In the early 1970s, Beverly Finley was living in Nigeria and coaching tennis at the University of Ife when she realized her calling. "There was a group of doctors who worked in the village where we lived," Finley said. "The doctors traveled by ship, sailing to countries to provide medical care to the needy."

Though passionate about their work, the doctors were constantly short of money and supplies.

"The doctors were educated and trained to be physicians," Finley said. "It was not part of their training to be administrators. Trying to handle both responsibilities took away from patient care.

"That's when I realized the need for leadership. I became aware of how good management could aid in the provision of patient care."

Two decades and countless miles later, Finley is managing the Stanislaus County Health Services Agency -- responsible for health issues affecting the county's 415,000 residents.

She oversees a system that treats the county's most needy: children of desperately poor and immigrant families; homeless people; people out of work or disabled; folks who work full time, but can't afford to join their employer's insurance plan or don't have one available. And people caught in drug or alcohol dependency.

They all need medical care; it is Finley's job to see they get it.

How and where it is handled is another matter.

The delivery of medical care has changed radically since November when Doctors Medical Center of Modesto took over emergency treatment of the county's poor from Stanislaus Medical Center -- leaving the county without its own hospital for the first time in 106 years. Finley guided the county through the transition.

"She remained enthused about the future while closing a chapter to the past," said Reagan Wilson, Stanislaus County's chief executive officer. "She helped create a larger, more ambitious county health system, a system that put (clinics) where people lived and placed more resources into disease prevention."

Finley and other county officials negotiated with Doctors to provide emergency care and in-patient treatment for residents receiving Medi-Cal and those without insurance.

It's too soon to judge, but Finley is confident the medical needs of the county's poor are being served.

"She has a passion for achieving excellence, for herself and everyone around her," said Cleopathia Moore, director of the county's Maternal Child Adolescent program. "She doesn't have a need to be recognized, but a need to make a difference.

"She's also a great rebounder."

That became evident when Finley learned she would lose the battle to keep Stanislaus Medical Center open.

"She stood for what she thought was right," Moore said. "When it was defeated, she may have been hurt, but she rebounded. She was able to lead us in other directions.

"She was able to look at the whole managed-care scheme and figure out how (the county) could be players."

Finely visits Doctors four or five times a month and works with its staff.

Despite an extraordinary flu season last winter that inundated Doctors and hospitals throughout the state, "the transition has gone better than expected," Finley said.

Stanislaus Medical Center was a big part of her life. It still is. Her office and meeting rooms are in the former hospital building.

Outside her office door is the huge, teal circular sign with the initials "SMC" that once hung near the hospital's roof.

When asked about the hospital's closure, she states the facts, talks about process: It was a sad time; the employees were like family.

But she doesn't wallow.

"My philosophy has always been either you support what the decision is after being honest and stating your opinion -- either you support it, or you have an obligation to leave. You can't look back on those kinds of things."

Like any high-profile executive, Bev Finley can play it close to the vest. She would fit into any corporate boardroom. She's well-put together: a stylish short cut for her blond hair, nails neatly manicured. Her voice is soft. She uses the same even intonation when speaking to the Board of Supervisors that she uses when talking to friends on the golf course.

And some things about her life remain private. Such as her age: "Numbers aren't important," she said. "Let's just say that I'm mature."

County system expanded

Wilson met Finley two decades ago when both were interns in county government offices.

"We were just kids then, and we carried all the energy and ideology of youth," Wilson said. "Twenty-five years later, Bev still carries that ideology."

It's Finley who has emphasized quality care for the underprivileged, Wilson said. "She's made access more generous here than in other communities."

Since she took over in 1990, the Health Services Agency's operating budget has doubled from $40 million to $80 million. The county has gone from one outpatient clinic to six.

"Eight years ago, we were seeing maybe 45,000 or 50,000 patients in the clinics," Wilson said. "Today, it's in excess of 200,000 a year. When you think about access, you can see the impact she's made."

Consumed by passions

It's a typical day: A morning meeting with 10 senior managers; a lecture and lunch at her alma mater, California State University, Stanislaus; a ground-breaking ceremony for a new outpatient clinic in Hughson; an evening meeting with the west Modesto health collaborative.

"I get here at 7:30 a.m. and many times she's here before me," said assistant Jan Roberts.

Finley has an open-door policy.

"That's one of the reasons 12-and 13-hour days are typical for her," said Peter Finley, her husband and an administrator and professor at Stanislaus State. "Anyone who wants to talk to her can. That's just part of her personality."

Because work demands so much, she prizes personal moments. The home she shares with Peter and two silky terriers reflects things dear to them: family, travel, music, literature.

Pictures of their three grown sons -- Hagen, Scott and Cameron and their wives and children -- are displayed throughout the tri-level townhouse in Modesto. A corner in the living room is stacked with toys and books, fun things for grandchildren.

Art, sculptures, and tapestries from around the world fill walls, mantels and shelves in every room. Each piece is connected to a memory.

One of their favorites is a bronze Ife warrior, purchased three days into their Nigeria experience.

"Bartering is a part of life there. We were negotiating with the peddler and literally bought it with the shirt off Peter's back," said Bev Finley, laughing. "It was a 'Hang 10' T-shirt. We gave him the shirt and 10 naira (about $15)."

The Finleys register places they've visited on a map in their upstairs sitting room. Push-pins are stuck in India, Italy, China, Ghana, Egypt and Mexico, to name a few. No pins in South America, yet. But it's on the list.

They approach travel as they do work.

"We go hard," she said. "It's not about R&R. We're there to go, see and do. The purpose of life is a life of purpose."

Both are voracious readers. Their dogs are Aengus and Fergus, characters from poems by William Butler Yeats.

Work ethic

Finley's life began in the Pacific Northwest. She was born and raised in Bellingham, Wash., a lush, green city on Puget Sound north of Seattle. Her father, Clyde Griffin, was a longshoreman; her mother, Gertrude, a homemaker.

They instilled their work ethic in their two daughters.

"We didn't have anything given to us," said Finley. "You had to earn it."

Finley started playing piano at age 5. She continued to play until college, where initially she majored in music.

She realized early that education would open doors. She was an A student in high school, where she met Peter. He was 16, she 15. They were in the same physics class.

"It wasn't love at first sight," Finley said. "He probably noticed me first. I was one of two girls in the class."

Recalled Peter: "She was the nicest person I knew. She was smart. She helped me with my physics homework."

The couple married four years later in 1953, while students at the University of Washington. They couldn't afford tuition for both, so Bev took a job at the campus library.

"I'd bring home journals and periodicals and read," she said.

Hagen arrived in 1955, Scott in 1958 and Cameron in 1960.

"I remember times when we were broke and had to really sacrifice and stretch our dollars," Finley said. "Heaven forbid we needed to buy a new tire for the car."

After Peter earned his doctorate in 1970, he took a teaching job at a relatively new university in Turlock. The family moved to California, and it was Finley's turn to finish school. She changed her major to economics and graduated cum laude in 1973.

That year, both were offered teaching positions in southwest Nigeria at the University of Ife. The family moved to Africa, where Bev taught and coached tennis. She guided the men's and women's teams to the All-African University Games, where they won a silver medal.

By 1976, Bev Finley and sons had returned to the United States. Peter stayed behind to tie up loose ends. When she returned to Nigeria to accompany Peter on the trip home, violence erupted as a coup toppled the Nigerian government.

"Our neighbors told us to stay in the house, and they would take care of us," she said. A few days later, a friend drove the Finleys 100 miles to the airport in Lagos, telling them not to make eye contact with soldiers. They flew from Lagos to Kano, in northern Nigeria.

"Soldiers marched all the passengers off the plane atmachine-gun point," she said. "They questioned everyone before letting us back on the plane."

One passenger didn't heed the advice. "He looked at them, and gave them a wrong look and they took him off the plane," she said. "I don't know what happened to him.

"When the plane finally took off, everyone on board applauded. We were relieved. I've never been so scared."

More than fear lingered with Finley. Often, when she makes decisions that affect the poor of Stanislaus County, she thinks about Nigeria.

When duty called

Her experiences in Ife crystalized her career goals. After returning to California, Finley got a job at Stanislaus Medical Center, then Scenic General Hospital.

Her economics background and interest in health-care finances allowed her to foresee coming trends. She went back to Stanislaus State to earn a master's degree in public administration, juggling work, school and family.

Finley wanted to prove herself in private business. She left Scenic in 1983 to become executive director of the first outpatient surgical center in the county. Two years later she moved to Westworld Healthcare Resources, a hospital management company, then joined Emanuel Medical Center in Turlock in 1986 as senior vice president of administration.

After six years in the private sector, she knew change was coming.

As Finley learned to navigate the shoals of health care finance, there was a storm developing nationwide. The cost of traditional fee-for-service care was skyrocketing. A national debate raged.

Patients with no money and no insurance were flocking to hospital emergency rooms for non-critical conditions -- whether they could afford to pay the bills or not. Public hospitals, the last line of medical defense, were saddled with burgeoning costs.

Stanislaus Medical Center was one of them.

The hospital was picking up the cost for scores of patients who had no money. There were serious problems with billing and making sure patients qualified for dwindling state-funded reimbursement.

In 1989, the county formed a blue-ribbon committee to examine the hospital's future. Finley, now at Emanuel, was asked to serve.

After the committee's report was completed, Finley learned county officials had her in mind for another task: becoming the hospital's chief executive officer.

She was hesitant. She had heard the rumors, that the county hospital was doomed.

"I had a good job at Emanuel, and I wasn't looking to leave," she said. "I wasn't confident that I could do what was needed to be done. Given the trends, I wasn't sure it could be done.

"Given everything else, there was nothing to assure me that (the hospital) wouldn't close even if we were successful. I'd be stepping on a half submerged log, trying to make it float."

But she took the job.

"I could see there were solutions. Once I had a plan, I thought, 'Yeah, I want to try this.' "

Rough times ahead

Controversy erupted even before she accepted the position. Finley declined the county's initial $80,000 salary offer; she wanted $100,000. A group of doctors offered to pay the $20,000 difference. Some were critical, saying it could lead to a conflict of interest. County officials eventually met her price.

Meanwhile, the hospital's finances resembled a roller-coaster ride -- up one moment, down the next.

By 1993 it was apparent the hospital couldn't survive.

"We were making money but momentum was gaining on managed care," Finley said.

Doctors and hospitals were no longer being paid based on the care they provided. Reimbursement was based on the number of patients covered by a particular insurer they might see -- whether care is provided or not. Patients without insurance or money depend on the county to pay medical bills.

"You start applying those trends, and you begin to understand they will hurt you," Finley said.

In 1995, the hospital was making money. But Finley could see the future. As insured patients moved to private hospitals, the county would be left only with patients who could not pay.

"I started talking to staff, telling them that this time things were different. It wasn't based on anything we were or weren't doing. It was based on a whole new industry standard that was out of our control. Many, especially longtime employees, couldn't accept that the hospital would close."

But it did.

Looking to the future

On Nov. 30, 1997, a Sunday, Stanislaus Medical Center treated patients for the last time.

"We saw patients until midnight and had a potluck after," Finley said. "It was more of a wake. It was a very emotional day. A poignant day."

Finley tried not to cry in front of others.

"She doesn't accept defeat easily," said Cleopathia Moore. "She doesn't give up or give in. That drive enables her to keep motivating everyone around her."

While facing the inevitable, she and her top managers set up clinics throughout the county for checkups, immunizations, mental health services and other treatments. Health workers emphasized prevention.

She likes some things about managed care -- access to primary-care physicians, and getting care from sources outside the emergency rooms.

"It's also holding individual providers accountable in a way they haven't been before. There are good things about managed care, but it's certainly not where it needs to be," she said.

"Has it gone too far? Probably. But it's finding its way.

"I think there was a need for providers to get used to a different way of doing medicine. I know it's difficult to have so much of your authority taken away from you and I know physicians don't like that. But health care had to change. The old system was being abused by all of us."

In Stanislaus County, as in the the rest of the nation, the old way has all but disappeared. It's up to people like Finley to make the new system equitable and comprehensive.

"My role is to have a vision, give people the tools to make it happen, then get out of their way," she said. "I've been privileged to fill a leadership role and to serve my community."

She's still trying to solve the problems that first struck her in Nigeria: "I want to reach out into the community, to make health care available to everybody."

Reprinted by permission of Modesto Bee.