Bill would better protect foreign J-1 doctors

By Marshall Allen

Friday, May 15, 2009 | 2 a.m.

State lawmakers are considering legislation to stop the exploitation of foreign doctors who have come to Nevada because there aren’t enough physicians here.

Many of those doctors have been overworked and underpaid by their bosses, or reassigned from their clinics in underserved neighborhoods, where they are supposed to serve the poor, to insurance-rich hospitals where they can make more money for their employers.

A bill before lawmakers would give the Health Division the teeth to enforce the program’s guidelines and prevent employers from undermining it.

The proposed legislation, Senate Bill 229, would:

• Make a violation a more clearly punishable offense under state law, prosecutable by the attorney general’s office.

• Charge the participating employers a fee that would cover the cost of enforcement.

• Protect whistleblowers who report violations from civil and criminal liability.

The legislation is the latest of reforms sparked by a 2007 Las Vegas Sun investigation into the so-called J-1 visa waiver program.

Congress created it to bring foreign doctors into blighted urban communities and rural areas that struggle to recruit American-born doctors. The foreign doctors, who originally came to the United States for their residency training, are given special immigration status as long as they commit to working full time for at least three years in the medically needy communities.

The program has been touted nationwide as a win-win for the foreign doctors and patients, but it’s been undermined in dozens of cases in Nevada and other states by greedy employers who abuse the system for profit. They sponsor the foreign doctors’ visas, which gives them the leverage to work them to exhaustion, pressure them into unfair contracts and divert them from the needy patients to more affluent areas, a violation of federal law.

The foreign doctors have rarely complained for fear of losing their job and their legal right to remain in the country, and because regulators until now haven’t shown an interest in their plight.

Federal agencies dealing with immigration and labor issues are charged with enforcing the program but have been unresponsive to ongoing violations in Nevada. The Nevada State Medical Examiners Board gets involved only if violations are harming patients.

SB229 is sponsored by Sen. Maggie Carlton, a Las Vegas Democrat and a member of an advisory committee formed to oversee the program. The bill would give clear direction so state officials, employers and foreign doctors would know what happens when doctors do not serve the required time in underserved areas, or employers violate terms of the contract. The legislation would send instances of alleged misconduct to the State Health Board, which could trigger investigation by the attorney general’s office.

Richard Whitley, administrator for the state health division and one of the leaders of the effort to reform the program, said possible violations would be discussed publicly before the health board. Regulations would be developed to handle violations, he said, with a range of penalties for various situations.

Without the statutes and regulations, complaints involving the J-1 program are left to a single state employee who runs the program, who then has to interpret the guidelines developed by various federal agencies, Whitley said.

The administrative fee proposed in the Senate bill would be no more than $500 and would be paid by employers when they apply to hire foreign physicians. The money would be used to train and educate the doctors and employers so they clearly understand the program’s guidelines, and to fund unannounced site visits to ensure compliance with the program.

SB229 was passed unanimously by the Senate and is now in the Assembly.