Tuesday, Oct. 2, 2007 | 7:05 a.m.
1. A J-1 doctor will start his job in the underserved clinic from the day he has the valid licenses, irrespective of hospital privileges.
2. An employer must pay salaries as the contract states, biweekly or monthly , with no delays.
3. The J-1 doctor must get annual vacation and medical education time every year as per contract. Employer must provide evidence that an annual vacation was granted.
4. The foreign doctor's contract cannot be changed once it's finalized. Changes must be reported and justified to state health officials.
5. A J-1 doctor's salary may not be altered based on the monthly patient census.
6. Every six months, employers must provide copies of all J-1 doctor's pay stubs.
7. J-1 doctors must be able to report all abuse and harassment.
8. It is the employer's responsibility to provide patients for the J-1 doctor.
9. Noncompete clauses will not be allowed.
10. Employers can not assess monetary penalties if the J-1 doctor leaves the employer for a valid reason.
Nevada legislators will investigate allegations published in the Sun of employers taking advantage of foreign doctors and abusing the system that allows them to stay in the United States to work in medically underserved areas.
Assemblywoman Sheila Leslie, D-Reno, is leading the legislative Health Care Committee and promised to add the subject to its agenda when it meets for the first time this month. "There are several, if not numerous , cases of exploiting foreign doctors - and that's bad enough," Leslie said. "But the bigger issue from the state's perspective is that we're supposed to be serving these underserved communities."
On Sunday the Sun reported multiple instances in which employers appear to be abusing the Conrad State 30 program, which allows foreign doctors who did their residency in the United States to stay in the country , as long as they commit to perform primary care for 40 hours a week for at least three years in medically underserved areas. The Sun found that many employers are apparently diverting these so-called J-1 doctors to more profitable shifts in hospitals or clinics in more affluent neighborhoods .
In addition, some J-1 doctors told the Sun their employers underpay them, overwork them to dangerous levels of exhaustion and coerce them into contracts with unfair noncompete agreements.
The pressure to acquiesce is great because, the foreign doctors said, their employers sponsor their visas. Complaints could lead to termination, which might force them to leave the country.
"If these allegations are correct something needs to be done," said Dr. Don Havens, president of the Clark County Medical Society. "It's not just a concern for the doctors. It's a concern for the public."
Havens said the State Board of Medical Examiners needs to investigate the employers because they appear to be filing false records with state and federal authorities to verify their compliance with the program. And, he said, these practices stigmatize the profession.
Tony Clark, executive director of the State Board of Medical Examiners, said disciplinary action can be taken against any physician who brings disrepute to the profession , but someone must file a formal complaint. The discipline could include a fine and probation, he said.
Havens said he will investigate whether the medical society can file a complaint, but that it will be hard without firsthand information.
Some of the foreign doctors who spoke to the Sun said they were willing to lodge complaints. Dr. Elsa Von Schulenburg said she will report her former employer, Dr. Michael Rosenman, who she claims coerced her into signing a new contract for $24,000 less than her original agreement. Karen Nicholson, who worked in a clinic in Pahrump run by Dr. Nutan Parikh, said she will lodge a complaint saying that the foreign doctors there were not working in the clinic 40 hours per week, to the detriment of the rural town's medically needy residents.
Both also said they will file complaints with the Medicaid Fraud Division of the Nevada attorney general's office.
Assembly Majority Leader Barbara Buckley, D-Las Vegas, said it's imperative that legislators examine the problems with the J-1 visa waiver program.
If the physicians are being diverted to more lucrative assignments "then something should be done," Buckley said. "The state should step in and do a thorough examination to make sure these type of abuses aren't occurring."
The State Health Division, which administers the program on behalf of the federal government, needs to make site visits to investigate whether the foreign doctors are fulfilling their obligation , Buckley said.
"The whole purpose of the program is to fulfill a great community need," she said.
State officials must stop relying on self-reporting, Buckley said, and audit and inspect the clinics. It also is important that officials speak directly to foreign doctors, Buckley said. There are many simple checks that could be implemented , she said.
Leslie said there's a powerful disincentive for the J-1 doctors to complain, and that creates a barrier to the state getting accurate information. She expressed disappointment that no one saw the problem before, but now that it's clear, she said, it needs fixing.
Dr. Amir Qureshi, who sits on a panel that reviews agreements between the foreign physicians and employers, has been trying to reform the system. He and two current J-1 doctors put together a list of "10 Commandments" that the state could implement to improve oversight. The list includes banning noncompete agreements, forcing employers to abide by their contracts when it comes to vacation time and salaries, and forbidding employers from changing the agreements.
Officials from the State Health Division previously told the Sun they had heard of no instances of employers or foreign doctors not following the guidelines of the program.
Alex Haartz, administrator of the division, said Monday there were problems about five years ago with doctors not working in underserved areas. The state responded by requiring doctors and employers to file paperwork every six months declaring they were spending 40 hours a week in the areas.
The Sun's visits and queries to multiple clinics - as well as interviews with J-1 doctors and clinic employees - showed that the mandate to the underserved areas is often ignored.
Haartz said the Sun's report shows that the Health Division must "improve the J-1 physician experience here in Nevada."
Haartz emphasized that the Conrad State 30 program was created by the federal government and the state receives no money to ensure regulations are followed.
He also said the Health Division on Monday asked the Nevada attorney general's office whether it has recourse to sanction employers and foreign doctors who file false statements.