Doctors join cry to protect doctors and patients

By Marshall Allen (contact)

Sunday, Oct. 21, 2007 | 6 a.m.

The state’s two largest medical societies are pressing Gov. Jim Gibbons to launch investigations of Las Vegas-area doctors who, the Sun found, game the government by exploiting foreign doctors for their own benefit, at the expense of medically needy patients.

The investigation should be launched as quickly as possible “to preclude any future abuses of the program,” Dr. Edwin Kingsley, president of the Nevada State Medical Association, and Dr. Weldon Havins, president of the Clark County Medical Society, wrote Friday.

Gibbons spokeswoman Melissa Subbotin said he would review the issue with legal counsel during the weekend to decide whether to forward the matter to Nevada Attorney General Catherine Cortez Masto.

The Sun reported Sept. 30 that multiple employers in Las Vegas — immigrant physicians themselves — have systematically abused the so-called J-1 program, which is designed to place foreign doctors in medically underserved areas — usually, clinics in rural or poor urban neighborhoods.

Instead, the bosses divert physicians to more affluent areas, where they can bring more money to the practice. In some cases, the employers violate contracts and federal law by failing to pay the foreign doctors their wages. Many of the foreign doctors also complain of being overworked to the point of exhaustion, jeopardizing patient care.

Federal and state oversight agencies fail to identify such abuses, the Sun investigation found, and the foreign doctors are afraid to complain for fear of being fired, losing their visas and being deported.

Kingsley and Havins, who represent about 1,500 Nevada doctors, said they are “deeply concerned” that foreign doctors may have been mistreated and that the abuses of the program could “shake public confidence.”

The Sun investigation has triggered other calls for investigations and a review of federal guidelines.

Nevada State Health Division officials say they are pressing forward on their promise to better police the program. Unannounced visits to clinics to make sure J-1 doctors are working there will begin in the coming weeks, and inspectors say they want to interview the foreign doctors.

The Legislature’s Committee on Health Care is to discuss the problem when it meets Oct. 31.

Senate Majority Leader Harry Reid and Sen. Kent Conrad, D-North Dakota, who sponsored the legislation authorizing the J-1 program, have called for a federal investigation into the program. The matter has been sent to the Homeland Security Department, which oversees immigration. Chris Thorne, spokesman for Conrad, said that, because of the abuses, oversight and enforcement must become more aggressive.

The foreign doctors entered the United States on J-1 visas to serve their medical residency. The law allows a limited number of doctors to remain in the United States if they pledge to work for at least three years in underserved areas. Every two years Congress needs to reauthorize the program. The next time will be in June.

Greg Siskind, a Tennessee-based immigration attorney who reviews the program’s guidelines and suggests changes to the law, previously recommended only minor changes, thinking the program was generally operating smoothly. There might be more dramatic changes this time, he said.

At any time there are 4,000 foreign doctors assigned to underserved areas in the United States, Siskind estimated.

Siskind says he hadn’t seen widespread cases of U.S. doctors abusing foreign doctors or diverting them from underserved areas. And foreign doctors can always transfer to other employers if there are severe problems, he said. The doctors say switching employers is expensive and might get them fired.

The foreign doctors say they aren’t surprised by the generally rosy assessment of the J-1 program by government officials and immigration attorneys because there is little government oversight and the doctors rarely complain.

Siskind’s job has taken on new urgency with the senators’ calls for investigation. And now, Siskind and other immigration attorneys, as well as congressional staffers, are reviewing possible changes to the law to address the apparent problems.

Siskind, chairman of a national task force on physician immigration, says he’s unsure whether the law needs changing, or whether the problems just show a failure in enforcement.

He said state health departments, which facilitate the program on behalf of the federal government, have been biased against foreign doctors when complaints have come up. Exposing the problems might help immigration officials be more understanding of the plight of the doctors, and serves as a wake-up call for state officials, he said.

The states, he said, “need to be more balanced and not always side with the employer.”

Siskind said Congress might be asked to funnel more money to states so they can better oversee the program and protect foreign doctors from being overworked.

Other issues being reviewed, Siskind said, are noncompete clauses in contracts in which employers bar the foreign doctors from practicing in particular areas when they leave their sponsors — which undercuts the program’s goal of seeding medically needy areas with physicians. Such contract language is forbidden in some states but not Nevada.

Although government officials might still be uncertain of the pattern of abuses in the program, foreign doctors who have immigrated to the United States have long heard complaints from their counterparts in the J-1 program.

Dr. Nadeem Kazi, president of the 12,000-member Association of Pakistani Physicians of North America, said the Sun’s investigation led him to two doctors at an Arizona hospital who said they had been exploited by their employers. He said most abuses go unheard because the foreign doctors prefer not to cause problems.

“We think it’s wise to investigate this whole thing and come up with a solution,” Kazi said.

Kazi said the government should provide financial assistance so foreign doctors can self-sponsor their visas and open their own clinics in underserved areas. That would eliminate the leverage that unscrupulous bosses have over the doctors, and would force them to invest time and effort in an underserved areas, making them more likely to stay in the community long term.

The government should also find a way to fund the program for state health departments, so the laws will be enforced, Kazi said.

Until the law is reformed, he said, abuses will continue because “this is a capitalist country and everyone will take advantage of everyone else.”

Marshall Allen can be reached at 259-2330 or at marshall.allen@lasvegassun.com.