Doctors who abused doctors get off scot-free

By Marshall Allen (contact)

Saturday, Dec. 15, 2007 | 6 a.m.

State health officials Friday proposed better oversight of a program that allows foreign doctors to work in medically needy parts of Nevada.

But they showed no willingness to investigate past violations of the government program or to take enforcement action against Las Vegas doctors who violated its terms by exploiting, overworking and cheating the foreign physicians.

“We’ve heard things have happened, it’s been brought to our attention, but really we want to look ahead and learn from our past,” said Rhonda Smoot, program manager of the health division’s Primary Care Development Center.

Judy Wright, chief of the division’s Family Health Services Bureau, said there is nothing that can be done about the past, but the system can be changed to prevent such abuses in the future.

At issue is how Nevada monitors the “J-1” visa waiver program, which allows foreign physicians to gain legal U.S. residency if they agree to work 40 hours a week for at least three years in underserved areas, including North Las Vegas and Pahrump, after completing their medical residency programs in this country. The doctors can accomplish that goal by working for doctors who operate clinics in those areas.

State officials are reforming the program after a Las Vegas Sun investigation found employers have been systematically gaming the program for their own benefit over the past decade.

Dozens of J-1 doctors told the Sun that their employers either cheated them financially, diverted them from the underserved patients they’re supposed to treat or worked them more than 80 hours a week, which research shows increases medical errors. The foreign physicians said they felt compelled to bend to their bosses’ demands for fear of losing their jobs.

Sen. Majority Leader Harry Reid, D-Nev., and Sen. Kent Conrad, D-N.D., have called for the Homeland Security Department, which oversees immigration, to investigate the problems.

Nevada State Health Division officials responded swiftly to the Sun’s stories, which were published in late September. Friday’s meeting included about 50 people — representatives of the medical board, doctors associations and employers of the foreign doctors — connected via teleconference in Carson City, Elko and Las Vegas.

The forum was led by health division officials, who referred only vaguely to employers who profited by exploiting doctors and disregarding federal laws and state guidelines.

Had state officials decided to be more aggressive, employers who violated regulations could have been cut off from hiring foreign doctors or reported to federal enforcement agencies.

Instead, discussion on Friday was focused on how to fix the system.

The proposed changes include:

• Requiring the foreign doctors’ contracted salaries be set at the prevailing rate, the amount a similarly skilled American doctor would be paid. Any changes to the contracts — some J-1 doctors said their agreements were switched against their will — would have to be submitted in writing to the health division.
• Mandating that employers maintain records showing the J-1 doctor is in the clinic for at least 40 hours a week, including 32 hours of time seeing patients and eight hours for related administrative tasks.
• Banning noncompete clauses, which would bring Nevada in line with federal guidelines. One Las Vegas employer’s noncompete clause has prohibited J-1 doctors from seeing patients at any hospital in Clark County where they had privileges while working with the employer.

Other changes could include adding a one-time $750 fee per physician application to fund trips to visit clinics to monitor compliance with the rules. The J-1 visa waiver program has never been funded by the federal government.

Dr. Carl Heard, medical director and interim CEO of Nevada Health Centers, a nonprofit organization that runs rural health clinics throughout Nevada, said the meeting showed a “healthy response” by state officials to the Sun’s revelations. The proposed changes will not be a problem for employers who have been following guidelines, Heard said.

Although it’s a positive step for the state to shore up the program and improve oversight, Heard said it’s also important to provide enforcement when employers violate the regulations.

“I don’t see any evidence that any teeth are being bared,” Heard said.

Wright and Smoot said they will enforce violations that are discovered by the more rigorous oversight.

Because under the program’s guidelines J-1 doctors may be reported to the U.S. State Department if they break the rules, state officials said they should also report any violations by employers so J-1 doctors can be reassigned to new bosses. Employers caught violating regulations will not be allowed to hire doctors and may be reported to federal enforcement agencies, they said.