Las Vegas Sun

October 20, 2014

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SUN FOLLOW-UP: INDENTURED DOCTORS:

Doctor’s J-1 actions go under microscope

Physician accused in abuse of program applies to hire another foreign doctor

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A state advisory committee today will examine the practices of a politically connected Las Vegas doctor who has been accused of exploiting foreign physicians — and now wants to hire another one.

The showdown will be the first major demonstration of the committee’s gumption to hold doctors’ feet to the fire.

The committee was created after a 2007 Sun investigation found that employers, often immigrant doctors, were enriching themselves by exploiting a government program intended to help medically underserved patients. It serves in an advisory role to the Nevada State Health Division.

The committee today hopes to question Dr. Rachakonda Prabhu, who has hired more foreign doctors than any other employer in the state to work in his clinics for the underserved in North Las Vegas and the one he formerly operated in Pahrump. He has applied to hire another foreign doctor.

He is the first among the accused employers to come before the committee.

The foreign doctors are serving under the J-1 visa waiver program. Congress has granted J-1 doctors immigration privileges on the condition they work at least 40 hours a week for at least three years in areas where the government has determined there aren’t enough physicians.

But several doctors who have worked for Prabhu claimed that until the Sun published its expose of the program, they and their colleagues spent little time treating underserved patients, a violation of federal law. Instead, Prabhu’s doctors were ordered to treat patients in hospitals, often using their specialties, so they could make more money for their boss.

In addition, multiple doctors who worked for Prabhu reported being overworked — more than 80 hours a week — which research shows leads to medical errors.

Prabhu is one of a half dozen employers — almost all of them immigrant physicians — who were specifically accused of abusing the program in a similar manner. He forcefully denied to the Sun that he had done anything wrong.

The foreign doctors, who are sponsored by their employers, are loath to complain about how they are exploited. If they are fired, they could be deported.

The Health Division has radically changed the program since the Sun’s reports. Now, an advisory council reviews applications and makes recommendations for the J-1 visa waiver program.

The J-1 program is subject to federal law but is administered by the states, which benefit by recruiting the much-needed foreign physicians.

Prabhu has been summoned to the council’s meeting today because he is seeking the state’s approval to hire a kidney specialist, Dr. George Baramidze. The letter to Prabhu says he will need to explain several issues to the council, including allegations in the Sun’s articles.

Prabhu, who has been appointed to advisory committees by governors, said he was unsure whether he would attend today’s meeting. He denies violating the law that guides the J-1 program.

“Stop printing lies about me,” he told the Sun this week.

John Hickok, Prabhu’s chief operating officer, said he cannot vouch for what happened at Prabhu’s clinic before he was hired about two years ago, but that the Sun provided no evidence of past wrongdoing.

To verify whether Prabhu’s J-1 doctors were working in the underserved areas, the Sun visited El Dorado Medical Center in North Las Vegas in 2006, where eight J-1 doctors were supposed to be working at least 40 hours a week. There, clinic staff members said several of the J-1 doctors were only in the clinic about 10 hours a week. Otherwise, they were in Las Vegas hospitals, they said.

Hickok said that because of horrendous turnover, clinic staff members didn’t know what they were talking about.

The Sun also obtained an El Dorado physician schedule that showed the J-1 doctors working the same number of hours — about 10 a week — as reported by the desk staff.

J-1 doctors who worked for Prabhu vouched for the schedule’s accuracy. Hickok said it was not reliable.

Several of the J-1 doctors, two of whom were employed at the time by Prabhu, said Prabhu did not allow them to work 40 hours a week in the underserved areas. They were upset about it because they knew they were violating the terms of their visas. They said Prabhu ordered them to work in hospitals, which generates more income for Prabhu’s business.

Hickok said the complaints of the J-1 doctors should be ignored because they are anonymous, their identities known only to the Sun.

After the Sun published its investigation, J-1 doctors working for Prabhu said they were reassigned to work the required 40 hours a week in the North Las Vegas clinic — but that there were too few patients to keep them busy.

More than one J-1 doctor who has worked for Prabhu says that if the state cares to verify whether the allegations published in the Sun are true, officials can check the “encounter sheets,” which for each visit show the name of the patient, the doctor, the date and the diagnosis. The encounter sheets would verify whether Prabhu’s doctors were working in the underserved area 40 hours a week, the doctors said.

State officials have avoided verifying past complaints, focusing instead on program changes to prevent future abuses. But some foreign doctors say the state needs to verify and enforce past violations by employers to save its credibility — which was low, but tanked this week with revelations that five J-1 doctors complained to the state in writing but were ignored.

The J-1 doctors who have worked for Prabhu in the past year also questioned some information presented to the state in the application to employ Baramidze.

Hickok says he stands behind the number of patient visits as presented on the application — ranging from 3,162 in February to 3,512 in April — numbers that are intended to justify the hiring of another J-1 doctor. But an employee of Prabhu’s said there are only about 50 adult patients a day divided by four J-1 doctors, so the physicians are not busy.

Hickok said the patient count includes a small percentage of instances when a doctor’s attention was not needed, such as for blood work and shots.

During the Sun’s initial investigation, Prabhu offered — and then reneged — to provide the newspaper with a complete record of patient visits to determine how many involved J-1 doctors.

Hickok conceded that in the application to hire Baramidze, the need for more doctors at the clinic was exaggerated.

In the application, Kathy Hernandez, chief executive of Prabhu’s practice, wrote that the “poor patient population” of North Las Vegas will suffer without Baramidze and that other clinic doctors will quit if more cannot be recruited to meet the patient demand.

“Without Dr. Baramidze, the one-month waiting time for a visit will continue to spiral to unacceptable levels,” Hernandez wrote.

Hickok said there is no waiting time for appointments and that Hernandez’s statement “may not have been worded very well.”

He added that the J-1 doctors at El Dorado are not overly busy now, but three of them will be leaving the clinic in November, so there will be need for Baramidze. The J-1 advisory committee will be assured that all the rules will be followed, Hickok said.

Applications to hire five other J-1 physicians also will be considered today by the advisory council.

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