New watchdog: Doctors’ abusers are in for it

By Marshall Allen

Tuesday, Jan. 29, 2008 | 2 a.m.

For a while, it seemed that doctors who violated the rules of a government program by exploiting foreign physicians would be let off the hook by state officials.

But that may be changing.

The state has transferred oversight of the beleaguered J-1 visa waiver program from one bureau of the Nevada State Health Division to another. And the new overseer, Lynn O’Mara, says she will aggressively enforce the program’s guidelines.

The transfer was in the works anyway, state officials said, but it was hastened by the Sun investigation, published in September, that highlighted repeated failures in oversight of the program, which places foreign doctors in medically needy communities for at least three years.

The Sun found that employers were taking advantage of the foreign physicians for their own financial benefit, in violation of federal law and state guidelines.

The newspaper’s findings triggered national and statewide calls for an investigation into the program and reform.

O’Mara, a manager in the Health Planning and Statistics Bureau, said addressing problems with the J-1 visa waiver program is her most important job, adding that she will be reviewing the allegations detailed in the Sun.

The rules have always had teeth, O’Mara said; they were just not enforced.

“It’s an issue of holding people’s feet to the fire,” she said.

O’Mara seems more assertive in her approach to enforcement compared with Judith Wright, chief of the Family Health Services Bureau, who previously oversaw the program and was charged with revamping it after the problems came to light.

Congress adopted the J-1 program to bring foreign doctors to rural and urban America. The doctors, who came to the United States for their medical residency, were allowed to remain as long as they worked at least 40 hours a week for three years in the underserved regions.

Many of the J-1 doctors have complained to the Sun that they were diverted to affluent hospitals in Las Vegas, where they could bring in more money for their bosses. Some said they were worked to exhaustion — sometimes 100 hours a week — and others said they were cheated out of their salaries. The abuses were all possible because the employers sponsored the foreign doctors’ visas.

One employer, Dr. Sherif Abdou, president of Summit Medical Group, admitted to the Sun that he did not follow federal and state regulations when he hired foreign doctors. He said he knew they were supposed to work in underserved areas, but instead assigned them to hospitals throughout Las Vegas. Meanwhile, Summit officials told the state the doctors were working in medically needy areas.

Even as Senate Majority Leader Harry Reid and county and state doctor groups called for an investigation into the violations, Wright backtracked from initial promises to take action. She had promised that reform efforts would include speaking individually with foreign doctors during visits to clinics.

O’Mara said that never happened.

In October Wright was asked whether she would investigate and report offending employers to disciplinary agencies or prohibit them from hiring more J-1 doctors. She demurred.

“This can be tricky because some of them are very involved in the community,” she said of the employers. “Our first brush may be working with the violators to clean up their activities.”

Then, at a public hearing in December, Wright said nothing can be done about the past and the focus needs to be on enforcing the program in the future.

O’Mara, who has had her new assignment for about two weeks, promised to privately meet with Nevada’s J-1 doctors in the next six months to address the abuses reported by the Sun.

“I’m not going to tell you that the politics aren’t going to be touchy,” O’Mara said. “But our department and division want to get beyond the politics.”

There are several steps O’Mara could take to enforce past violations, including reporting possible fraud to the Labor Department, U.S. Immigration and Customs Enforcement or the Nevada Board of Medical Examiners.

O’Mara said she may also file complaints against the foreign doctors for not fulfilling the terms of the J-1 waiver program — that they work in underserved areas. Foreign doctors will be required to complain rather than comply with bosses who tell them to violate the rules, she said.

“The people of this state need access to medical care,” O’Mara said. “If we don’t do this we can’t attract physicians to this area.”

Dr. Ikram Khan, a retired surgeon and medical consultant who has served on the state’s J-1 advisory committee, applauded the state’s more aggressive stance, saying employers and foreign doctors must realize there are consequences for breaking rules.

O’Mara said state officials will solidify the policies and procedures that govern the program and will clearly communicate them to employers and J-1 doctors. The state also plans to expand the advisory council to include seven members who are not state employees involved in the program. The committee will follow open meeting laws, she said.