Tuesday, Nov. 17, 2009 | 2 a.m.
When Congress created a program to allow foreign doctors to work in medically needy parts of the country, nobody in Las Vegas took advantage of it more than Dr. Rachakonda D. Prabhu.
Since 1999 Prabhu has hired 27 of the foreign physicians for clinics affiliated with his Red Rock Medical Group — more than any other employer in the state — making them the backbone of his practice.
Now, Prabhu is under investigation on two fronts for alleged mistreatment of the doctors and violations of the law that guided the program.
Five sources have told the Sun that the U.S. Homeland Security Department is investigating Prabhu’s involvement with the so-called J-1 visa waiver program. At issue is whether Prabhu properly assigned the doctors to see patients in medically needy communities.
And in the past week the Nevada State Health Division has filed a complaint against Prabhu with the Nevada State Board of Medical Examiners, alleging that patients may be at risk because pediatricians working for him have been required to see as many as 75 patients in a day.
Prabhu would not comment for this story, but previously has said he obeyed all laws that govern the J-1 program. The medical board complaint stems from a minor employment dispute, his chief operating officer said.
The program was established by Congress in 1994 to address America’s doctor shortage. It allows foreign doctors to reside in the country as long as they work at least 40 hours a week, for at least three years, in blighted cities or rural towns designated as “underserved” by the federal government — such as North Las Vegas and Pahrump. When they finish their term, the doctors can apply for permanent residency.
The Sun reported widespread problems in 2007, prompting Senate Majority Leader Harry Reid and Sen. Kent Conrad, D-N.D., to call for an investigation by the Homeland Security Department, which oversees Immigration Services.
A Reid spokesman said Monday the senator did not know about the current probe, but was pleased to hear it’s taking place.
Homeland Security officials did not return calls for comment. Sources who have spoken to Homeland Security investigators, or are familiar with their case, said the probe has been ongoing since at least spring 2008.
Federal investigators are concerned about two issues, sources said: that patients in underserved communities are being ignored, as was the case with several employment arrangements investigated by the Sun, and that foreign doctors are unfairly competing with American physicians in areas that are not underserved.
Investigators have subpoenaed state and hospital records and interviewed multiple physicians who have worked for Prabhu, sources said. The sources said that Prabhu is the subject of the investigation, not the doctors he employed, because he allegedly directed them to work outside the underserved areas. The case will be presented to a federal grand jury, the sources told the Sun.
John Hickok, chief operating officer of Prabhu’s practice, said he has heard nothing about the Homeland Security investigation.
As the Sun reported in 2007, employers are able to take advantage of J-1 doctors because they also sponsor their visas, and the foreign physician would be unlikely to complain for fear of losing that sponsorship and being deported from the United States. So instead, the J-1 doctors, who are paid a set salary, allowed themselves to be assigned to hospitals where they made more money for their bosses, and neglected the underserved communities. In some cases the J-1 doctors were worked to exhaustion, by putting in the required hours at neighborhood clinics as well as making revenue-producing hospital calls for their bosses.
In its investigation, the Sun talked to 11 J-1 doctors who worked for Prabhu. Of those, about half said Prabhu treated them fairly and the others said they felt overworked or that Prabhu often failed to assign them 40 hours a week at his clinics in North Las Vegas and Pahrump.
Workers at Prabhu’s Eldorado Medical Center in North Las Vegas told the Sun during a visit in 2006 that at least four of the eight J-1 doctors were at the site only 10 to 20 hours a week. The Sun was provided a clinic schedule that showed most of the doctors were assigned in an underserved area for three- or four-hour shifts, a few days a week.
Hickok said the schedules are unreliable.
The Nevada State Health Division, which administers the J-1 program on behalf of the federal government, launched major reforms of the program after the Sun’s investigation. Now, an independent advisory board makes recommendations about the program, which operates in a manner that’s transparent to the public. State inspectors make regular site visits and hold employers and doctors accountable when there appear to be violations.
The complaint to the medical board is based on contact with two J-1 doctors who work at the Eldorado Medical Center — pediatricians Dr. Samrat Das and Sutapa Khatua. Neither would comment for this story.
But according to the complaint sent Thursday by Richard Whitley, administrator of the health division, the pair contacted the state on March 13, saying they thought patients were at risk because they each had to see up to 60 children in an eight-hour day. State officials pulled appointment listings during a site visit and found they had seen up to 317 in a month during the time, the complaint said — an average of about 14 patients per day. The reason for the different figures was unexplained.
At that time, state officials encouraged the doctors to complain to the medical board directly, the complaint said.
On Oct. 29 Das forwarded to the state an e-mail he had sent to Prabhu saying he was tired of seeing up to 75 patients in one day and was concerned about their safety, according to the complaint.
Earlier this month the state received phone calls and an e-mail from Das saying he felt threatened by the office manager and Hickok, the chief operating officer. The pediatrician said the supervisors were talking in threatening tones and that Hickok told him there would be “consequences” if he reported anything to the state, the complaint to the medical board said.
Hickok denied making threats and said the doctors are disgruntled about their pay after the practice recently withdrew its financial incentives for seeing more patients. He said there was a time in the spring when the doctors were seeing up to 55 patients a day — and that this was too many — but the practice has since hired a nurse practitioner to work with them. Now they see fewer patients, which decreased their incentive payments, which led to their disgruntlement, Hickok said.
He said he has “no problem” with the medical board investigating the complaint, because the practice has done nothing wrong.
State health officials said the complaint to the medical board is not a judgment about the veracity of the complaints. But if the allegations are true, then they’re serious enough that they need to be investigated, officials said.