A Virginia criminal case, while focusing on claims of fraud against the federal government, also has exposed a long-running and nightmarish pattern of what prosecutors assert has been a Chesapeake gynecologist’s rampant mistreatment of his patients, many of them women of color and poor.
Dr. Javaid Perwaiz is on trial because authorities say he “manipulated records to cover crimes that enriched him but endangered pregnancies, sterilized women unnecessarily, and pressured them into needless procedures to finance his lavish lifestyle,” the Washington Post reported.
The newspaper’s articles, as well as the efforts by the FBI and federal prosecutors to develop the charges against the jailed specialist, raise disturbing questions about not only Virginia medical regulators but also the hospitals where the gynecologist practiced and colleagues who have described a “frenzied environment in which hospital staff struggled to keep pace with Perwaiz as he rushed from procedure to procedure.”
Prosecutors say they pursued their case after receiving a hospital employee’s tip about Perwaiz. But the zeal with which he pursued his dubious practices was hardly secret. The criminal case against him involves more than two dozen patients. The Washington Post said it interviewed at least that number of women who claimed the gynecologist had medically mistreated them. The complaints about Perwaiz grew so pervasive that the FBI set up a web page to take tips and inform the public about the expanding case against the doctor. Authorities say hundreds of women have contacted them.
A history of problems
But, as the records show, Perwaiz already was known to authorities as a problem doctor.
As the Washington Post reported, he was convicted of tax fraud. He had been fired for surgical misconduct. He had multiple malpractice lawsuits filed against him (more on that in a second). The Virginia medical licensing board twice took him to task, censuring him first for his poor records and “lack of judgment” in engaging in a sexual relationship with a patient. That was regulators’ soggy response — so inept that their censure letter said they were “censoring” him (an entirely different activity) — to claims that the gynecologist “performed 11 hysterectomies on women in their 20s, 30s and early 40s without medical reason,” the newspaper reported.
That was not the end of the doctor’s legal skids:
“Perwaiz was charged with federal tax fraud for allegedly making $158,300 in personal purchases — including Oriental rugs, lingerie and porcelain fixtures — then deducting them as business expenses on his taxes, according to news reports. Perwaiz also allegedly bought a Mercedes-Benz and a red Ferrari, claiming them as ‘business malpractice insurance’ and an ultrasound machine. He pleaded guilty to two of six counts, a conviction that again brought him before the Board of Medicine in 1996. His medical license had been automatically revoked after his guilty plea, but the board reinstated it — this time with stipulations and supervision.
“While under the board’s watch, Perwaiz’s admitting privileges were briefly suspended then reinstated at Chesapeake General, now known as Chesapeake Regional Medical Center. Perwaiz also returned as a staff member at Maryview Hospital, which monitored his surgical cases. The hospital would later change its name to Bon Secours Maryview Medical Center and name Perwaiz its chair of obstetrics and gynecology…”
State authorities eventually re-established Perwaiz’s license in full, with the board writing to the doctor that it “wishes you well in your future endeavors.”
The doctor has defended himself by insisting he did no wrong. He asserts his galloping volume of tests and procedures made sense because he was so focused on his practice, in which he sought to be aggressive — in medically acceptable fashion — to ensure that women’s reproductive problems did not advance into cancers and other worse problems.
The hospitals where he practiced say they duly checked him out before awarding him privileges, and they cite privacy concerns in declining to discuss Perwaiz’s activities and the criminal charges pending against him.
The Washington Post, however, has reported on the pain, anguish, and sadness that torment Perwaiz’s patients, notably those he sterilized when they were young or left with lifetimes of suffering from what they say were rushed and botched surgeries. The women, many of them African Americans and many who had sufficient financial struggles that their care was Medicaid covered, said they feel betrayed and violated by the medical system in which they put great trust.
In my practice, I see the harms that patients suffer while seeking medical services, and the strength and courage it can take for them to find justice for wrongs inflicted on them by neglect and abuse in the health care system. As I have written, medical mistreatment of women is all too prevalent, and is a shame of the U.S. health care system. Gynecologists have become the subject of scandals involving hundreds of patients and hundreds of millions of dollars in damages paid to harmed young women at college campuses, including at Michigan State, the University of Southern California, and the University of California, Los Angeles. Unacceptable, too, are the gaping disparities in the quality and safety of medical care for African Americans — and especially black women.
Evidence of the inequities mounts by the day, with troubling reports from Stat, the science and medical news site, about: the rise of medical software and diagnostic algorithms that “infuses racism into U.S. health care,” or the challenges and isolation that black women experience when seeking infertility treatment. NBC News has posted a report on how the “odds are stacked” against black women with the diagnosis and treatment of breast cancer.
Missed or overlooked problems?
For all Virginians, however, cases like those involving Perwaiz surface critical issues about doctor oversight — by regulators, hospitals and clinics, medical colleagues, and those who pay health care costs (insurers and government programs like Medicaid and Medicare). With the current fee-for-service model that U.S. health care operates with, doctors and hospitals, alas, are too often rewarded for volume and not the safety or quality of the medical services they provide. When practitioners generate as many tests and procedures as Perwaiz clearly did, do red flags not go up — for nurses, other doctors, hospitals, insurers, and Medicaid and Medicare? Or, for example, do the suits with their MBAs prize high-volume doctors for the high revenue they generate for hospitals, labs, and other clinicians to whom they may make referrals?
Perwaiz, according to published news reports, was the subject of multiple malpractice lawsuits. They did not advance, but their presence could have provided yet another alarm about the doctor. As I have noted, doctors, hospitals, and insurers don’t like malpractice cases. But they can serve as an important way to spotlight bad practitioners, harmful practices, and systemic wrongs. A growing body of research underscores, too, that such cases are uncommon and few. It also is a slice of doctors who get sued, and studies find that these few practitioners all too often are seeing multiple malpractice cases filed against them and losing these claims. Criminal prosecutions of doctors, notably for the medical services they provide, tend to the unusual, and Perwaiz’s case focuses on prosecutors’ assertions not only about his bad treatment but claims about he wrongly charged government programs for unneeded tests and procedures.
The case, sadly, will be worth watching, especially as it provides a painful reminder of how much work we need to do to safeguard patients.