A 70-year-old obstetrician-gynecologist likely will spend the rest of his life in jail. A federal judge sentenced Dr. Javaid Perwaiz to 59 years’ imprisonment for a decade-long spree of enriching himself by practicing costly, unneeded, and harmful medicine on women in the Hampton Roads, Virginia, area.

As the Washington Post reported of the heinous acts that prosecutors proved at trial that Perwaiz committed:

“Several of [his] former patients testified that he performed procedures and surgeries they did not need — and that in some cases left them with permanent physical damage — so that he could collect their insurance money. Prosecutors said he gave his patients unnecessary, irreversible hysterectomies; improper sterilizations; and other procedures, including regular dilation and curettages that he called ‘annual cleanouts’ …  The doctor would perform diagnostic procedures with broken equipment, prosecutors said, and scare patients into surgery by telling them they had cancer when they did not.”

His motive was greed, the Virginian-Pilot reported from court testimony, noting:

“At trial, prosecutors argued the longtime OB-GYN took advantage of his patients’ trust and performed the unneeded work to fund a lavish lifestyle and buy pricey gifts for his mistress and employees. Many of his patients were low-income, poorly educated women on Medicaid … Prosecutors also are seeking to recover many of Perwaiz’s assets, which include a 4,300-square-foot home on Mill Stone Road in Chesapeake, his office buildings, a 2001 Bentley Arnage Red Label, a 1986 Mercedes-Benz 560SL Roadster, money in his bank accounts, and $2.28 million he earned while performing the unnecessary procedures. Earlier this year, prosecutors asked for a restraining order to prevent him and his associates from selling, transferring, hiding, or giving away his assets. The request was made after they discovered Perwaiz sold his 1986 Mercedes Roadster — considered a classic car — for $1 to the son of a close friend, according to court documents.”

The doctor, who previously had a serious run-in with licensing officials over his misbehavior, maintains his innocence. The Virginian-Pilot reported he expressed zero remorse for his criminal conduct in a jailhouse interview, in which he called patients suing him for malpractice “vultures” and characterized them in racial terms.

Perwaiz was convicted in November on 52 federal counts of health care fraud and making false statements. The infuriating aspect of his case, however, still turns on the question of how he was not stopped far earlier, long before he could cause such carnage.

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. The Washington Post 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.

The Washington Post also earlier reported this about the doctor and insurers he was convicted of bilking:

“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. With a history of medical misbehavior serious enough to warrant action by medical authorities, why were licensing officials seemingly unaware of Perwaiz’s misconduct — and sooner? While doctors, hospitals, and insurers may grouse a lot about medical malpractice lawsuits, this case may offer yet another excellent example of how brave plaintiffs may unlock professional silences that allow health care wrongdoing to flourish.

The Perwaiz case, by the way, offers yet another reminder as to why patients may want to take advantage of new laws that require doctors to provide them their health records online and on demand. This includes notes about their care. This information, which may not always be easy to understand and may even be accessible before reputable practitioners have had the chance to discuss distressing findings, 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.