Foreign-born Ohio transplant surgeon denied work visa

A hospital has been forced to suspend its 36-year-old kidney transplant program, leaving patients 40 miles from the nearest alternative.

By Myrle Croasdale, amednews staff. Dec. 15, 2003.

Tanmay Lal, MD, a licensed transplant surgeon, can live here but he can't work here.

Dr. Lal, originally from India, is one of a handful of foreign-born transplant surgeons in the United States who have been denied work visas. So far no transplant programs have had to close permanently as a result, but Dr. Lal's employer in Akron, Ohio, was forced to suspend kidney transplants in July.

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However, Summa Health System, which runs Akron City Hospital, is hoping to find a way to save its 36-year-old kidney transplant program.

"It's been hard on our patients, particularly ones who have the least resources," said John Jacobs, MD, nephrologist and medical director of Akron City Hospital's dialysis and transplant program.

Ninety-six patients have chosen to stay on the hospital's waiting list though it's been inactive since July. The closest alternative is 40 miles north in Cleveland.

"Those who can travel to Cleveland or Pittsburgh or Columbus have been able to do so," Dr. Jacobs said. "Our disadvantaged patients don't have the ability to go to other cities to get worked up."

Physicians on an H-1B visa must work 32 hours a week in an underserved area.

Ironically, Dr. Lal's arrival was expected to solve a dilemma, not create one. Akron's kidney specialists had decided they would have to find a full-time transplant surgeon or shut down the program. Relying on part-time surgeons from Cleveland meant patients weren't always getting timely care.

Finding a good fit was difficult because the program was small (30 transplants a year), so there wouldn't be a second surgeon to share call.

"We were very lucky to find Dr. Lal," said Dr. Jacob. Then came the visa hitch.

"Both of our senators and our congressmen wrote impassioned letters to immigration services. This program services a lot of people and has for a long time. To lose it would be devastating for our community," Dr. Jacobs said.

Dr. Lal is optimistic, despite the denial of his O-1 visa application this October.

"I'm not bitter at all," he said. "I know I'm not being singled out for this."

The O-1 is for applicants of extraordinary ability at the top of their fields and is a typical path for transplant surgeons. Now, Dr. Lal hopes to get an H-1B visa. The visa will require him to work 32 hours a week in an underserved area for three years. Ohio has only 30 of these visas to give out each year through the state Conrad 30 program.

Should Dr. Lal be granted an H-1B he'll have to work at a clinic in a federally designated underserved area a few miles from Akron City Hospital, and he'd focus on general surgery rather than transplants. Any work outside the clinic, including surgical time on clinic patients, would not count toward his H-1B hour requirement. Transplant work would be in addition to his clinic hours, unless he saw those patients at the clinic.

While Dr. Lal has been struggling, his wife, a pediatric intensivist, who already had an O-1 visa, is working at Akron Childrens Hospital. Dr. Lal couldn't say why she was considered renowned in her field and he wasn't, but he suspects it may be because she got her visa before Sept. 11, 2001.

The U.S. Citizenship and Immigration Service says such assumptions are false. Chris Bentley, spokesman for USCIS, said decisions on O-1s have nothing to do with nationality or race but are based entirely on each applicant's merits.

Bob Deasy, an immigration attorney in Pittsburgh, oversees several O-1 visa applications each year.

"The agency is chronically inconsistent," Deasy said. "In some ways it is worse since 9/11. There's a 'forgive no transgression' attitude."

Akron isn't the only city to see its transplant program jeopardized by USCIS decisions. The University of Kentucky Hospital Transplant Center in Lexington almost lost a heart surgeon from Pakistan who'd had a visa to work in the United States for more than 10 years. And in Houston, a regionwide heart-lung transplant program almost closed when its key surgeon, who was originally from Turkey, found his O-1 was denied. In both cases political pressure seemed to facilitate getting the visas renewed.

Meanwhile in Akron, Dr. Lal is still waiting.

"We have the possibility of losing a very good guy and his wife, too," said Dr. Jacobs. "We don't want to lose good people because they happen to be the wrong nationality at the wrong time in history.