Gynecologist guilty on U.S. charges, but questions linger about his practices

docofficegoogle-300x188A federal criminal case concluded with felony convictions for a Virginia gynecologist. But the questions are only now beginning as to how a doctor could have caused so many women so much harm for so long without other clinicians, hospitals, administrators, insurers, and regulators stepping in to stop him.

As the Washington Post reported, jurors took 2½ days to convict Dr. Javaid Perwaiz on 52 counts in what prosecutors alleged was his years of defrauding insurance companies by performing life-altering hysterectomies and other unneeded surgeries on women patients. He is scheduled to be sentenced in March, facing a maximum sentence of 465 years imprisonment.

His conduct, condemned and proven by prosecutors in a trial that ran for weeks, included “performing diagnostic procedures with broken equipment and scaring patients into surgery by falsely claiming they had cancer,” the newspaper reported, adding:

“Perwaiz was convicted of felony tax fraud in the 1990s. He also had a disciplinary letter from the Virginia Board of Medicine in the 1980s chastising him for bad note taking after he was fired from a hospital for allegedly performing 11 hysterectomies without medical reason. Perwaiz’s patients have spent the year since his arrest grappling with feelings of anger, betrayal, loss, and shame. Though hundreds of women requested their medical records from law enforcement, 29 patients were specified in court documents. Others have reached out to medical malpractice attorneys and have sought medical advice from new doctors about the validity of their care.”

Patients testified that Perwaiz lied to them about their medical needs and services he claimed to provide, filing records and claims full of falsehoods about women’s faked conditions and how they responded to his demand that they undergo tests and surgeries. Perwaiz argued that he acted aggressively to safeguard women from diseases, notably phantom cancers.

But nurses, who had described him carrying out a hectic schedule that colleagues found hard to keep up with, testified they had complained repeatedly to supervisors that Perwaiz was engaged in wrongful practices affecting patients. Among the issues they raised: His scheduling of women’s deliveries  — at his convenience and not necessarily when patients were due. Prosecutors made the case that Perwaiz acted to enrich himself and to fund “a lavish lifestyle that included purchasing a pair of Mercedes-Benzes, a Jaguar, a $4,000 fur coat, and a $1,000 pen. Perwaiz denied that during testimony, though he conceded ‘I like shopping.’”

The newspaper reported that he kept busy: “At the time of his arrest, Perwaiz had admitting privileges at Bon Secours Maryview Medical Center, and Chesapeake Regional Medical Center. He also had two private practice offices in Chesapeake.”

The hospitals have said they checked the doctor out appropriately before granting him privileges. But they have declined further comment as the criminal case against Perwaiz had proceeded and medical malpractice cases have been filed against them. Bon Secours earlier was known as Maryview Hospital, and administrators there had known of Perwaiz’s previous, serious medical licensing problems because they agreed to monitor his cases for a time. Later, though, the hospital would name Perwaiz as its gynecology and obstetrics chair.

During his trial, significant questions arose as to why hospitals, clinicians, and insurers had not questioned Perwaiz’s practices, the Washington Post reported:

“Between 2010 and 2019, Perwaiz billed insurance companies more than $2.3 million for gynecological care partially justified by diagnostic procedures he never performed, prosecutors allege in the indictment. In testimony earlier in the trial, an investigator for Anthem Blue Cross Blue Shield said that, over a decade, more than 41% of Perwaiz’s patients had surgical procedures compared with 7.6% for the other 628 obstetrician/gynecologists that billed the company.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the great courage and persistence they must muster if they seek justice for damages inflicted on them by health providers. Women long have suffered disproportionate injury from the medical establishment, and the Perwaiz conviction shines yet another harsh light on the secrecy and shame that has allowed gynecologists, notably at colleges and universities, to engage in wrongdoing for years against huge numbers of women before others intervene.

Federal authorities, while building the case against Perwaiz, fielded so many claims about him that they took the rare step of setting up a web page for complainants. The weeks-long case against him involved more than two dozen women, while news media reporting on the matter quickly had dozens of sources. Prosecutors had said they knew of 175 women who contacted federal authorities about him.

While doctors, hospitals, and insurers may grouse a lot about medical malpractice lawsuits, this case may offer yet another excellent example on how brave plaintiffs may unlock professional silences that allow health care wrongdoing to flourish. Plaintiffs’ pursuit of justice in the civil system can lead to important system reforms of medical wrongs. Did Virginia regulators, who already knew about Perwaiz, field complaints anew about him — and what was done? If angry nurses did the right thing and red-flagged this doctor, repeatedly, what did their bosses and hospitals do about the complaints? If insurers saw jarring numbers about one practitioner out of hundreds performing an extreme number of tests and major surgeries, did the companies express concern?

The Perwaiz case, sadly, offers yet another reminder as to why patients may routinely want to request and read their own health records, especially the notes that doctors write about them. This can provide an early warning of problems with a practitioner. But we clearly have lots of work to do, so widespread harms do not get buried in silence, or dealt with when far too many patients have suffered lifetime harms.

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