Las Vegas Sun

September 17, 2014

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INDENTURED DOCTORS:

Complaints about foreign doctor program linger with feds

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State officials Wednesday praised the importance of a program that brings foreign doctors to Nevada’s medically needy communities, saying the program could be even more successful if federal agencies kept up their side of the bargain.

Foreign doctors working with the J-1 visa waiver program provided about 325,000 services to patients in 2009, state officials said. The 43 J-1 doctors account for 9 percent of the primary care physicians in the state’s underserved areas. The program allows up to 30 new J-1 doctors to work in Nevada per year, but in recent years the state has only been able to attract about 10 per year.

After years of abuse by employers and mismanagement by state bureaucrats, the structure is now in place to ramp up the program so J-1 doctors can treat more needy patients, state officials told the Legislative Health Care Committee on Wednesday.

Christine Roden, who manages the program for the Nevada State Health Division, said the state Board of Medical Examiners and the attorney general’s office have been responsive to complaints from the state when employers have apparently violated the program’s provisions, but problems she has forwarded to federal enforcement agencies have not been addressed.

Sparked by a 2007 Las Vegas Sun investigation that showed widespread misuse of J-1 doctors to benefit employers, the state reformed the program, and Senate Majority Leader Harry Reid and Sen. Kent Conrad, D-N.D. — who created the program — called for the Homeland Security Department to investigate.

Since March 2008, federal investigators have subpoenaed records for 36 J-1 doctors who were hired by six employers — some of them prominent Las Vegas doctors, Roden said. She met in September with a Homeland Security investigator and an assistant U.S. attorney, but little information has been provided since then, she said.

Some employers are still not complying with the guidelines, Roden said, and she has forwarded those issues to the federal government.

“We are still having complaints from physicians regarding heavy patient loads; complaints they’re being threatened at their work site; complaints that they are being asked to do on-call in areas that are not underserved. Those allegations have all gone to Immigration and the U.S. attorney’s office.”

The federal agencies have given no guidance to the state, which is trying to determine whether it should place new J-1 doctors with some of those employers.

“We need to know how to proceed,” Roden said.

Reid told the Sun in a written statement that he remains “deeply concerned” about the allegations of abuse in Nevada and has confidence in the Homeland Security investigation.

Reid said he is working with Conrad and the Senate Judiciary Subcommittee on Immigration “on ways to reform existing law to make sure that the J-1 visa program cannot be used as a loophole to exploit foreign doctors.”

Richard Whitley, state Health Division administrator, told legislators the program has made great strides since the Sun investigation. The Sun found that foreign doctors who were hired to work in medically needy communities were being reassigned by their employers, often well-connected physicians, to work in more affluent areas where they made more money for the employers.

Roden listed numerous reforms that were put in place as a result of the Sun’s stories:

-- An advisory committee was created to consider applications and employment contracts at public meetings.

-- A system was established to allow doctors to complain about abuses by employers. And unlike the past, the state has responded.

-- Unannounced site visits verified whether the J-1 doctors were working at least 40 hours a week in the medically underserved areas required by federal law.

-- Legislators passed Senate Bill 229 in the 2009 session, which codified the changes and provided whistleblower protection to doctors who complain about employers.

-- When problems were identified, the state forwarded evidence to the appropriate agencies: the medical board, the Labor Department or Immigration and Customs Enforcement.

Nevada’s J-1 program had been plagued with problems, but now could be a model for other states, officials said. But the federal government’s lack of rigor threatens its success, state officials said.

The J-1 program was created by Congress in 1994 and is a partnership between states and federal agencies, which approve the arrangements and provide law enforcement.

For example, the immigration department approves visas based on the agreement that the doctors work at least 40 hours a week for at least three years in a rural town or blighted urban area that the government has deemed underserved. The Labor Department is charged with making sure the doctors are paid a salary commensurate with what a similarly skilled American physician would earn.

The state Health Division has no muscle, in comparison, and must send complaints to the proper agencies. The federal agencies don’t seem to take ownership of the program, Whitley said.

The breakdowns “still remain at the federal level,” Whitley said.

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