Foreign physicians back boss — to a point

By Marshall Allen

Saturday, Aug. 30, 2008 | 2 a.m.

Dr. Rachakonda Prabhu, one of Nevada’s most politically connected physicians, is struggling to clear his name in the alleged abuse of a government program to employ foreign physicians in medically needy areas.

The allegations, which triggered reforms in Nevada after they were published by the Sun in 2007, claimed Prabhu exploited the foreign doctors for profit, at times keeping them from the kind of clinic work in poor neighborhoods the government mandated.

On the day before Prabhu’s application to hire another foreign doctor was to be scrutinized by a state advisory committee, he asked the six foreign doctors working for him to swear, under penalty of perjury, that he abided by the law and treated them fairly.

Three doctors refused. They did write statements, but they would then not swear to their accuracy.

By taking that position, the doctors threw a wrench into the case Prabhu presented to the committee. Its members are left to wonder why three employees would not vouch for their statements and to decide whether that counts for or against Prabhu.

Several doctors who had worked for Prabhu have told the Sun Prabhu worked them to exhaustion, which puts patients at risk of medical errors, and violated federal law by failing to allow them to work 40 hours a week in medically underserved areas.

John Hickok, chief operating officer for Prabhu’s medical group, said he put no pressure on the doctors to sign the declaration this month. Prabhu was merely trying to facilitate the meeting with the advisory committee by eliminating the need for the doctors to testify in person that Prabhu had followed the rules, he said.

Doctors familiar with the declaration called it an example of Prabhu’s trying to get the doctors to mask his abuses. By refusing to sign under penalty of perjury the Prabhu-drafted declaration, three of his doctors made it clear they weren’t going to accommodate any possible cover-up, sources said.

The doctors in question said they would not speak for attribution for fear of reprisals by Prabhu, who is well-connected in the medical community.

Another foreign doctor speculated that Prabhu is trying to protect himself, in case he is investigated, by having the doctors document that their work habits complied with the law. The state is auditing Medicaid records to determine whether the foreign doctors were fulfilling their obligations to underserved patients, and state officials said they will forward findings of violations to the appropriate authorities.

Prabhu hires the doctors under the J-1 visa waiver program, which was created by Congress and is administered by the Nevada State Health Division to provide medical care to needy communities. Prabhu’s doctors are assigned to El Dorado Medical Center in North Las Vegas.

In 2007, a Sun investigation named a half-dozen Las Vegas employers, most of them foreign-born physicians, who violated the law and the spirit of the program by overworking and underpaying J-1 doctors, diverting them from medically needy patients and/or requiring them to sign unfair contracts. The bosses have leverage over the J-1 doctors because they sponsor their visas.

Prabhu’s doctors never had a problem with being paid. And since the Sun reported the violations, the work assignments for Prabhu’s J-1 doctors have been in compliance with the law, by all accounts.

But when his application to hire another foreign doctor went before the state’s Primary Care Advisory Council on Aug. 7, it was clear there would be scrutiny, Hickok acknowledged. Prabhu needed to buttress his position, so he had his attorney draft a declaration for six of the doctors who currently work for him to sign “under the penalty of perjury.”

The main points were that:

• From the beginning of their employment the doctors consistently provided 40 hours per week of primary medical care to patients who are seen at El Dorado.

• Prabhu never asked, scheduled or pressured the doctors to work more hours in a week than the doctors felt able to work competently.

• Prabhu treated the J-1 doctors in the same manner as non-J-1 employees.

• Prabhu treated the doctors “fairly and in accordance with both the letter and intent” of the J-1 visa program.

Two pediatricians and an obstetrician signed the declaration. Doctors familiar with Prabhu’s practice said the pediatricians and obstetrician have worked the required time in the underserved clinic.

Doctors familiar with the declaration said the other three doctors did not sign under penalty of perjury for various reasons. They may not have worked the required time in the underserved area and may not feel they’ve been treated fairly by Prabhu, sources said.

Hickok has been with the practice for about two years, and when he’s asked whether J-1 doctors always worked the required time in North Las Vegas, he insists the state never made it clear what was meant by 40 hours per week.

“We can go around and round about the past,” Hickok said. “But you know that anything that happened in the past, the state is very complicit in that. The state had zero oversight. None ... They didn’t put out guidelines. The guidelines were so generic, so vanilla.”

The J-1 guidelines from 2006 are not complicated. They say a J-1 doctor must agree “to practice primary care medicine a minimum of 40 hours per week, excluding travel or ‘on-call’ time” at the underserved location.

Hickok, saying Prabhu has nothing to hide, provided the Sun with the six statements by the doctors. Those written by the three doctors may be most noteworthy for what they do not say. Dr. Paramesh Ramadugu, who has been with Prabhu since 2005, essentially copied the main points submitted in the declaration.

Dr. Shady Salib, who has also worked for Prabhu since 2005, said in his statement that he’s always worked 40 hours a week in the underserved area and been paid on time. He did not go beyond those two issues.

Dr. Randa El Husseini, who has been with Prabhu since July 2007, said only that she’s worked the required time in the underserved area and been paid on time.

More than one doctor who has worked for Prabhu told the Sun that Ramadugu and Salib, among other J-1 doctors, were not working the mandated 40 hours per week in an underserved area in 2005 and 2006. And on the Sun’s visit to Prabhu’s clinic in 2006, office staff said Ramadugu and Salib were in the clinic for less than 20 hours per week because they are always working in hospitals. An El Dorado schedule from early 2007 shows the same thing.

Hickok has said his staff can’t be trusted to be accurate about the doctors’ schedules, and that the schedule is wrong.

Ramadugu and Salib declined to comment for this story.