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J-1 visa waivers: Prasads on both sides of issue. (Impact of Halt in Screening).

Dr. Suresh Prasad has seen both sides of the J-1 visa waiver program.

Three years ago, Dr. Prasad, a newly minted graduate of the internal medicine residency program at the Texas Tech University Health Sciences Center in Odessa, applied for and received a J-l visa waiver. The waiver allowed Dr. Prasad, a citizen of India, to stay in the United States if he agreed to practice medicine in an underserved area for 3 years.

Dr. Prasad did agree and has spent the last 3 years working at a hospital and an outpatient clinic in Monahans, Tex., 40 miles west of Odessa.

"I wanted to serve in an underserved area where no doctor wants to go," he said. "I know the problems [first-hand]. My father and uncle are diabetic, and I've seen what kind of problems they suffer" because they live in rural India without easy access to care.

But while Dr. Prasad has had a positive experience with his waiver, which expires in August, his wife Kalpana has not Dr. Kalpana Prasad, who came to the United States nearly a year after her husband arrived, is just finishing her internal medicine residency at Texas Tech. She, too, applied for a J-1 visa waiver. Unfortunately, her application was too late.

On March 1, the U.S. Department of Agriculture, which performs the initial screening of J-1 visa applicants, announced that it would no longer do so. That was the same day that Dr. Kalpana Prasad's lawyer had planned to deliver her waiver application to the USDA. The USDA has been participating in the program since 1994. Its role has been to write letters of recommendation for international medical graduates who apply for the waiver. The waiver application is then sent to the State Department for approval. Some 43 state governments also have been approved to serve as application screeners, but Texas is not one of them.

Two weeks after the Sept. 11 attacks, the USDA suspended its processing of applications and began reviewing its participation in the waiver program. "The review, which is still ongoing, has shown that USDA has no specific authority to conduct adequate background checks on applicants or on-site compliance reviews of the physicians and their employers," the agency said in a statement. The USDA decided to drop out of the waiver program, although it will finish processing the 86 applications that were pending as of Feb. 28.

The White House has formed an interagency task force to decide what should become of the waiver program. The Bush administration appears to be inclined to keep the program going in some form. To that end, the task force has two goals, USDA spokeswoman Alisa Harrison said: "to make sure we're providing health care providers to underserved areas, and also to make sure we meet our national security needs."

Medical groups have taken a low-key approach to the issue. The American Medical Association does not have a policy on it, although the issue is likely to come up at the group's June meeting, a spokeswoman said.

The American College of Physicians-American Society of Internal Medicine also supports the waiver program, said Jack Ginsburg, the college's director of health policy analysis and research.

He noted that the Bush administration is very concerned about providing adequate security checks on visa waiver applicants. "Our concern is that health care services be provided to underserved areas. The solution is not to bar the international medical graduates but to provide the needed security checks."

While the task force decides the fate of the program, the Prasads simply wait. Dr. Kalpana Prasad, who is expecting the couple's second child in July, can remain in the United States even if she doesn't get the waiver--but only if she doesn't work. Otherwise, she has to go back to India for 2 years.

The Prasads' dilemma also could affect the availability of health care in Monahans and the surrounding area.

Although the clinic Dr. Suresh Prasad works in started out with several physicians, two of them have left in the past month, and another plans to retire. "For all practical purposes, I'm the only internist here," he said.

Dr. Kalpana Prasad had signed a contract to work at the clinic, but because of her waiver problems, it may be a while before she gets to work there.
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Title Annotation:Drs. Suresh and Kalpana Prasad
Author:Frieden, Joyce
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Jun 15, 2002
Previous Article:Single Sigmoidoscopy Screen. (Clinical Capsules).
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