“Yes, I knew the 30-day requirement. I just couldn’t say no,” he said from the witness stand Thursday. “I’m an advocate for my patients.”
He said he performed the sterilizations in contradiction to the requirement to benefit his patients. Often, they had discussed sterilization with doctors who referred them. They told him, he testified, that their insurance would run out if he waited or that they could not get a ride or a babysitter on other dates. Asked during cross examination if he could name which of the patients in the indictments told him that their insurance was running out, Perwaiz could not.
Backdating forms is part of three broad categories of charges against Perwaiz. Prosecutors say he altered medical records to justify unnecessary surgery, often scaring women by mentioning the threat of cancer. They allege he changed due dates so he could induce women into labor on the Saturdays he was operating on other patients at Chesapeake Regional Medical Center. And they contend he billed insurers for office medical procedures done with broken equipment.
He is also charged with falsifying his application to health-care providers by omitting a felony conviction for tax fraud in 1996, which resulted in a brief suspension of his license, and failing to admit his loss of privileges at Maryview Hospital in 1983. Perwaiz, 70, has been jailed since his November arrest.
In a full day of testimony, Perwaiz, led by defense lawyer Emily Munn, defended the care he gave to the two dozen patients named in the 61 counts against him. In case after case, she broadcast his medical charts and the form he filed with Chesapeake Regional Medical Center before surgery. The charts were identified by the initials of the women prosecutors charge he operated on unnecessarily — D.B., D.P., A.G., T.D.C., A.F., A.N. S.N., D.B.D — and by their age and the complaints they wrote down, complaints several women who testified previously said were false.
In case after case, Perwaiz explained that the complaints by the women — often pelvic pain, bleeding and cramping — justified his procedures. Often, he said, women asked him to be sterilized. In none of the cases of women named in the indictments, Perwaiz said, did he refer them to other doctors after finding evidence of cancer.
During cross examination by Elizabeth Yusi, an assistant U.S. attorney, Perwaiz said due dates for patients were changed not for his convenience so he would be paid for the deliveries, but because he relied on a “range” of possible dates from several ultrasound examinations. The American College of Obstetricians and Gynecologists and Chesapeake hospital guidelines advise against inducing labor before 39 weeks without a medical reason, saying it leads to health problems for the baby. Chesapeake Regional Medical Center prohibited inducing labor before 39 weeks without a medical reason.
Perwaiz said his own research indicated no reason for that policy. “There is no difference in immediate morbidity and mortality” he told Yusi. “I find it not understandable that we enforce 39 weeks.”
He conceded that for each of the six patients with seven deliveries named in the indictments that his recalculation of the “range” indicated by ultrasounds produced an earlier date than the earliest ultrasound, considered by doctors to be the most accurate. In the case of A.B., who delivered two babies with Perwaiz, her due date for a 2018 pregnancy changed from Sept. 15 to Sept. 8 and he induced her on Sept. 1, when she was at 38 weeks. For a second pregnancy, her original due date was Nov. 10, 2019, later changed to Nov. 2. She was induced on Oct. 26 at less than 38 weeks. Both delivery dates were Saturdays when Perwaiz scheduled surgeries at the hospital.
Munn asked how many of the 33 patients whose babies he delivered during 2019 before his arrest were induced before their original due date. Perwaiz avoided answering, saying only that he did his own calculation based on a range of possible due dates. He testified that “only a few” did not deliver on Saturdays, when he was already at the hospital.
Due dates weren’t the only information Perwaiz testified that he changed on charts.
When staff members recorded a high blood pressure reading on patients, a potentially dangerous condition for pregnant women, they were required to write it only on a sticky note on the chart. Perwaiz then checked the blood pressure again, entering a lower number representing a normal reading. Asked why he didn’t admonish staffers or get them training, Perwaiz said he never considered it. “I knew I was going to do it myself,” he explained, so there was no need.
He also changed the results on glucose tolerance tests from high to satisfactory after speaking with patients. He testified they told him they had not been able to abide by the fasting requirements. Besides, he added, during the few times he sent them for a longer three-hour test, “most of the time it would be normal.” Glucose tolerance tests diagnose potential gestational diabetes, which can be a risk to mother and baby during pregnancy.
During cross examination by Yusi, Perwaiz said he hired only women to work in his office, usually without any previous medical-care experience. Rather than have patients fill out a form with their health history and complaints or have a staff member take that information, Perwaiz entered it himself.
He said he never used monitors inside operating rooms that projected his procedures so those assisting could view because they were not available when he trained. He tried them, he said, but didn’t have the eye-hand coordination required. Doing operations with the screens, he testified during questioning by Munn, was not as safe and took longer.
Prosecutors say the fraud scheme supported a lavish lifestyle that included purchasing a pair of Mercedes-Benz, a Jaguar, a $4,000 fur coat, and a $1,000 pen. Perwaiz denied that during testimony, though he conceded “I like shopping.”
In addition to the criminal case, several malpractice suits are pending against Perwaiz, who had offices in Chesapeake, south of Norfolk, and privileges at Bon Secours Maryview Medical Center and Chesapeake Regional Medical Center.
The criminal trial before Judge Rebecca Beach Smith continues Monday with Perwaiz under cross examination. The case could go to the jury late next week.
Perwaiz first became an OB/GYN and established his private practice in 1982. State records show he allegedly performed 11 hysterectomies on women that year without medical reason. Maryview Hospital fired Perwaiz citing “poor clinical judgment, unnecessary surgery, lack of documentation and discrepancies in recordkeeping,” and the Virginia Board of Medicine censured him for bad note-taking.
In 1995, Perwaiz was charged and later convicted of tax fraud. He briefly lost his license before it was reinstated. Two of the indictments against him allege the doctor made false applications to health benefits providers, failing to disclose his felony conviction.
He testified that he never attempted to hide his tax conviction and that he didn’t reveal the Maryview disciplinary action to insurers because it slipped his mind. “The only thing on my mind was the most recent one,” he testified. “It was not intended to hide anything.”