Thursday, Nov. 1, 2007 | 7:34 a.m.
CARSON CITY - Nevada legislators launched their review Wednesday of a government program that has allowed foreign physicians to be exploited by their U.S. employers, and quickly heard from a fretful witness.
Shaji Mathew, a doctor from India, said he decided to testify after a sleepless night because authorities needed to hear what he faced in the J-1 visa waiver program.
Mathew said he was hired by a Las Vegas doctor who financially cheated him and then threatened to have him and his family deported if he refused to extend his employment contract and guarantee a loan to finance the clinic where he worked.
Mathew said he decided to speak out after his boss dared to sue him.
Scott Tisevich, Mathew's attorney, said people need to look no further than the 13th Amendment to see that Mathew's rights were violated.
"There is no indentured servitude" in the United States, Tisevich said.
Mathew became the first J-1 doctor in Nevada - and perhaps nationally - to explain to elected officials how a system designed to recruit foreign doctors for medically underserved areas in the United States can lead to doctors being overworked, underpaid and sometimes tied to onerous employment contracts.
Mathew testified before the Legislative Committee on Health Care, which is examining the J-1 program after the Sun reported how it was riddled with employer abuses.
The state Health Division is investigating the program as well, with an eye toward improving Nevada's oversight of doctors and employers.
The J-1 program, created by Congress, allows foreign medical school graduates who serve their residency in the United States to remain if they spend 40 hours a week, for at least three years, in rural towns or blighted urban areas where there's a dire shortage of physicians. In return for their service, they gain permanent residency and begin the immigration process.
The Sun reported in late September that many employers of J-1 physicians systematically abuse the program and exploit the doctors. They overwork the doctors - up to 100 hours a week in some cases - which increases the likelihood of medical errors. Some do not pay the doctors as federal law and their contracts dictate. And many employers neglect underserved patients by assigning the doctors to shifts in hospitals, where they can bring in more income.
The employers sponsor the visas of the J-1 doctors, which makes it difficult for them to complain. A doctor who rocks the boat risks deportation - as Mathew found.
Nevada should help J-1 doctors confidentially report problems to authorities and ensure that the employers are allowing the physicians to fulfill their commitment to underserved communities, Assemblywoman Sheila Leslie, the health care committee's chairwoman, told other members.
"There appear to be quite a few examples where it appears the whole purpose of the program has been subverted," Leslie said. "As a policymaker, that makes me quite concerned."
State officials said they are moving from passive to proactive oversight.
Alex Haartz, Nevada Health Division administrator, told lawmakers Wednesday he is "dismayed" by the abuses . He said the state is considering eliminating noncompete agreements in contracts, conducting exit interviews so doctors can give "unvarnished" comments and creating an Internet-based complaint system.
The state will investigate complaints, he told the Sun outside the meeting, and will forward relevant findings to the appropriate state and federal agencies.
Mathew, who had been reading about problems with the J-1 program, said he decided after a sleepless night to testify Wednesday, having steeled himself to tell his story.
His emotional account brought the problem into sharp relief for lawmakers, who mostly were focused on more bureaucratic issues surrounding the J-1 program.
Mathew had completed medical school in India and came to Nevada in 1991 to do his Ph.D. work and a fellowship at UNR. He was among the first pediatric residents to serve at University Medical Center. Among his professors was Dr. Ravi Krishnan, a Las Vegas physician he says became his mentor and friend. After his residency, Mathew says , Krishnan invited him to work at Nevada Children's Center, a clinic he was opening in Reno.
Mathew says he worked five years for Krishnan. During that time, he says , he was underpaid by $60,000 and was threatened with the loss of his job - which could lead to his and his family's deportation - if he refused to sign a loan guarantee for $75,000 to support the practice and a contract extension.
Mathew says he left the Reno practice in August 2006 because he had received his green card and fulfilled the terms of his original five-year contract. Krishnan sued him for breach of contract in August.
Krishnan's suit alleges that Mathew ditched the contract early and stole patients when he left. Mathew is defending himself through a countersuit.
Michael Stein, Krishnan's attorney, called Mathew's accusations "preposterous."
Stein said J-1 doctors are lucky to be paid good money in the United States instead of working in their home countries, "where they would probably get a bowl of rice for their services."
The attorney said Mathew knew he was violating his contract when he quit to open his own practice, leaving Krishnan with fixed costs that he could not recuperate. Mathew was paid his entire $120,000 salary every year, Stein said.
Mathew's testimony before the legislative committee was nothing more than a "red herring" to cover his weak case, Stein said.
"These are the actions of a guy who doesn't want to honor his contracts," Stein said.
The J-1 program receives little government oversight, the Sun investigation found.
The Labor and Homeland Security departments, which oversee immigration, say they are not aware of the abuses and don't check on employers or doctors. And officials with the Nevada Health Division, which administers the program on behalf of the federal government, said they have not heard complaints or found cases where the program was not being followed.
But Mathew said he complained to many people . He said he spoke to teachers at the medical school, an immigration attorney and a Health Division official. All told him to "sit tight, don't rock the boat," until his five - year contract was finished, he said.
Mathew said he was angry because, at that point, he had been in this country 14 years and no one acted on his complaints.
"What would you do?" he said. "I tell you what I did. I sat tight. I closed my ears and closed my eyes and did my 40-plus hours."