J-1 doctors, employers are under scrutiny

By Marshall Allen

Sunday, Jan. 25, 2009 | 2 a.m.

State health authorities have their eyes on Dr. Titilola Famakinwa and her bosses at the Apex Medical Center.

The foreign physician is not fulfilling the requirements that allow her to practice in the United States in exchange for immigration concessions, the authorities say.

If the internal medicine doctor doesn’t get her act together and start working full time as expected at the Apex clinic, near University Medical Center in Las Vegas, she may become the subject of an investigation by federal immigration authorities, according to a state health division official.

The news here isn’t so much that Famakinwa may not be fulfilling the conditions of her visa, but that Nevada is cracking down on her and her boss.

Famakinwa is one of hundreds of foreign physicians over the past decade who have worked in Nevada under a federal program designed to increase the number of doctors in medically needy communities. Foreign doctors are granted legal residency in exchange for working 40 hours a week in federally-designated underserved communities for at least three years. When they finish their terms, they can begin the immigration process.

A Sun investigation found that neither the federal nor state government was closely monitoring the program and employers in Nevada were exploiting the foreign doctors for profit.

The J-1 visa program dictates that employers sponsor the foreign doctors’ visas, giving unscrupulous employers leverage over the foreign physicians — allowing employers to coerce doctors to violate the terms of the program knowing that they would be reluctant to complain.

Many doctors in the program told the Sun they weren’t allowed the time to see low-income patients — their primary mission — and were given better-paying hospital assignments that generated more revenue for their bosses. Many complained they were worked to exhaustion — more than 80 hours a week — which jeopardized patients. And some foreign doctors were not paid their salaries — which are set at certain amounts by the federal government.

The Sun investigation showed that even though such problems were rampant in Southern Nevada, the state was doing nothing to protect the doctors or ensure the medically needy patients were getting treatment they deserved.

Employers who have used the program to enrich themselves include some prominent members of the Las Vegas medical community, including the politically connected Dr. Rachakonda D. Prabhu of Red Rock Medical Group and Dr. Sherif Abdou, founder of Summit Medical Group. Prabhu has denied any wrongdoing. Abdou told the Sun it was never his intention to comply with the federal laws that guided the program.

The Sun’s stories triggered multiple reforms of the J-1 program by state health authorities, including better efforts to monitor compliance with the program.

In their most aggressive response yet to violations in the J-1 program, state officials are in the midst of unannounced site visits to clinics where foreign doctors are assigned. In November and December, they visited 15 sites that employed 22 doctors and found a number of violations of the program. Among the findings:

• Four doctors were not working the required time in the underserved clinics.

• Thirteen doctors were working in clinics where there was no notice that patients would be treated regardless of their ability to pay.

• Employment contracts for five doctors called for them to pay up to $250,000 if they broke their agreements. Such clauses are discouraged by the state because they are often used by employers to keep physicians in oppressive situations.

• Contracts for eight doctors included noncompete agreements that would prevent them from working in the underserved area after they leave their current employers. Such agreements go against the goals of the program to encourage doctors to settle here and are now banned by the state.

State officials realize that in most cases, it’s the employers pressuring the J-1 doctors to not comply with the program. But they sent letters to employers and doctors alike, because the foreign physicians are also responsible for their compliance.

Christine Roden, a manager with the Health Division, sent letters to the doctors and their employers on Jan. 2 informing them of the violations and telling them what they need to do to comply.

The four locations where foreign doctors are not working full time — interpreted as 32 hours of direct patient care in most cases — were the most severe violations, and the doctors and sponsors were given 30 days to correct the problems or risk being reported to the U.S. Citizenship and Immigration Services Bureau. Three of the doctors are now scheduled full-time at their clinics, Roden said. The outstanding violator is Famakinwa and her employer, Dr. David Ezeanolue.

When Roden visited Apex Medical Center on Dec. 9, Famakinwa was not there — and nor was she there when the state called the clinic three other times, according to a Jan. 2 letter from the state to the doctor. In the letter, the clinic was told its appointment schedule didn’t provide evidence that the required amount of patient care was being provided.

“This is a serious issue that requires corrective action within 30 days,” the state said. Noncompliance could mean serious consequences — including being reported to federal immigration authorities — which may be the biggest motivator for J-1 doctors to follow the rules.

Ezeanolue told the Sun that because Famakinwa spends most of her time working at UMC, which qualifies as an underserved area, he would simply tell the state that she would work at both locations.

Roden said that such an arrangement would need to be discussed by the Primary Care Advisory Council, an advisory group created by the Health Division in the wake of the Sun’s stories to provide expert guidance to the state. But its next meeting isn’t until Feb. 5 — after the 30-day deadline.

By the time the current round of clinic inspections is completed, Roden said, she will have visited about 20 clinics employing 40 J-1 doctors.

Such state oversight of the doctors in the J-1 program is unprecedented and, according to congressional guidelines, long overdue.

In past years, state officials announced their visits or did not do them at all. This time Roden made surprise visits, reviewed patient charts and appointment books and conducted one-on-one interviews with the foreign doctors, asking them directly if they’ve been exploited or pressured to violate the terms of the program.

The interviews have revealed that there are ongoing problems of J-1 doctors being exploited by their sponsors, she said. Doctors still report being worked to exhaustion by their employers, Roden said.

But now the state is hearing firsthand of the abuses and taking corrective steps, Roden said.

It’s clear, she said, that “the physicians are feeling more empowered to say what they want to say.”