a disappointment to him. It was an executive committee decision to hold a second election to ensure the validity of the process.”

Hedstrom, however, is convinced otherwise. “If Dorothy Reno pats you on the back,” he says, “you better look and make sure there’s not a knife in it.”

Charles Maletz, M.D. swivels in his chair behind a desk in his office at Cassidy Medical Arts in Vista, gesturing to a wall of plaques, citations, and degrees before him. “My record is impeccable,” he says. “Yet this woman impugns my integrity and judgment.” Maletz is referring, of course, to Dorothy Reno, his erstwhile boss and long-time tormentor. He is particularly bitter about a final assessment of him inserted into his personnel file at North County Health Services. The rating, he says, was not even signed by his immediate supervisor. In category after category, he is rated “unsatisfactory” or “needs improvement.” The evaluation, which he was never given an opportunity to rebut, reported he “had a major problem with understanding his role at North County Health Services.” He is said to be unable to “take appropriate supervision to correct this misconception.” It is dated February 28, 1986 — the day he was fired as a North County Health Services physician.

Maletz is cynical. After his dismissal, he sought assistance from a whole range of county, state, and federal authorities, without results. In April of 1986, he spoke to U.S. Senator Pete Wilson and told the senator of his problems with Reno and North County Health Services. Wilson told him to contact one of his aides, and Maletz followed up in writing.

Maletz had a big problem. After graduating from UCLA in 1978, he entered Harvard Medical School. Two years later. he accepted a $32,000 scholarship under the auspices of the National Health Service Corps, a federal agency that attempts to distribute physicians to underserved areas. In exchange for his agreement to serve in such an area after medical school, the National Health Service Corps agreed to help pay for his medical education. However, the agreement also stipulated that should Maletz renege on his obligation, he would become liable for triple the amount of his scholarship, plus interest. At the time he wrote to Wilson, as a consequence of being fired by North County Health Services, he was in imminent danger of having federal authorities demand more than $140,000 from him.

For three months following his dismissal, Maletz worked as medical director at the Vista Community Clinic, where he hoped his scholarship obligations would be fulfilled. In the meantime, he wrote similar letters to congressmen Ron Packard and Bill Lowery, as well as then-Fifth District Supervisor Paul Eckert. But Maletz says no one in public officialdom came to his assistance. He soon took a job with El Progreso del Desierto in the Coachella Valley, which federal authorities agreed was appropriate for fulfillment of his obligation, and served there for eighteen months. A certificate of appreciation from the clinic is among the many kudos on his wall. Maletz’s solid appraisal of himself and the reaction of other clinic administrators is confirmed by Barbara Mannino, executive director of the Vista Community Clinic, where Maletz took refuge immediately after his dismissal. Regardless of what Reno may say, says Mannino, “[Maletz] is one of the best doctors I have ever worked with.”

Maletz also took his complaints to the North County Health Services Board of Directors but received no response whatsoever. In a letter to the board, Maletz alleged specific wrongdoings by Reno; he said he suspected that she refused to remove “dilapidated and obsolete electronic equipment” from the Santa Ysabel Clinic because she wanted to be able to claim “video relay capabilities” for grant applications. He told the board that practices at the San Marcos and Ramona clinics violated state laws that bar nurses from diagnosing illnesses and prescribing medicines. He complained that physicians were being wound into an ever-enlarging ball of red tape that wasted their talents. And he told them he had been fired a week after telling the federal auditor that there were serious problems with North County Health Services’ delivery of medical care in Santa Ysabel.

Insiders on the board of directors say Reno’s reaction to the Maletz accusations was to belittle his letter by pointing out spelling and grammatical errors. “She said he was unstable,” says one board member, who spoke on the condition of anonymity.

Maletz was not the only former North County Health Services physician, however, who wrote to the board. Dr. Judy Goldstein of Children’s Hospital and Health Center also wrote. She had worked as a North County Health Services physician between 1975 and 1979, before she felt compelled to resign. In her own letter, Goldstein also made serious allegations. She said she was forced to “rubber stamp” a policy of giving a certain kind of infant formula to women participating in a state-sponsored nutrition program, even though she had objections for medical reasons. Goldstein said she was similarly compelled to approve general immunizations for swine flu, again contrary to her medical judgment. “I was informal that the free flu shots were an important public relations move and would proceed despite my doubts,” she wrote. Goldstein also complained that she was accused of being “elitist” when she refused to sign the charts of nurse practitioners “whom I had never met.” She said that Reno once threatened to fire physicians who met together to discuss a patient’s death at the Ramona Clinic.

Reno reacted to Goldstein’s letter by contacting her superior at Children’s Hospital, Dr. David Chadwick, to complain that Goldstein had written her letter on Children’s Hospital stationery. Chadwick himself wrote a letter to the board disassociating himself and Children’s Hospital from Goldstein’s remarks. There followed an apologetic letter from Goldstein, who said, “I typed the letter on Children’s Hospital letterhead without thinking.”

Another physician who had difficulties with Reno took a different route with her complaints: she filed a lawsuit. In March of 1986, Dr. Margaret McCahill filed a complaint for breach of contract in Vista Superior Court. Like Maletz, she too was a National Health Services Corps physician. But unlike Maletz, McCahill quit and the government was after her to pay up on loans she received while attending the University of Maryland School of Medicine. She contended that the only reason she was in default was her refusal to engage in unprofessional conduct while at North County Health Services.

McCahill alleges in the lawsuit that, in October 1983, a state inspector warned her during an inspection at the San Marcos clinic of NCHS she could forfeit her license to practice medicine in California because of clinic practices. Nonphysician staff, alleged McCahill, was prescribing and dispensing medications without her knowledge or consent. She contended in the suit that her attempts to rectify the problem “were rejected or ignored by the executive director of the clinic, Dorothy Reno, despite many meetings and specific written requests.” McCahill’s lawsuit was settled before trial. Neither side will reveal the exact outcome. “The lawsuit was settled for the payment of some consideration” is all McCahill’s attorney would say for the record.

In an interview, Reno dismissed the complaints of the physicians who attacked her as the results of simple labor-management disputes. “Whenever you’re in a business where you have to make decisions,” she says, “you’re not going to please everyone all the time. Anytime you are working in medical care and you are delivering the kinds of health services we are, you are going to have some physicians who don’t fit in.”

According to Dr. William Norcross, associate clinical professor of medicine and director of residency training in family medicine at UCSD, almost every physician who ever worked for Dorothy Reno did not fit in. Norcross says his experiences with Reno eleven years ago at the Ramona Clinic caused UCSD’s Department of Family Medicine to sever relations with North County Health Services.

Norcross says his trouble with Reno began when he was a young doctor just out of UCSD’s family medicine program and worked for Reno at the North County Health Services clinic in Ramona. “She was advertising the facility as being open twenty-four hours a day, seven days a week,” recalls Norcross. “You could come in there anytime for your medical problems.” The problem, he says, was that there was not always a doctor on duty. "One night a young asthmatic — a male — came into the clinic in acute respiratory distress,” says Norcross. “He was in big-time trouble and looking for medical care. All that was there was an LVN, and she didn’t know what to do. She didn’t even know where to find the medication. The guy died.” Following the death, which occurred in 1977, says Norcross, clinic staff began to meet together in an attempt to come up with a way to persuade Reno to change staffing patterns. “It was almost like a James Bond movie,” he says. “We all met up there late one night. We were about two hours into the meeting when we hear this loud beep go off. We looked in between some books and papers in the room and found that a tape recorder had been planted there. I am absolutely sure Dorothy was behind that. We couldn’t prove it was Dorothy, but who else could it have been? The KGB? The FBI?”

Norcross says medical professionals at the Ramona clinic had to plead with Reno in order to get a “crash cart” for the nighttime hours — a cart that has emergency cardio-pulmonary resuscitation equipment and various drugs and tools prearranged to be at a physician’s fingertips in a medical crisis. He insists that none of the requests of Reno by physicians were oppressive.

Norcross says that he, like Maletz, invoked Reno’s ire by pointing out problems to a health official visiting the Ramona clinic from Washington, D.C. As he, Reno, and the bureaucrat toured the clinic, Reno picked up an X-ray as an example of the clinic’s work. Norcross says when he saw the X-ray, he couldn’t contain his consternation. “It was an X-ray of a one-year-old child that had X-rayed the child’s entire body — the head, the feet, the arms — the whole thing was on this film,” he says. “I was aghast that this kid’s entire bone marrow was being irradiated just for a chest X-ray.”

Although he is sympathetic to the plight of Dr. Maletz, Norcross says the young doctor has only himself to blame because Norcross warned him not to go to work for Reno or North County Health Services. “I told him this was going to happen to him,” Norcross recalls. “I said, ‘You don’t want to go there. She’s going to chop your weenie off. You are going to be really unhappy.’ ”

Dorothy Reno is unquestionably a remarkable woman. After-taking ten years to obtain an undergraduate degree in science from San Diego State University, she accepted her first job in 1969 at the age of thirty-eight as a representative for the American Cancer Society in Vista. Since then she has parlayed intelligence, resolve, and personality into one of the largest health-care organizations in San Diego County. Last year more than38,000 patients passed through the thresholds of North County Health Services’ seven affiliate clinics. The corporation today operates clinics in Encinitas, Clairemont, San Marcos, Valley Center, Ramona, Santa Ysabel, and Oceanside (the Oceanside Clinic is administered by the corporation’s County Medical Services contractor — Northeast San Diego Health Plan). The corporation employs about 175 people.

For each of the last fifteen years, largely through the efforts of Dorothy Reno, more than a million dollars in federal money has found its way to North County. That’s a long way from the $166,000 planning grant that she and others had to fight for in 1971, when the federal Office of Economic Opportunity nearly deleted the North County Health Project from a grant request by the Department of Community Medicine at UCSD.

“When it got back to Washington, they immediately just redlined it out,” says Reno. But she did not surrender so easily. “We sent letters. We made telephone calls to Washington. We sent telegrams.” As a consequence, she says, OEO officials sent two representatives to North County to investigate. “They were impressed enough that they went back and wrote us back in for the planning grant.” The following year, the project survived another narrow miss with federal budget cutters. Just twenty-four hours before the Nixon Administration axed OEO altogether, the North County Health Project and the San Ysidro Health Center won approval of plans transferring them to the Department of Health, Education, and Welfare. Both programs survive today.

Reno is very comfortable chatting about grants, bureaucrats, and monies. She points out that North County Health Services was recognized in 1986 as the outstanding rural health care practice in America by the National Rural Health Care Association. North County Health Services was nominated for the award by a federal official in San Francisco.

But when the interview turns to controversy in her clinic system, Reno begins to fidget and pause. The interview took place over lunch at a pizza parlor in Claire-mont, not far from the Clairemont Clinic operated by North County Health Services. When it came to trouble in the lost provinces of her empire, she did not want to get very specific. She hinted that anyone who has criticized her has a hidden agenda. “It is not something people would normally do” she said.

She will not discuss the Maletz firing because “that’s private information.” She remembers reading the Dr. Judy Goldstein’s letter to the North County Services board of directors but “thought the letter was very confusing.” The lawsuit that Dr. Margaret McCahill filed “is something that was settled a long time ago,” and the doctor’s allegations were not true. North County Health Services “had a small site in Borrego Springs that we had to drop from the system because that is no longer considered a medically underserved area.” As the interviewer probes for specifics, Reno’s hostility grows. “I do not make policy decisions,” she says. “Those are made by the board of directors. It is simply my job to carry out the day-to-day duties and to ensure that we comply with regulations.”

The way Reno tells it, the only real problem she has administering the seven North County Health Services clinics is finding the money to operate them. In the last year alone, she says, patients have increased forty percent, while funding from government sources has steadily diminished. The last few years have been tough ones for those whose businesses depend on government subsidies. Reno spends much of her time these days negotiating with bureaucrats over how much of the taxpayers’ pie North County Health Services will get. She wonders what the last few years of budget-cutting tell us about ourselves. “What’s the social conscience of this country? What’s the social conscience of the state? What’s the social conscience of our county? What are we going to do? What level of service are we going to provide to people? Those aren’t answers I can give you. I don’t make those kinds of decisions.”

To hear Reno tell it, she makes no decisions herself. Her board makes decisions. The government makes decisions. She merely implements them. But Reno did make a decision when she started her career. It was a very personal decision that seems since to have expanded into a variety of social philosophy, a view of the world that might help explain her attitude toward physicians. “I have three children with genetic immunological disorders,” she says. “I have experienced a great deal of frustration as a parent in trying to obtain services for those children. I experienced the effects on the family when the medical profession is not particularly sensitive to the challenges of a family obtaining medical care in cases like this. I know what it’s like not to have enough money to buy the kind of care your children need.”

Things surely are not so tough for her family today. She makes a good salary as executive director of North County Health Services, although she says it is not “good” by community standards. Reno refused to discuss her salary during the interview. How much does she make? “I don’t know,” she says. “I would have to look at my paycheck. I don’t pay much attention to it.” Reno did, however, pay attention to it when her board of directors was clamoring for financial information two years ago. Sections of those documents that revealed her salary and the salaries of other top professionals at North County Health Services were blacked out. Even her board, which was supposed to set her salary, was in the dark.

Some of Reno’s most strident critics are those who operate clinics not part of her system. They say she has refused to cooperate with them in joint endeavors that would help poor people in their communities, opting instead to pursue the single-minded goal of expanding and enriching North County Health Services. But few are willing to speak publicly about Reno. One person who did speak publicly is Gabriel Arce, chief executive officer of the San Ysidro Health Center. Arce’s career and the growth of his agency parallels that of Reno’s. Both began at the same time from a small federal grant. Both have grown much larger. Both administer contracts for County Medical Services. But the differences between the two organizations are more instructive than their similarities.

In his seventeen years at the helm of the San Ysidro Health Center, Arce has found it necessary to get rid of a physician only once. His agency is called “a model” by Norcross and enjoys excellent relations with UCSD. One of the UCSD provosts sits on Arce’s board. The San Ysidro Health Center is an active member of the Council of Community Clinics, a countywide alliance of nonprofit primary health-care providers. North County Health Services is not. “(Reno) has been a friend for many, many years,” says Arce, reluctant to criticize. ‘‘But we work in teams with other agencies. She does a lot by herself. She devotes almost one hundred percent of her time and effort to her program.”

Arce says he has noticed something about Reno that many of his other colleagues have also noted. “We like the team approach,” he says. “She likes a different approach!’

Reno seems unaware that there are people in the world who are threatened and frightened by her. She does not understand why that should be. “If anyone is afraid of me,” she says, “it would have to be something they conjured up in their own mind. Anyone who knows me very well would not be afraid of me.”