Las Vegas Sun

October 19, 2018

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indentured Doctors:

Patients in rural areas suffer

Jim White was relieved after moving to Pahrump, because it put him so close to a cancer treatment center.

White needed chemotherapy three times a week to treat a type of blood cancer found in bone marrow, and the clinic operated in Pahrump by the Las Vegas Cancer Center was most convenient.

But when he tried to make appointments with the cancer specialist assigned to the clinic, Dr. Prasad Kudalkar, he said he was told the physician was there only one or two mornings a week. The rest of the time, he said he was told, Kudalkar was seeing patients in Las Vegas hospitals and at other Las Vegas Cancer Center clinics.

And that wasn't what White - or the government - expected.

Kudalkar is a foreign doctor who, as a participant in the federal J-1 visa program, was permitted to live and work in the United States after pledging to the state and federal government s that he would work in an underserved area. He would make good on that promise by seeing patients in Pahrump - a government-declared underserved area - for at least 40 hours a week.

But former employees who worked at the clinic before Kudalkar was hired told the Sun that Dr. Nutan Parikh, who runs the Las Vegas Cancer Center, assigned foreign doctors such as Kudalkar to other locations where they could bring in more money, and that none of them worked the federally mandated 40 hours a week in Pahrump.

Parikh denied the allegations, saying Kudalkar and the other foreign doctors always did their best to work 40 hours a week in Pahrump, although they were bored there because there were not enough patients.

Kudalkar, who is now working in Ohio, told the Sun he always "spent close to 40 hours" a week in Pahrump, but that "for some reason, we didn't have any patients." He said he arrived at the Pahrump office every morning at 7:30 or 8 and saw only about five patients a day.

"I was sitting around," Kudalkar said. "I didn't know what to do with the time."

He said he often returned to Las Vegas in the mid afternoon to work in hospitals.

Kudalkar worked into the night in Las Vegas hospitals , he said, logging about 70 hours a week and sometimes returning to Pahrump on Saturdays to complete his 40-hour assignment.

White's complaint that a J-1 doctor was not at his assigned clinic full time was consistent with the Sun's investigation of the J-1 program. Among the Sun's findings:

Numerous employers have hired foreign doctors to work in medically underserved areas, only to neglect the patients in those areas by assigning the J-1 doctors to more profitable locations.

Employers have worked the foreign doctors an exhausting number of hours - frequently more than 80 hour s a week, putting patients at risk.

Some bosses paid their doctors less than their contracted amounts, or less than the level required by the Labor Department.

The abuses don't reach the government's attention because the foreign doctors are unwilling to complain for fear they would be fired and lose their visas . Some of the doctors say they are trapped in a type of indentured servitude.

No one knows how many patients are being cheated of medical care they otherwise could receive through the J-1 program. But within the close-knit medical community, the practice of U.S. doctors ' abusing the J-1 program is considered a dirty little secret.

Pahrump is a town of about 33,000 located about 60 miles west of Las Vegas. The town's first hospital, Desert View Regional Medical Center, opened 18 months ago and is served by about 60 doctors, virtually none of them specialists.

Getting doctors to places like Pahrump is "a constant problem," said Larry Matheis, executive director of the Nevada State Medical Association. "As difficult as it is to recruit to a metro area, it's much more difficult to recruit to our frontier areas."

Those kinds of recruiting difficulties, leaving some rural and blighted urban areas desperately underserved by doctors, is why Congress created the program.

White and his wife, who pay $800 a month for health insurance, believed they would receive good medical care after moving to Pahrump. White described Kudalkar as an excellent doctor, and was hopeful about his chemotherapy.

Then, he said, he was told Kudalkar would not be available for afternoon appointments.

White said he was told by the office staff that Kudalkar "was only in Pahrump about three or four hours a couple days a week. "

"He never was here five days a week, for 40 hours ," White added.

White said he didn't realize he was a victim of J-1 abuses until he read the Sun's articles.

The couple now worr y about other patients in underserved areas.

"Some of the patients are very old and frail," White said. "I'm not sure they have the means to go hop in a car and go to Vegas."

In response to the Sun's investigation, state health officials pledged to improve oversight and go after violators . Sens. Harry Reid, D-Nev., and Kent Conrad, D- N.D. - who authored the J-1 legislation - along with Clark County and Nevada medical associations, have asked for investigations. Congress needs to re authorize the program in June, so it's possible the law could change to close loopholes that allow such abuses.

White says employers who abuse the system should be held accountable.

"They should be punished and the whole situation should be corrected so we can get doctors here 40 hours a week," White said.

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