Foreign doctors get new guardians

By Marshall Allen

Friday, April 11, 2008 | 2 a.m.

A program that a Sun investigation revealed had been widely abused by employers, leading to the exploitation of foreign doctors and neglect of medically needy patients, is taking another important step toward reform.

Today is the first meeting of the Primary Care Advisory Council, a seven-member committee that will oversee the J-1 visa waiver program, which allows employers to hire foreign doctors to work in areas where physicians are in short supply.

The council’s duties include making recommendations about where the doctors are assigned, which employers may hire them and how to handle complaints.

Caroline Ford, assistant dean and director of the University of Nevada School of Medicine’s Center for Education and Health Services Outreach, sat on the previous J-1 advisory committee and serves on the new council.

She said the public expects a higher level of accountability following the revelations about the J-1 program and an unrelated crisis — the hepatitis C outbreak that stemmed from dangerous injection practices at a Las Vegas clinic. The new council will be part of a more rigorous and transparent approach to running the J-1 program, she said.

The changes stem from a Sun investigation that found that some employers were abusing the J-1 system. Bosses worked the foreign physicians more than 80 hours a week, which research shows is bad for patient care, underpaid them and assigned them to affluent areas where they could bring in more revenue — at the expense of the medically needy patients the doctors were required by law to serve.

The abuses occur nationwide and are possible because employers sponsor the foreign doctors’ visas, which stifles complaints. The problems are exacerbated because the program is steeped in bureaucracy. It was created by Congress and involves multiple federal agencies, but is supervised by individual states.

The employers who allegedly abused the program include two of the city’s most prominent physicians, Dr. Rachakonda D. Prabhu and Dr. Sherif Abdou. Prabhu denied doing anything wrong, though doctors who worked for him said they were not allowed to work the required time in a medically underserved community. Abdou admitted to the Sun that he did not hire doctors with the intent of having them work in medically needy areas.

In other cases, foreign doctors went unpaid for months or their contracts were changed against their will.

The state took many actions in response to the Sun’s revelations of abuses. Nevada State Health Division officials put a new person in charge, Lynn O’Mara, who has pledged to conduct regular site visits and be rigorous about investigating complaints.

The state also created a Web site so foreign doctors could complain anonymously, and elected officials held hearings to discuss solutions to the problems. So far, however, none of the employers found to be abusing the system has been held accountable.

The new council is significantly improved in several ways. The group has been expanded from five voting members — two of whom were state employees who ran the program — to seven prominent leaders independent of the state.

In addition to Ford, the new council is made up of Gabriel Bonnet, a retired physician from Reno; Nevada State Sen. Maggie Carlton, D-Las Vegas, community development director of the Great Basin Primary Care Association in Las Vegas; Dr. Carl Heard, interim chief executive and chief medical officer of Nevada Health Centers; Larry Matheis, executive director of the Nevada State Medical Association; Mary Wherry, nurse and deputy administrator of the Nevada Health Care Financing and Policy Division; and Dr. Amir Qureshi, a Las Vegas infectious disease specialist who also served on the previous J-1 review committee.

Qureshi said the foreign doctors are not as vulnerable now as in the past because the media’s spotlight has put employers on notice.

“Everyone has to think twice or thrice before they abuse the way they used to,” he said. “The abuse potential has gone down.”

But the new council is not necessarily going to prevent abuses, Qureshi added, because that will depend on how the state implements the program and conducts inspections. What the council can do, Qureshi said, is bring experts with different points of view into the process, all of whom have a stake in making sure the program runs smoothly.

Another key improvement requires the council to follow open meeting laws. That means applications to hire foreign doctors and discussions about the program are public records, and there will be public comments at the council’s quarterly meetings.

O’Mara said the council’s duties will eventually extend beyond the hiring of J-1 doctors to include recruiting to address the state’s shortage of primary care physicians.

She added that the state still intends to investigate the reported J-1 problems and determine whether employers should be reported to agencies such as the Nevada State Medical Examiners Board, which oversees physician licensing, or the U.S. Labor Department.

The process has been slow because there are so many other priorities, including the hepatitis C crisis, she said. But if the state doesn’t do all it can to hold employers responsible, J-1 doctors will have no confidence that the state will respond to abuses, which in turn will inhibit complaints, O’Mara said.