Indentured Doctors:

Patients in Pahrump shortchanged, ex-clinic workers say

Sunday, Sept. 30, 2007 | 6:59 a.m.

Karen Nicholson and Bonnie Edwards say it's time to tell the truth about a clinic that was supposed to serve the medically underserved residents of rural Pahrump.

They say they are indignant because their former boss, Dr. Nutan Parikh, profited by hiring foreign doctors ostensibly to work full time at his Pahrump clinic - and then neglected the underserved patients by shifting the doctors to more lucrative tasks in Las Vegas.

The doctors were hired under a government program that allows foreign doctors who come to the United States for their residency to stay if they work in areas declared by the federal government to have a shortage of physicians. Pahrump, about 60 miles west of Las Vegas, is such a place.

In the past, government officials loosely monitored the employers and foreign doctors to ensure they're working at least 40 hours a week in the underserved areas. But the four foreign doctors working for Parikh from 1998 to 2003 were never full time in Pahrump, Nicholson and Edwards said. Furthermore, the women say they were repeatedly ordered by their office manager to lie about the doctors' whereabouts.

The Pahrump office is one of four clinics owned by Parikh under the name Las Vegas Cancer Center. Two of Parikh's other clinics are in Las Vegas, and one is in Kingman, Ariz.

Edwards worked at Las Vegas Cancer Center for 14 years, in capacities that included handling billing and appointments, until she left in 2003. Nicholson was the lone full-time employee in the Pahrump office from 1999 to 2002. Both women say none of the four J-1 doctors hired by Parikh during their tenure worked the required 40-hour-a-week shifts in Pahrump.

They provided office memos to the Sun that, they say, were prepared by office manager Karen Konie and that outlined various ways office personnel could explain the absence of a J-1 doctor in case inquiries were made by patients - or state or federal authorities.

The most recent J-1 doctor who worked for Parikh left recently. He was a cancer specialist who worked at the Pahrump clinic only on Mondays and Wednesdays and did not accept non-cancer primary-care appointments, according to an office receptionist queried by the Sun. If that's true, the physician was violating the two most basic requirements of the J-1 program: that he work 40 hours and that he deliver primary care to the underserved area.

Parikh did not return calls from the Sun. When Konie was told of the complaints by Nicholson and Edwards, she replied: "Well that's not very sweet, is it?" but declined to further comment.

J-1 doctors were typically moved among Parikh's other clinics and various Las Vegas hospitals, according to Edwards and Nicholson. "Some patients got mad and went elsewhere," Nicholson said of the rural clientele. "They couldn't get in to be seen," because the clinic was restricted to cancer patients and the doctors were rarely there.

J-1 doctors assigned to Las Vegas Cancer Center in years past told the Sun they don't recall violating their visa terms.

Dr. Hari Deshpande, who now works in Connecticut, said he worked "pretty close" to 40 hours a week doing primary care and oncology in Pahrump, and spent an additional 40 hours a week at the other locations.

Dr. Kanchana Anand, who's now in Los Angeles, said there were days in Pahrump spent "twiddling our thumbs" to clock 40 hours a week because there were not enough patients. Then doctors would do hospital rounds in Las Vegas in the evening, she said.

Nicholson kept a copy of what she said were office instructions in Konie's handwriting instructing the staff on how to cover for a doctor's absence.

"If someone calls when he is not here, (say that) he is on a house call or over at another Drs office," the note said.

A set of typed office instructions from Konie refers to "the day" the foreign doctor is in the office, even though he should be there all week.

Nicholson and Edwards said the deception of covering for absent J-1 doctors in Pahrump came to a head when state health officials announced when they would visit to ensure the J-1 doctors were complying with regulations.

Nicholson said patients had been scheduled for morning appointments only , so they were rescheduled for the afternoon, when the state officials would be there, and other patients were urged to visit the clinic that day. Nicholson said she was instructed by Konie to fill the J-1 doctor's appointment book with the names of pharmaceutical representatives so it would appear he was busy Monday through Friday. Nicholson says she refused, so Konie filled in the schedule herself.

When the state health inspectors arrived at the appointed time, Nicholson said, Konie told them that current and past J-1 doctors spent at least 40 hours a week in the clinic - and that the current one was so dedicated he even came in on Saturdays.

"I think he did that one time," Nicholson said.

Nicholson left Parikh's practice several months later, and in October 2003 she and Edwards filed complaints with the Department of Homeland Security - Immigration and Customs Enforcement.

"I feel it is reprehensible that this kind of immigration fraud is going on," Nicholson wrote. "And I feel Dr. Parikh is not the only one in Las Vegas or in the rest of the United States who is defrauding the immigration service in this manner. An audit of the billing records will attest to this fraud."

They said there was no response to their complaints.