Physician under fire gets 2nd chance

By Marshall Allen

Wednesday, Sept. 10, 2008 | 2 a.m.

A State Health Division committee created to correct abuses in a program that brings foreign doctors to medically needy communities on Tuesday effectively endorsed the employer who critics allege is one of its biggest offenders.

At issue was a request by Dr. Rachakonda Prabhu, one of the state’s most politically powerful physicians, to hire a foreign doctor to work in his clinic in North Las Vegas.

Several foreign doctors who worked for Prabhu told the Sun a year ago that he violated the “J-1” program by working them to exhaustion in Las Vegas hospitals, employing them under restrictive contracts and not allowing them to work full time in medically underserved areas, as the law required. The abuses — all of which Prabhu denies — were possible because Prabhu sponsored their visas, which made it difficult for them to oppose him.

The committee — the Primary Care Advisory Council — was born out of reforms triggered by the Sun’s investigation of the program. But on Tuesday, state officials said they didn’t have the evidence to corroborate what the newspaper reported and thus had no grounds to refuse Prabhu’s application to hire Dr. George Baramidze.

Foreign doctors who have worked for Prabhu and have firsthand knowledge of the alleged abuses say the committee’s decision is the latest example of failed state oversight. Prabhu and other bosses who exploit the program will flaunt the approval to show they can get away with abuses of their power, the doctors said.

The J-1 visa waiver program was created by Congress to provide doctors to communities where American-born physicians do not generally want to work. It’s managed by the state, which has the authority to approve and monitor contracts between employers and foreign doctors.

The problem in Nevada and other states is that unscrupulous employers have the leverage to overwork the foreign doctors, not pay them according to their contracts and ignore the underserved communities in favor of assignments in hospitals, where more money can be brought in for the boss.

State officials admit to gross mismanagement of the J-1 program in the past. Before the Sun published its investigation in 2007, state officials claimed they had not heard one case of an employer’s abusing the system. After the Sun investigation was published, they acknowledged widespread problems and initiated multiple reforms. In August, state officials discovered written complaints by foreign doctors against other employers buried in files.

Lynn O’Mara, the state employee who has been working since January to reform the J-1 program, said the application was approved because Prabhu had done everything the committee requested to comply with the program in his application to hire Baramidze. The application’s approval does not mean that he or any other employer is off the hook for past abuses, O’Mara said.

An investigation of potential past abuses by employers is ongoing, O’Mara said, but it’s been slow-going because the foreign doctors will not go on the record with their complaints. She said she had spoken with foreign doctors hired by Prabhu, but they have to substantiate the information they provided, which is difficult if the doctors remain anonymous.

The state is still conducting an analysis of Medicaid billing records, O’Mara said, which could verify whether the foreign doctors were working the required 40 hours a week in medically underserved areas.

Foreign doctors have told the Sun they would tell the truth if state officials asked them about their employers in private. And when O’Mara took over the program in January, she promised state officials would sit down with the foreign doctors individually within six months. Unforeseen budget constraints have made the visits impossible, she said.

Thus, members of the Primary Care Advisory Council said Tuesday that they’d done all they could to make sure Prabhu follows the law in his employment of Baramidze. In August, they tabled Prabhu’s application to hire Baramidze until the contract could be made more fair to the foreign doctor. They made Prabhu remove the noncompete agreement, a clause that would have required Baramidze to pay $300,000 if he broke the contract. The council also made Prabhu agree in writing that Baramidze will provide at least 40 hours a week of primary care in Prabhu’s underserved clinic, as the law requires.

“This is the maximum the council can do,” said Dr. Amir Qureshi, a former J-1 doctor who is chairman of the group. “Now whether someone is fulfilling the rules is up to the state to monitor. Lynn will have to be more aggressive about monitoring.”

Qureshi added that current and former J-1 doctors who have legitimate complaints about their employers have a responsibility to contact O’Mara.

The doctors who say they’ve suffered from Prabhu’s abuses said the state’s failure to address previous complaints makes it unlikely anyone will come forward.

Doctors familiar with Prabhu’s clinic say the exploitation has mostly abated since the Sun’s stories were published a year ago, and that the J-1 doctors are now spending their required time in the clinic.

O’Mara said state officials will conduct unannounced site visits to ensure compliance with the program.

“We’ll keep tabs on things,” she said.