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Immigration See other Immigration Articles Title: La Clinica remedies pains La Clinica remedies pains This story was published Monday, May 2nd, 2005 One month ago, when Francisco Castillon arrived at La Clinica in Pasco as its interim chief executive officer, the community health center was in a world of hurt. Months of turmoil and bickering among staff, the administration, the physicians, nurses and medical assistants and community members had left widespread distrust, tenuous decision-making by a leaderless management team and a board overwhelmed by turnover of its own membership. La Clinica had come under the scrutiny of federal health officials late in 2004 after complaints about the former chief executive officer John Troidl and former board president Greg Garcia. Both men left their positions last fall. Castillon has proved to be a paladin and a healer. He has the board's full authority to make tough personnel decisions but also the responsibility for restoring the trust lost between the various interests. Two labor unionizing efforts, a demoralized management team, a medical staff that is demanding more say in clinic operations, confused patients and several vacancies in key top level positions await Castillon's attention. He is a consultant with 25 years experience in rural and migrant health care issues and a degree in public affairs and a master's in health administration. He grew up in a migrant agricultural worker family and is bilingual in Spanish and English. Castillon, who in from Sacramento, was executive director of the California Health Federation for 10 years. While in that state, he was active in drafting health care legislation that benefited rural and migrant clinics. "We look forward to Francisco's coming and having input. We expect there will be changes," said Teddie Mahaffey, director of operations, after his arrival in late March. She was right. One of the first things Castillon did was open the door to his office, and he insisted others in the La Clinica administration do the same. Where only months earlier there had been pervasive secrecy between the employees and executive managers, two-way communication now is encouraged. Castillon has been meeting with board members almost nightly to involve them in his strategies for reviving -- almost reinventing -- the clinic. He's also met with staff members individually and in groups. Two major changes in the executive management team also have occurred. Dr. Jim Arthurs, who was hired by Troidl 18 months ago as medical services director, and George Thomas, the clinical services director for the past year, have been reassigned. Arthurs now is seeing patients at La Clinica's Kennewick office, and Thomas is no longer supervising nurses but has new duties in risk management, grant writing, oversight of the dental programs and is the health information confidentiality compliance officer. Before choosing someone to step into Arthur's former job and be interim medical services director, Castillon sought input from La Clinica's doctors, nurses and physician assistants. He ended up picking Dr. Eduardo Vides. Ironically, Vides was one of the rebel doctors who led the charge to oust Troidl last summer. Troidl retaliated by firing Vides and two other internal medicine physicians, but public outcry convinced the board to reinstate them. As a health care management consultant, Castillon seems to specialize in nursing troubled clinics back to health. Before coming to Pasco, he provided interim management services for the San Benito Health Foundation in Hollister, Calif., and guided the board in hiring a permanent chief executive officer. He also did some administrative services for the Alviso Health Center in San Jose, Calif., in the 1990s. One of his toughest assignments was in 1993 at the El Progresso del Desierto clinic in the Riverside County, Calif., community of Coachella. Several employees, including the executive director, had been fired during a political maelstrom involving the board president. He was only partially successful. "That was very difficult. I brought a season of healing, but eventually that clinic lost its grant because of all the troubles," he said. Castillon intends to leave nothing unexamined at La Clinica. "We have to shift a lot of paradigms around here. I'll look at everything," he said. "I want to assess strengths and weaknesses." Before he leaves sometime in late summer, Castillon will have helped the board hire his replacement and find people for the executive management team, including a medical director, clinical services director and human resources director. He also is considering a top-end restructuring. Some positions may be redefined or combined with others to streamline the administration, Castillon said. Board members like what they see. "I think we're in a positive mode," said board vice president Jon Lindeman. "Francisco is taking decisive steps. I'm optimistic, but it is going to take a while." Lindeman said the clinic had problems before Troidl came, but even more when he left. "He did more damage than help. He almost broke us down." But the board learned hard lessons, and La Clinica is on the mend, Lindeman added. "We have to make sure we have the right people in the right positions with the right pay," he said. Castillon said filling the CEO position is one of what he calls "four bigees" that have to be resolved before he can feel like he's finished his assignment. The three other top concerns are reorganizing the executive management team, preparing La Clinica staff to work in a union labor environment, and finding a way to coexist with the Yakima Valley Farmworkers Clinic, which has announced plans to establish a center in the Tri-Cities. The administrative reorganization is well under way with the reassignment of Arthurs and Thomas. One of the two labor unionizing efforts last summer at La Clinica was successful. The Office and Professional Employees International Union Local 8, representing the nonmedical staff, was certified last week. Castillon promised to recognize, respect and work with the union. The other unionizing effort by United Staff Nurses Union Local 141, which is for doctors, nurses, nurse practitioners and physician assistants, is on appeal awaiting certification from the National Labor Relations Board. Brisa Guajardo, board president, said establishing a mutually acceptable working relationship with the Yakima Valley Farmworkers Clinic is a high priority. Her concern upon hearing of the Yakima clinic's plans was that competition is the last thing La Clinica needs as it tries to repair itself. Castillon said he has met with Yakima clinic executive director Carlos Olivares, who has agreed to slow the process so La Clinica can have time to get back up to prior operational levels. There also is the possibility of a partnership and a sharing of services, Castillon said. Guajardo said Castillon has helped the 11-member La Clinica board, seven of whom have less than six months experience, refocus. "We are all taking more responsibility, working harder and are actively engaged. It's a lot more clear to us now as to what our responsibilities are," said Guajardo, who joined the board in 2002 and became president last fall. "It's been a huge learning curve, and I've grown a lot," she said. Castillon lives his job. His days run early to late, often 14 hours or more. He hasn't been back home to his family in Sacramento for five weeks, and doesn't plan to until Mother's Day. "This my passion," he said. "I really enjoy getting involved to help this organization back on its feet. This is crisis intervention. I'm trying to bring leadership and accountability and we are working on communications." He added, "It's been a lot of fricking hard work. And prayer, too, morning and night because I'm a spiritual person." Minnie Pesina, one of the newest board members and a community member who picketed the clinic during Troidl's tenure, said the administrators' open doors and improved staff morale show positive change. "(Castillon) seems like a real team player who will be able to work well with us and I am really impressed with the caliber of people we have on the board now," Pesina said. Mel Gochioco, a certified physician's assistant, said morale and patient care have improved with Castillon, "but we still have a ways to go." All the past hubbub and internal changes being brought by Castillon are of less interest to Mayra Aguilar. What matters to the Pasco woman is that La Clinica will be there when she and her family need it. "We come here because they are one of the few places that will accept medical coupons," Aguilar said Monday after a medical visit with her friend and friend's baby. "They are very nice here." All paid for with YOUR tax dollars, so that the illegal aliens can send more of their American dollars home to Mexico.
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