Sunday, Sept. 30, 2007 | 6:59 a.m.
Dr. Elsa Von Schulenburg is one of about 1,000 foreign doctors at any given time who completed their medical residencies in the United States and, at Uncle Sam's beckoning, stayed to work in America's medically underserved areas, treating patients who might not otherwise see a doctor. In exchange for this three- to five-year commitment, these so-called J-1 doctors are allowed to remain here as legal residents.
Many J-1 doctors say the biggest flaw in the government's program is allowing employers to sponsor their visas.
"That's where the trick begins," said Von Schulenburg, a Mexican national who speaks with a German accent and easily shifts into Spanish when treating patients.
Now that she has completed the J-1 program and started her own pediatrics practice in Las Vegas, she speaks in terms of the suffering she felt at the hands of her first J-1 employer, another Las Vegas pediatrician, Dr. Michael Rosenman.
Von Schulenburg still smolders because, she says, Rosenman took advantage of her immigration status to cut her salary by $24,000.
Then, a court found, Rosenman overcharged a hospital by almost $50,000 for her services - after a costly legal battle for Von Schulenburg.
This was possible, Von Schulenburg says, because she was a foreign doctor and Rosenman sponsored her visa. She needed the job to stay in the country legally, so it was too risky for her to file a formal complaint. Now her biggest frustration is that the system that allowed her to be exploited still has not been fixed.
Rosenman and Von Schulenburg met during her U.S. medical residency in San Antonio .
Von Schulenburg supports her story through documents. Rosenman declined to be interviewed, but answered her accusations with a written statement saying he did nothing wrong.
Von Schulenburg shows a 1997 application with the U.S. Labor Department in which Rosenman says he will hire her at a salary of $120,000. In a 1998 employment agreement filed with the government, Rosenman makes the same salary promise to Von Schulenburg.
But in 1999, when she started to work for Rosenman, she said, he ordered her to sign a new contract for an annual salary of $96,000. "You're here, take it or not," she claims Rosenman told her.
Von Schulenburg said Rosenman told her the previous contract "was just to get you the visa" and that she needed to sign the new contract if she wanted to remain employed.
She said she reluctantly agreed to a salary $24,000 less than promised because she had invested too much - six years of medical school in Mexico, nine years of post-medical school training and thousands of dollars on immigration attorneys - to lose her job and leave the country.
A day later, she said, Rosenman presented Von Schulenburg with a third contract, a $139,000 income guarantee agreement between her and Lake Mead Hospital (now North Vista Hospital). Such agreements are common recruiting incentives to bring doctors to underserved areas. She agreed to sign over her hospital paychecks to Rosenman, who used the money to pay her salary and expenses related to maintaining her office.
According to the hospital income guarantee agreement, if Von Schulenburg earned less than $11,583 in any month, the hospital would make up the difference. But if she earned more than $11,583 a month, she would reimburse the difference to the hospital.
Hospital officials were supposed to conduct regular audits of Rosenman's books and Von Schulenburg's billings to determine the necessary subsidy or repayment.
Within months, Von Schulenburg said, she was billing so much for her boss's practice that the hospital no longer had to pay on the guarantee. Even so, the hospital continued to make the payments.
In the meantime, Von Schulenburg said , she deliberately grew belligerent toward Rosenman with the hope of being fired - and succeeded, a year after she began working for him.
But her travails were not over.
The hospital sued Von Schulenburg and Rosenman, claiming it overpaid for her services by about $50,000. Von Schulenburg in turn sued Rosenman, and eventually became embroiled in a legal battle that cost her about $25,000.
In May 2003 a district judge agreed with the hospital and ordered Rosenman to repay the money he had improperly received.
A former administrator at North Vista Hospital who is familiar with the J-1 program said it was common for employers to divert the salary subsidies away from the J-1 doctors and alter the paperwork that identified which doctors were charging for hospital services.
Rosenman has since been disciplined for malpractice in unrelated matters by the Nevada State Medical Board, and he now works in Las Vegas for Foot Hills Pediatrics.
In a letter to the Sun, Rosenman said he went to "great lengths" to help Von Schulenburg get her visa, only to fire her after a year for poor performance. He said he was forced to close his North Las Vegas office, which resulted in litigation and paying a reimbursement to North Vista Hospital.
Von Schulenburg completed her J-1 program under Dr. Paul Vega in North Las Vegas. She says he followed the rules of the program but worked her hard, six days a week. She started in January 2001, and three years, eight months and two weeks later - "I counted each day" - she was free to work on her own.
Von Schulenburg says that, had she known of the abuses she would sustain in the J-1 program before enlisting, she would not have done so.
"It seemed very good on paper and that people could not take advantage of you, that people would pay you the same as they pay Americans," she said. "But the system is flawed by the human beings who offer the positions."