State bars physician from J-1 visa waiver program

By Marshall Allen

Sunday, Aug. 2, 2009 | 2 a.m.

State authorities who oversee a program that brings foreign doctors to medically needy communities have taken their first drastic enforcement action, revoking a Las Vegas doctor’s participation because he repeatedly did not comply with the rules.

The state removed Dr. Dhiresh Joshi from his sponsorship role in the J-1 visa waiver program, effective Monday, for failing to ensure the foreign physician he employed, Dr. Anne Marie Roberts, spent the required amount of time in a clinic in a medically undererved part of North Las Vegas.

Joshi, who leads a medical group called Infectious Disease Specialists, said the state is “too picky” about the number of hours Roberts worked in the clinic or the hospital. He said he let Roberts find another employer because she was unhappy.

The Nevada State Health Division sent Joshi a letter July 27 detailing his failure to comply with the program, which is governed by federal law. The J-1 program was created by Congress to draw physicians to blighted urban areas and rural towns where medical providers are in short supply. It allows foreign doctors to work in the United States on the condition that they spend at least three years working 40 hours a week in an area where there’s a shortage of physicians. Parts of North Las Vegas fit the program’s criteria.

The state approves the contracts between foreign physicians and their employers, who also serve as the sponsors of their immigration visas.

The state’s action against Joshi is the latest example of reforms in response to a Sun investigation that found widespread abuse of the program. The Sun’s reports in 2007 showed that employers, most of them foreign-born doctors themselves, were overworking the J-1 doctors, paying them below federal standards and diverting them from the medically needy patients to affluent areas where they could make more money for their employers.

Roberts’ agreement with Joshi was to see patients for at least 20 hours a week in a clinic on Perliter Avenue in North Las Vegas, and 20 hours a week at North Vista Hospital. Both locations qualify as underserved areas.

Roberts, who is from Trinidad, was employed in late 2008. In January the state sent Joshi a letter saying Roberts had not been complying with the terms of their agreement. Another letter in early July detailed noncompliance again.

Roberts was assigned appointments away from the clinic — a situation that Joshi said he corrected after being confronted by the state.

The state has found that since April, Roberts has not put in sufficient clinic hours. Roberts, who did not return calls from the Sun, told state officials that Joshi had canceled her clinic days and sent her to work at other locations.

The state is now encouraging Roberts to find another J-1 employer.

Joshi can appeal the decision by Aug. 10 but said in an interview with the Sun that he let Roberts go because she was too much of a “headache.”

Joshi told the Sun there were not enough patients to justify isolating Roberts in the clinic. He said he referred patients from parts of Las Vegas that are not underserved to the North Las Vegas clinic for follow-up with Roberts, but that they didn’t like to make the drive to her office. Sometimes Roberts would cancel her time at the clinic or not show up for work, he claimed.

Richard Whitley, administrator of the health division, said withdrawing support for Roberts’ employment with Joshi could be analyzed in various ways. Roberts was the first applicant reviewed by the Primary Care Advisory Committee, a panel of experts assembled to provide oversight of the J-1 program. Ideally, the screening process would have identified Joshi as not having a sufficient number of patients in North Las Vegas to support the clinic, Whitley said.

On the other hand, the goal of the program is to increase patient access to doctors in underserved areas, and it’s important for the state to monitor the employment arrangements to ensure patients are getting the care they need, he said.

Whitley said the health division will forward a complaint about Joshi’s noncompliance to appropriate agencies for investigation. That could include the Nevada State Medical Examiners Board or the Homeland Security Department, which oversees immigration-related issues.