Sam Morris

Larry Matheis of the Nevada State Medical Association updates the Legislative Committee on Health Care on the J-1 waiver program.

By Marshall Allen

Wed, Feb 13, 2008 (2 a.m.)

State officials are taking steps to correct lax oversight of a program that brings foreign doctors to medically needy Nevada communities.

A series of corrective steps by the state is intended to stop abuses that included some Nevada employers exploiting the foreign doctors and neglecting the patients they were supposed to serve.

The Las Vegas Sun disclosed the widespread problems in September, documenting how some bosses forced foreign doctors to work 100-hour weeks, cheated them out of pay and used them to generate higher profits by directing them to care for affluent patients.

Richard Whitley, the newly appointed administrator of the Nevada State Health Division, recently disciplined one employee and transferred oversight of the program to Lynn O’Mara, program manager of the Health Planning and Statistics Bureau.

O’Mara is overseeing reforms that include:

• Replacing loose guidelines with formal policies and procedures. O’Mara is consulting the Nevada attorney general’s office to see whether the policies can be turned into regulations, which have more teeth.

• Creating an independent panel whose seven members will meet publicly to oversee the program. The panel will replace an informal advisory committee whose members include state employees and whose meetings are private.

• Speaking regularly and confidentially with the foreign doctors to check up on employers. The previous state overseers never made good on their promise to do that.

• Reporting past violations to agencies that have the authority to investigate and sanction employers. The previous managers said past abuses by employers would be forgotten.

Larry Matheis, executive director of the Nevada State Medical Association, said Tuesday at a meeting of the Legislative Committee on Health Care that the “J-1” visa waiver program is important because it delivers much-needed care to medically needy communities.

The J-1 program helps ease a shortage of primary care doctors in Nevada, allowing foreign doctors who did their medical residency in the United States to stay in the country as long as they commit to working at least 40 hours a week for at least three years in a medically underserved area. When they finish their terms, the doctors are allowed to pursue permanent residency.

The program is a “win-win” for foreign doctors and the state, Matheis said, but its reputation was being ruined by employers who abused the system. The bosses could get away with exploiting the system for profit because they sponsor the visas of the foreign doctors. Complaining about an employer could have gotten J-1 doctors fired, which could have meant forfeiting their visas and perhaps having to leave the country.

Matheis has been one of the primary advocates for reforming the J-1 program. He said one reform that still needs to be discussed is providing whistleblower protection for the foreign physicians.

“They should be able to go to the authorities and say, ‘This is wrong’ and not be punished for it,” he said.

Matheis said the reforms follow a situation in which many factors worked together to bring problems to light. The Sun investigation exposed the problems, then many concerned officials and health care professionals rallied to fix them, he said. He ticked off a list of people who contributed to bringing about the change. Assemblywoman Sheila Leslie, who leads the Legislative Committee on Health Care, immediately added the issue to the committee’s agenda and held hearings. Dr. Edwin Kingsley, president of the Nevada State Medical Association, and Dr. Weldon Havins, president of the Clark County Medical Society, wrote to Gov. Jim Gibbons demanding that employers be held accountable and the state muster its resources to fix the problems. And the health division held a lengthy meeting in December with people involved in the program to determine the best course of action, Matheis said.

“I think this is moving exactly in the right direction,” he said.

The Sun found widespread abuses of the J-1 waiver program across the country, leading to reform efforts on the federal level.

The J-1 waiver program was created by Congress and is up for reauthorization in June. Senate Majority Leader Harry Reid of Nevada and Sen. Kent Conrad, D-N.D., the legislator who created the program, have called for an investigation of the problems, and staff in both Senate offices have voiced a commitment to closing loopholes that allow the abuses.

Leslie concluded Tuesday’s hearing by asking O’Mara how the state would remedy past abuses.

“I just don’t want those doctors who came forward to feel we’re abandoning their individual situations,” Leslie said. “I don’t think it’s appropriate for the committee to delve into their details. But I do think it’s appropriate for the health division to do so.”

Leslie also stressed the importance of ensuring that J-1 doctors are working their required 40 hours a week in the medically needy communities, which she said, among all the problems, was the most troubling.

O’Mara said she is working with the attorney general’s office to improve the auditing process.