Ruth Rothstein came to Chicago in 1950 as a union organizer but spent most of the rest of her life reviving area hospitals and working to improve the health system in Cook County.

Known for her tough, no-nonsense exterior and deep caring for the poor and ill, Mrs. Rothstein became an influential leader in health care despite never having gone to college. She was CEO of Mount Sinai Hospital for 25 years and ran the Cook County Bureau of Health Services until 2004.

Mrs. Rothstein, 90, died Sunday, Aug. 4, 2013.

“Ruth was a pioneer,” said Cook County Board President Toni Preckwinkle, who was a close friend of Mrs. Rothstein’s. “She was a lifelong believer that quality health care is a right for all residents. … Countless individuals – many without ever knowing her name – have benefited and will benefit from Ruth’s advocacy and leadership.”

Mrs. Rothstein’s improbable rise through the health system began in the 1950s, when she started training with a friend who was a lab technician at a union HMO. She then took a job in the laboratory at Jackson Park Hospital on the South Side. There, she used her union experience working with people to persuade the hospital to open a personnel office and name her the director.

In the 1960s, she applied for a job at Mount Sinai Hospital, but the director turned her down and suggested that she consider a secretary position instead. Mrs. Rothstein declined the offer. “I don’t type,” she said she told the director, in a 2003 interview with the Tribune.

Five years later, she was running the West Side hospital. As CEO, she led Mount Sinai through an economic crisis and helped to integrate the hospital into the community.

Mrs. Rothstein transformed Mount Sinai into “both a pillar of the local community and a bridge between our community and the Latino and African-American communities,” Jewish United Fund leaders David T. Brown and Steven B. Nasatir said in a statement.

“I think she was very proud of the fact that she was able to preserve that institution, which had a Jewish identity, as a force for positive change on the West Side,” Jonathan Rothstein said.

After retiring from Mount Sinai, Mrs. Rothstein, then in her late 60s, became the first chief of the Cook County Bureau of Health Services, where she revived the troubled county hospital and established 30 neighborhood outpatient clinics.

“Hers is a story of commitment, perseverance and utter determination,” Dr. Ram Raju, CEO of Cook County Health & Hospitals System, said in a statement. “Every path she paved was guided by her belief that access to quality health care was a fundamental human right.”

Mrs. Rothstein also presided over the creation of the Centro CORE Ruth M. Rothstein, a clinic that uses a “one-stop-shopping” model to offer high-quality care to people with infectious diseases.

Friends and colleagues remember Mrs. Rothstein as a visionary and pioneer who was always working to improve conditions for the needy and underserved.

“Every meeting with her was a negotiation,” said Cook County Commissioner Larry Suffredin. “She had a goal of what she wanted to accomplish. She always had an idea of what we needed to be doing next. She never accepted the status quo.”

She was driven to “make the world a better place, not for the money and not for the fame, but just because it was the right thing to do,” her son said.

Her achievements did not go unnoticed. While high school was the highest formal education she achieved, Mrs. Rothstein’s real-world experience earned her honorary degrees from Kenyon College, Rush University and Rosalind Franklin University of Medicine and Science, where she served on the board of trustees until her death.

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If you would like to honor Mrs. Rothstein’s commitment to provide quality health care services for persons living with HIV/AIDS in Chicago, you can make an online donation, or donate by mail or telephone to The CORE Foundation, 2020 W. Harrison St., Suite 2-200, Chicago, IL 60612, (312) 572-4764.