Despite abuse reports, state sent accused employers more J-1 docs

By Marshall Allen

Wednesday, Aug. 6, 2008 | 6:35 p.m.

State officials not only ignored complaints that Las Vegas employers were abusing a government program involving foreign physicians, but allowed them to further exploit it, according to documents obtained by the Sun.

The letters from foreign physicians hired to work in the Las Vegas Valley detailed allegations that their bosses violated federal law and intimidated them into subservience with threats of deportation.

State officials denied the existence of any complaints until last week, frustrating the foreign physicians who told the Sun in 2007 that they had spoken up about the problems.

Among the letters obtained by the Sun were five from 2001 and 2002 that contained detailed allegations of how business partners Munir Muhamed and Dr. Abdul Siddiqui had violated federal law.

They are accused of assigning the foreign doctors — who by law were supposed to work full time in medically needy areas — to Las Vegas hospitals where they could generate more income for their bosses. The complaints also accuse the employers of violating federal law by not paying the foreign doctors.

Siddiqui was on vacation and did not return calls. Muhamed could not be reached.

State officials not only took little action on the complaints, but approved five more foreign doctors to work for the same employers between 2002 and 2004. Those doctors voiced similar complaints to the Sun about not being paid or allowed to work in the underserved areas.

One complaint was apparently referred to the Nevada attorney general’s office. Dr. Pinky Kotwal told state officials that when her employers became aware that she and her colleague Dr. Sikisam Magoyag intended to leave the clinic, they called them into a room where they were threatened by “a stranger.”

The man shouted at the two doctors that he had obtained their visas, so they were answerable to him, Kotwal wrote. She also said the doctors were “messing with” her money and that the man said if they planned to leave he would “have us deported within 48 hours.”

“All through the conversation he kept warning us repeatedly that he had very close connections with the governor of Nevada and that is how he managed to get the other doctors’ visas in the first place,” Kotwal told the state in her 2002 complaint. “He said that he would use the governor’s office again to make sure that we could never leave.”

Kotwal could not be reached Tuesday for additional comment.

Siddiqui was one of a half-dozen employers named in the Sun’s “Indentured Doctors” investigative series in 2007 as allegedly exploiting foreign physicians. In those stories two doctors who started working for him between 2002 and 2004 told the Sun they went for months without being paid, and one said the physicians were overworked — up to 98 hours a week — and that they were not seeing patients in the underserved clinic.

The Sun has spent about two years investigating the “J-1” visa waiver program, created by Congress to recruit foreign doctors to medically needy communities. (The program is named for the visas that foreign doctors hold when they enter the United States for their medical residency.)

The doctors are required by law to work full time for at least three years seeing underserved patients. In return, they become eligible to start the process of becoming legal residents. The Sun revealed that employers in Las Vegas and nationwide systematically abuse the system to enrich themselves.

Because the employers sponsor the foreign physicians’ visas, they have leverage to ignore the law — and the medically needy patients — by assigning the J-1 doctors to tasks that make more money.

During the Sun’s initial examination of the program, state officials insisted they had not heard a single complaint from a J-1 doctor. After the stories were published, the state acknowledged widespread problems with oversight and revamped the program, putting in new leaders, creating public meetings to improve transparency and establishing an advisory board to review applications.

On Thursday the state released a report that acknowledged the past complaints by J-1 doctors.

State officials said they can’t comment about the now-acknowledged complaints until after Thursday’s meeting of the advisory board that makes recommendations about the J-1 program.

Larry Matheis, executive director of the Nevada State Medical Association and a member of the advisory committee, said the belated release of the letters shows that the health division was at least willing to “shine the light” on them. He said he’s not certain how the committee will handle past complaints or allegations of misconduct, and that it will probably seek advice from the attorney general’s office.

In addition to the five complaints about Muhamed and Siddiqui, there was a letter from Dr. Nicolas Nassar, who claimed his employer, Dr. Sunil Arora, threatened to withhold his paycheck unless he worked in San Bernardino, Calif., instead of Pahrump, where he was assigned. Nassar said Arora withheld one paycheck, so he complained to the labor board. Neither doctor could be reached for comment.

In the five other complaints, the foreign doctors said they’d been hired to work in three clinics purportedly operated in a federally designated medical shortage area. But they were instead subcontracted against their will to work for Inpatient Physicians of Nevada, a company that provides doctors to hospitals.

Dr. Nouhad Damaj and his wife, Dr. Rola Saad, both J-1 doctors, wrote in their Jan. 24, 2002, complaint that the employers said if the doctors balked at the arrangement, their contracts would be terminated.

Damaj and Saad said they were fired the day they questioned the illegal practices. They still practice in Las Vegas. Damaj declined to comment for this story and Saad did not return calls.

Inpatient Physicians of Nevada is owned by Dr. Sherif Abdou, a prominent Las Vegas doctor who sponsored about 20 J-1 doctors as his own employees. He told the Sun in a 2007 interview that he hired J-1 doctors with the intent of violating the federal law by ignoring the underserved areas. He compared it to driving over the speed limit and said it was the only way to staff his hospital contracts.

The J-1 doctors said in their complaints that they were not treating patients in the medically needy areas listed with the state and on their immigration documents.

“Based on my personal visits to all these sites in the past three months, none of them had any signs indicating the presence of a health care facility,” wrote Dr. Suman Rao in 2001, echoing comments in other complaints. Rao could not be reached for comment.

J-1 doctors are required by law to be paid the prevailing wage — a mandatory salary based on what a similarly trained American physician would earn. In their letters, doctors complained to the state that they went for months without being paid by Siddiqui and Muhamed.

“Munir Muhamed had six J-1 waiver physicians approved for his alleged underserved clinics but four of those are still practically unemployed because he does not have the money to pay them,” wrote Damaj and Saad in their complaint.

And even worse than not being paid, Dr. Renante Ignacio told the state, the employers forced him to take out a $150,000 loan to support the operations of the corporation. He did not return calls for comment.

A letter from attorney Carolyn Ellsworth, who represented Damaj and Saad, was included in the state’s file of complaints, and was copied to the Nevada Board of Medical Examiners and U.S. Immigration Department.

She says Muhamed and Siddiqui “conspired to take advantage of physicians coming to this country on J-1 waiver visas in the hopes that they will not complain for fear of losing their immigration status and medical licenses.”

Damaj and Saad ended their complaint with a plea to state officials that went unanswered. They pointed out that the employers have committed fraud and it was time to investigate the business.

The doctors asked the state “not to grant Munir Muhamed, Dr. Siddiqui, or whoever represents the Health Care Center of Las Vegas any further J-1 waiver physicians because he is abusing them, not paying them in a timely fashion and making them work in areas that are not underprivileged.”

The couple could not have known that despite their complaints a batch of additional J-1 doctors would follow them to the same employers, and make similar allegations of abuse.