Peñalver said Gold Coast’s financial failure at the Little Havana clinic was “predictable” because the facility’s primary purpose is to serve those who are able to pay little or nothing for care.

Gino Santorio, Jackson’s new vice president of ambulatory care, said that during the last year Jackson was at the Little Havana clinic, the system lost about $1.7 million on its operations there.

Jackson executives know from direct experience that primary care clinics are money-losers for the system — $34.6 million in fiscal year 2010-11, according to the audited report. While the system was hemorrhaging money from 2009 through 2011 — losing $419 million in three years — Jackson cut back on primary care, including closing two clinics.

Santorio said services are improving at Reaves. He said 20 percent more patients have been seen in the past three months and the average time for a patient from walking in the door to leaving the clinic is now three hours, one minute — down from four hours, 17 minutes.

What’s more, Jackson recently received a $4.7 million grant from the Centers for Medicare and Medicaid Services, and about $2.4 million of that would go into improved operations at Jefferson Reaves.

One of Darryl Reaves’ main complaints was that Jackson expected patients to go to Jackson Memorial Hospital to visit the pharmacy or obtain X-rays and sonograms — a major inconvenience for the many poor residents who do not have cars.

Jackson’s Santorio noted that the main campus is only 1.2 miles from the clinic, and Jackson provides 10 to 15 van trips a day between the facilities. Miami trolleys also connect the buildings.

Reaves also complains that patients are slowed down because the clinic is a teaching facility for a family-practice residency program, and the residents have to consult frequently with the attending faculty of the University of Miami.

Robert Schwartz, head of UM’s family-practice program, said the Overtown patients often have complicated cases including diabetes, congestive heart failure, kidney problems and chronic high blood pressure.

UM’s presence means better care for Overtown residents, Schwartz said, because of additional programs that the medical school brings, including a $1 million annual gift from the United Health Foundation for an innovative program to provide care for diabetics.

During the past year, Jackson executives have been meeting with Darryl Reaves and his board to discuss problems. Reaves said he was never satisfied, and the board voted to seek an outside provider to replace Jackson and UM.

That’s when Lillian Rivera stepped in to say the board did not have the power to do that. Rivera is the administrator of the Miami-Dade County Health Department, which despite its name is part of the state health agency. The Peñalver and Reaves clinics sit on City of Miami land, but the buildings were built with state funds, and Rivera’s department retains administrative responsibility.

“It’s in the best interests for our community to remain partners with Jackson,” Rivera told The Miami Herald, because the partnership creates a continuity of care, from clinic to hospital. The Affordable Care Act emphasizes integrated care organizations as a way to avoid duplicated tests and reduce other healthcare costs.

Rivera said she had permitted Peñalver to seek an outside provider in 2011 because Jackson was struggling and not showing much interest in primary care. But she said that she had recently seen a “tremendous improvement” in Jackson’s behavior toward the clinics.