Las Vegas Sun

November 20, 2018

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Indentured Doctors:

Physicians felt intimidated in state probe

The state has launched its inspections of primary care medical clinics in response to a Las Vegas Sun investigation that found employers exploiting foreign doctors and neglecting medically needy patients.

The investigation comes as the Legislative Committee on Health Care meets Wednesday in Carson City to discuss problems with the program, which was spawned by Congress and is overseen by the states. It allows foreign doctors to reside in the United States if they practice for at least three years in medically underserved areas such as Pahrump, North Las Vegas and parts of Las Vegas.

Two State Health Division officials, an analyst and a program manager, spent three days last week visiting about 15 Las Vegas and North Las Vegas clinics, gathering documents and promising improved government oversight of the J-1 program, named for the visa that brought the doctors to the Unites States.

Judy Wright, chief of the Family Health Services Bureau, said the visits to Las Vegas-area clinics were not intended to draw conclusions about the legitimacy of complaints or about compliance with the program, but to simply get an overview of the situation and be introduced to the doctors.

The visits, which were the beginning of a more thorough investigation, have already found evidence corroborating the Sun’s findings, she said.

The inspectors visited about two-thirds of the clinics where J-1 doctors should have been treating patients and found at least two sites that were little more than nonoperational storefronts, she said.

Some of the foreign doctors who work for Dr. Rachakonda D. Prabhu said they expected a more vigorous visit from the state than what unfolded — something of a meet-and-greet.

Several J-1 doctors who have worked for Prabhu accuse him of working them to exhaustion, which puts patients at risk, and working them at hospitals — where they can bring in more revenue — at the expense of their 40-hour-a-week requirement in underserved areas. Prabhu’s doctors also have complained of employment contracts with noncompete clauses that make it hard to stay in Las Vegas after leaving his practice.

J-1 doctors generally don’t complain for fear of riling their employers, who sponsor their visas. Many did talk to the Sun, however, after being promised anonymity.

Given the need for confidentiality, Prabhu’s doctors said they were surprised that state officials asked — in the presence of Prabhu’s chief operating officer — whether they had complaints.

The inspectors also asked, in the presence of Chief Operating Officer John Hickok, what the doctors thought about the Sun’s investigation, according to doctors in attendance.

One of Prabhu’s doctors said the inspectors seemed reluctant to uncover problems during the inspection.

“If we say anything is wrong then it’s the state’s fault, and the employer’s,” the doctor said. “It’s not really to (the state’s) advantage to find a lot of fault with this.”

Doctors who worked for other employers said they have complained for years, without effect, to the health division. State officials told the Sun they had not received complaints, even though doctors have said they were reassigned after complaining of the abuses.

The state announced it would examine the J-1 problems after the Sun published its report.

The J-1 program was created by Congress to allow foreign doctors to serve their medical residencies here. They can then seek a J-1 waiver to remain in the United States, provided they work 40 hours a week in medically needy areas for at least three years. The law requires employers to pay doctors the “prevailing wage,” the amount a similarly skilled American physician would earn, and assign them to work in the underserved areas.

The Sun found a pattern of abuses of the J-1 program by a handful of employers in Las Vegas, themselves immigrant doctors. The J-1 doctors are frequently kept so busy working in hospitals — where they earn more income for their employers — that they can’t spend the required time treating patients in areas with physician shortages.

Sens. Harry Reid, D-Nev., and Kent Conrad, D-N.D., have called for an investigation of the J-1 program by the Homeland Security Department, which oversees immigration, while the American Medical Association, the Nevada State Medical Association and the Clark County Medical Society have also requested that the program be reviewed.

Doctors who work for Prabhu, the state’s biggest employer of J-1 physicians, said the two state officials showed up at what was supposed to be a staff meeting Oct. 22.

Tension among the doctors escalated, they said, because until recent months they had not been complying with state regulations and federal law — but they had been reporting full compliance to the state.

According to doctors who were present, Hickok seemed eager to prove to the inspectors that there were no problems or complaints by prompting the doctors to report that they are putting in their required 40 hours a week in the clinic.

In the presence of the state officials, Hickok asked the J-1 doctors: “What is it I always tell you (that) you have to do?”

No one said anything, until finally one doctor answered with a weak reply, more of a question than an answer: “Our hours?”

Hickok didn’t leave the meeting, which the doctors said chilled honest discussion.

The health division’s officials explained to the doctors that a 40-hour workweek could reflect 32 hours with patients and eight hours of related office work.

Neither official spoke privately to the J-1 doctors, the physicians said.

The officials also reviewed charts of three patients for each of three J-1 doctors — too small a sampling, the doctors said later, to draw conclusions about the amount of work they do.

One of the doctors, who like others asked for anonymity to prevent reprisals, said J-1 physicians lack trust in the health division because of its failure to respond to past complaints.

Wright said Wednesday’s legislative hearing will discuss funding for increased oversight of the program. Fees might have to be assessed against employers or doctors to properly administer the program, she said.

Nine states charge fees ranging from $200 to $3,600 per doctor, she said.

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