No big deal if we don’t strictly follow the law, says doctor who oversees physicians on visas

Friday, Oct. 5, 2007 | 7:30 a.m.

Three days after the Las Vegas Sun published stories highlighting how some employers abuse a system that's supposed to provide foreign doctors to medically underserved areas, the phone rang.

It was a former administrator at Summit Medical Group, one of the state's largest organizations of doctors, describing the way physicians required by the government to treat patients for 40 hours a week in North Las Vegas were being assigned instead to shifts in Las Vegas hospitals.

The Sun had already interviewed some former employees of Summit, and they admitted they did not provide medical services in the underserved area. But on a previous visit by the Sun , the clinic was closed.

On Wednesday the Sun stopped by again and the clinic was open, but empty. No patients, and no sign of the three foreign doctors who are assigned to the location.

The clinic was staffed by a lone medical assistant who said patients don't bother showing up because the doctors are never there. They work full time in hospitals throughout Las Vegas, she said.

That led to a call to Dr. Sherif Abdou, head of Summit Medical Group, who offered an unexpected response to allegations that he violates federal and state regulations.

He admitted it.

Abdou, who now oversees about 60 doctors in Nevada with clinics throughout the Las Vegas Valley, works for California-based HealthCare Partners, which owns Summit Medical Group. He had not read the Sun's report on the systematic abuse of the program that's supposed to provide doctors to medically needy patients, and he frankly explained his point of view on the subject.

He knows the physicians are supposed to spend 40 hours a week in the clinic, he said, but was not familiar with the intricacies that govern the hiring of foreign doctors.

He is aware that the clinic is empty, he said, because he hired the doctors through Summit and based them there so they could work for one of his other companies, Inpatient Physicians Network , which provides in-house doctors to hospitals. They were hired to fulfill the network's hospital contracts throughout Las Vegas, he said.

Without the foreign doctors, he asked, "how the hell were we going to cover our nights and days?"

Summit began bringing in foreign doctors in 1998 and early on he was assigned to the hospital shifts, Abdou said. The stable of foreign doctors grew in a span of five years. Summit has hired 20 total, but has not hired any for several years, Abdou said, because it's too much hassle.

He says the federal government should redefine what it means by "underserved" areas. He considers all of Las Vegas underserved - although it's not, according to the federal government's definition.

"Somehow, somewhere, we're going to sit down and nitpick who's covering when and where?" Abdou said. "The speed limit is 25 and you're driving 28, but the intent is to drive safely."

But the foreign doctors have signed sworn affidavits, under penalty of perjury, that they will work for 40 hours a week in underserved areas, usually defined by the federal government as rural or blighted urban communities - the kind of places lacking American doctors. Summit officials and the doctors also have filed reports twice annually with the state verifying they have worked full time in the mandated area.

Abdou's cavalier attitude about federal and state regulations has not been popular with some of his staff. The administrator, who requested anonymity because she still works in the Las Vegas medical community, said many people in the office felt conflicted about lying to the government and said so to Abdou.

"We advised, warned, cajoled and said you really need to make this right," she said.

Finally, the administrator said, she couldn't handle it anymore.

"A number of us left," she said. "There comes a point where , I've always said , I won't do anything illegal or immoral."

Several of the foreign doctors told the Sun they did not work full time in the clinic. One said that even when the clinic was busy, supervisors would redirect them to make hospital rounds.

In 2000, the physician said , about eight of the doctors complained to Abdou. They told their boss it was impossible to do all the required hospital rounds and the 40 hours weekly in the underserved area required by the federal government. The doctor recalled Abdou saying the underserved mandate is "between you and the immigration department. I want to make money off you. If you stay in the clinic you can't even make up your own salary."

Abdou denies saying those words, but remembers telling the doctors , " It is your responsibility to do your clinic time." But he acknowledges that the steady hospital assignments created a Catch-22 when it came to keeping the clinic operational.

"If the doctors didn't show up there were no patients, and if the patients didn't show up there were no doctors," Abdou said.

The real shame, said the former Summit doctor, who still works in Las Vegas, is that it's possible to build a profitable practice in underserved areas. But employers are money-hungry , the doctor said .

"The problem is that instead of benefiting the community (the foreign doctors) are being moved to different hospitals where there's more profit and money for the company who hired them," the doctor said.

The former administrator said the real victims are the people in North Las Vegas, who should have had access to 20 more primary care doctors in the past nine years. They can rarely receive care in a place like the Summit clinic, where the door is always open but the doctor is rarely in.

"Had those clinics been valid there would have been better health care to the areas of the city that needed it," she said.

Abdou said he spends more time with his other companies than worrying about the details of following federal and state regulations.

"I can tell you with all certainty that none of us intended to violate any federal law," Abdou said. "Is it possible we did that? Absolutely."