June 30, 2003 Monday, 6/7 SPORTS FINAL

SECTION: MAIN; Pg. A1

LENGTH: 3896 words

HEADLINE: SCHOOLS LOWER THE BAR;

IN GUADALAJARA, A LAST RESORT FOR AMERICANS

SERIES: Med Schools: Lowering The Bar

Second Of Two Parts

Med Schools: Four That Flunk

BYLINE: JACK DOLAN; Courant Staff Writer

DATELINE: GUADALAJARA, Mexico --

GUADALAJARA, Mexico -- Peter Himonidis left Queens, N.Y., 30 years ago for medical school at the Autonomous University of Guadalajara because he didn't have the grades demanded by American schools. "If I got a 'C' in organic chemistry on my best day, I'd be lucky," he said. Today, Himonidis is not only a doctor, he's the chief salesman for Guadalajara's thriving trade as a last resort for would-be physicians who can't make the grade north of the border. From his comfortable, sun-filled office, where a cool breeze wafts in through a sliding-glass door, a dapper Himonidis warmly embraces a steady stream of mediocre students. He represents a profitable university, operated by a family that includes luxury resort developers, where Americans -- some with no college degree or Spanish-speaking skills -- get their MD's before heading back to practice in the United States.

Dismissing some 'A' students as overachievers better suited for a life on Wall Street, Guadalajara officials say their "altruistic" mission is to offer a medical education to middle-of-the-pack applicants unfairly denied their dreams by the high expectations of American medical schools. "We don't frown on someone with a 'B' average," Himonidis said. "We provide an opportunity for people who are determined to become doctors but are denied that opportunity at home." Less talked about is that catering to Americans who are desperate for a shot at becoming doctors generates a river of cash for the school. Foreign students pay the same tuition charged by public medical schools in the United States; Mexican students at Guadalajara pay half as much as their American classmates.

But, sometimes, the people who wind up paying the highest price for a Guadalajara medical education are the graduates' future patients. That's because graduates of Guadalajara are up to nine times more likely than doctors from the best schools to face disciplinary action from state medical boards and federal regulators in the United States, a Courant investigation found. The Courant analyzed national and state-level databases of disciplinary records for thousands of physicians and found that Guadalajara was among a handful of schools that produce a disproportionate share of troubled physicians.

While the vast majority of Guadalajara's graduates go on to practice without tarnished records, others -- such as Dr. Jose Nabut of Florida -- have dismayed courts and regulators across the country with their lack of preparation for the safe practice of medicine. Nabut seriously injured at least four patients using a surgical technique that plaintiffs' lawyers said he learned by practicing -- only once -- on a pig at a weekend seminar after graduation. One of those patients, Glenn O'Loughlin, required eight corrective surgeries after Nabut mistakenly stapled shut his bile duct during what should have been a routine gallbladder removal. Reached by telephone, Nabut refused to comment for this story. O'Loughlin said he was stunned to discover, much later, that Nabut had been accepted at Guadalajara without first earning a college degree. "If I had known any of that, I never would have gone to him," O'Loughlin said. "But when your insurance company refers you to a doctor, you just trust that they know what they're doing."

Commercial Mission

Unlike some small, notorious medical-diploma mills in the Caribbean that came under intense criticism in the 1980s, Guadalajara is a large, established university that has been supplying medical residents to understaffed American hospitals for decades.

Every spring , U.S. hospitals require thousands more trainee doctors than graduate from American medical schools. That gap is where Guadalajara has been making a living since the 1970s. "Go to any city, any hospital in your country, and you will find our graduates," said the school's dean of medicine, Dr. Ricardo Leon. The tuition for Americans, about $18,000 a year, is on par with medical schools at state universities in the United States and can be paid with loans from the U.S. Department of Education. In a country where the cost of living is comparatively low, the money coming in from U.S. students amounts to a windfall for the university, which is run by a wealthy Mexican family, the Leanos. One member of the large, influential family with varied business interests developed the Grand Bay Hotel and golf course, known as one of Mexico's most luxurious resorts.

Evidence of the commercialism at the heart of the medical school's mission can be found on the Autonomous University of Guadalajara's website, which is entirely in Spanish -- except for the section dealing with the medical school, which is entirely in English and clearly targeted at non-Mexicans. Although Guadalajara administrators consider a bachelor's degree "highly desirable" for students applying from the United States, it is not an absolute requirement. Americans and other internationals hoping to get licensed in the United States take the first two years of basic science courses at Guadalajara in special, segregated classes taught in English. But the final two years of medical sciences, which include lots of clinical, hands-on experience in a teaching hospital, are conducted entirely in Spanish.

Administrators promote the arrangement as one of the school's advantages over its American counterparts. Citing the emergence of Hispanics as the largest minority group in the United States, both Himonidis and Leon stressed that their graduates were particularly valuable to American hospitals. School officials say that 85 percent of the Americans who come through can understand enough Spanish to learn what they need to know. What happens to the rest is unclear. "You can't leave here without being bilingual," Himonidis said. In preparation for the final two years of Spanish-only instruction, students are expected to take language classes. Californians Dan and Krista Steffy, both studying at Guadalajara to become doctors, said they are studying "clinical" Spanish on the weekends, squeezing it in with all of their science courses. They're hoping to learn enough not to fall behind their Mexican and Puerto Rican classmates when they join the mainstream of the medical school in their third year. Both Dan and Krista landed in Guadalajara as a last resort. By their own admission, they had less-than-stellar undergraduate grade-point averages at Ventura College, where he studied engineering and she was on a nursing school track. And their Medical College Admission Test scores didn't help them much. "I did horrible on my MCAT," Krista said.

Loose Admissions

At least Krista had taken the MCAT, a prerequisite for getting into medical school. David Streckmann started at Guadalajara without having first taken the standardized test. After a failed attempt at starting his own business in Singapore, the 26-year-old Texan moved to Mexico last August, hoping to fall back on a career in medicine. He chose Guadalajara because his undergraduate grade point average was too low for most American medical schools.

He attributed those inadequate grades to a shaky freshman year and an intellectual aversion to the way certain science classes, including organic chemistry, were taught.

"The memorization of all the minutia of every reaction is pointless," Streckmann said.

Arriving in Guadalajara, he planned to study Spanish for a year, squeezing in some prerequisite science classes he hadn't taken in college before applying to the medical school. And,

he figured, he also needed time to prepare for his first shot at the MCAT.

But he had only been in Guadalajara for a few days when a student who was already enrolled there told him not to waste his time with all the traditional preparatory work, because the

university administrators are "very understanding." So, just days after arriving in Mexico, Streckmann paid for the first semester and started classes last August; as of March, he still

had not taken the MCAT.

Leon, the Guadalajara dean, insisted that the school never makes exceptions to its published admissions criteria, which include the usual complement of college-level biology,

chemistry and physics classes. Applicants from the United States also have to submit their MCAT scores, although no minimum score is specified.

"We cannot cheat on this kind of thing and accept them without all of the prerequisites," Leon said. "They have to take it [the MCAT]. Otherwise we're accepting someone who is going

to have a lot of problems in the United States when they go back."

When told that Streckmann got in without taking the test, Leon said that it was a decision by the admissions committee, which may have taken Streckmann's scores on a different test,

the Graduate Record Exam, into account.

"But it's really, really strange for me to hear this," Leon said. "In general, Americans have to fulfill all the requirement they would need for American schools."

Arrogant 4.0s

Administrators at Guadalajara were stunned to hear that their graduates have such a high rate of disciplinary action in the United States. Leon said he was at a complete loss to

explain it.

He said he never hears from state licensing boards about a graduate unless it's to verify that he or she indeed got a degree. He believes that the great equalizer among medical

schools is the fact that all doctors who want to practice in the United States have to pass the same licensing exam, no matter where they went to school.

Asked what percentage of Guadalajara graduates pass that exam on the first try, Leon guessed it was between 87 percent and 93 percent. But he couldn't say for sure because the

American board that administers the test, the Education Commission on Foreign Medical Graduates, has refused several requests from Guadalajara for the statistics.

"If we had some kind of feedback of where our students are weak, we could make some changes to support our own programs," Leon said.

Leon also said it's unfair to judge a medical school for a doctor's performance in a specialized field such as surgery because many of those specific skills are learned during a

post-medical school residency program.

"I don't know who to blame -- whether to blame Guadalajara or whatever residency program [the doctor] went to," Leon said.

Leon did not, however, think that the relaxed admission standards were the root of his school's poor showing in The Courant's analysis. On the contrary, both Leon and Himonidis said

the Guadalajara program is designed to produce doctors who are in touch with the compassionate, altruistic side of medicine -- an aspect of the profession both believe is too often

overlooked by hyper-competitive American schools.

"We are looking for a person with a true, true desire to help his fellow man," Himonidis said. "Anybody can read an MRI if you give them enough practice."

Many of the students who come to Guadalajara after failing to get into American medical schools got low grades because they didn't have much money when they were in college, Leon

said. They had to work while other students with rich parents had the luxury of studying without interruption.

Others got married or had children during those crucial early undergraduate years when grade point averages can be irrevocably damaged by the distraction. Such candidates often

show an aptitude during admissions interviews that is hard to discern from the raw data of grades and test scores, Leon said.

"We have had students come here with a 4.0 who have been arrogant," Leon said. "They should go make something on Wall Street, that's their place. Medicine is a career for

service."GUADALAJARA, Mexico -- Peter Himonidis left Queens, N.Y., 30 years ago for medical school at the Autonomous University of Guadalajara because he didn't have the

grades demanded by American schools.