An ob-gyn in Virginia performed unnecessary surgeries on patients for decades. When his victims learned the truth, they fought back.

By Rae Nudson

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1.

Debra* had hoped that her medical nightmares were over. In 2009, she was diagnosed with breast cancer that had spread to her lymph nodes. The disease was estrogen positive, which meant that it was feeding on her reproductive hormones. After six months of chemotherapy and a double mastectomy, the cancer was declared in remission. To keep it that way, doctors put Debra on tamoxifen, a hormonal drug used as a prophylactic against certain types of breast cancer. She expected to be on it for about five years.

*Asterisks denote pseudonyms.

Debra has a wide smile, dimples, and thin, arched eyebrows. She likes high heels and she likes to talk. She used to work as a hairstylist, a job well suited to someone who falls easily into conversation with strangers. She is also a mom to two boys, and always wanted more kids. Patients on tamoxifen are advised against becoming pregnant; Debra, who was in her early forties when she started taking the drug, planned to conceive once she’d completed treatment.

Then, about halfway through her tamoxifen regimen, Debra got a letter in the mail with bad news: The results of her latest pap smear were abnormal. She had undergone the procedure, which involves scraping cells from the cervix, during a routine visit to a Veterans Affairs medical center near her home in Portsmouth, Virginia. (Debra was in the Air Force from 1988 to 1992.) An abnormal pap can indicate the presence of cancerous or precancerous cells; follow-up testing is usually recommended.

Debra knew that even with the tamoxifen, there was a risk that her cancer might come back, possibly in a part of her body other than her breasts; oncologists call this a distant recurrence. So she took the pap results seriously. When the VA referred her to two ob-gyns, Debra reached out to both. One had a monthslong waiting list, but the other had immediate availability. His name was Javaid Perwaiz. 

Dr. Perwaiz’s main practice was in a small redbrick building near a strip mall in the city of Chesapeake. The parking lot had 14 spaces, including one for handicapped drivers, and cars came and went in quick succession. Perwaiz had a reputation for working fast: An established patient could expect to arrive for an appointment and be back in their car in under 15 minutes. The waiting room was small, with a vaulted ceiling, a bank of windows, and walls painted a soothing mauve. Many of Perwaiz’s patients were Black women on Medicaid. Debra fit that profile.

When she met Perwaiz in July 2012, Debra felt confident about him as a doctor. He was in his early sixties and short, with a thick, well-groomed white mustache, bushy eyebrows, and a comb-over. During appointments he wore a white coat. He was matter-of-fact but not cold. He remembered details about his patients’ personal lives and asked about their loved ones.

According to Debra, after performing some tests, Perwaiz told her that she had precancerous cells on her cervix that would likely develop into cancer. He said that there was no drug she could take to stop that from happening. Given her history of breast cancer, he recommended a hysterectomy.

Debra was shocked and scared. She didn’t want to lose her ability to have more children. But she also wanted to live to see her sons grow up. After subsequent appointments with Perwaiz, during which she underwent additional tests, she agreed to have surgery, but said that she didn’t want her abdomen cut open. The doctor who performed the C-section during the birth of her first son had used a “beautiful subcutaneous suture” to close up the incision, resulting in a faint scar. “You couldn’t even tell that I’d ever had a surgery,” Debra told me. She wanted to keep her stomach the way it was. According to Debra, Perwaiz assured her that he could perform the surgery through her vagina; no abdominal incision would be required.

Debra trusted what Perwaiz told her. From their conversations, her understanding was that he would remove only her ovaries, because decreasing the estrogen in her body might diminish the risk of her cancer recurring. In fact, a hysterectomy by medical definition involves the removal of the uterus. But Debra didn’t know this going into surgery, because, she said, Perwaiz never explained it to her.  

On the morning of December 29, Debra arrived at Chesapeake Regional Medical Center and filled out the required paperwork for her procedure. One of the nurses was someone she knew from church, a friendly face. Then Debra was prepped for the operating room and given the sedative propofol. Hospital staff were wheeling her on a gurney down a hallway when she saw Perwaiz.

“What time do I need to tell my friend to come back and pick me up?” Debra asked him.

“That’s not the surgery you signed for,” she remembered Perwaiz replying.

She wasn’t sure what that meant. The propofol was making her sleepy. Then everything went dark.

When Debra woke up in a recovery room, she knew something was wrong. Groggily, she moved her hands to her stomach. She found tape covering an incision. Debra didn’t understand. She began to cry.

She was discharged the next day, and only then did it fully sink in: Perwaiz had performed an invasive surgery, slicing into her abdomen. Within a few days, Debra felt persistent, agonizing pains in her lower belly. The area also became swollen and tender. Debra was alone most of the time—her elder son had already moved out, and the younger one was in school during the day. She had trouble getting out of bed.

Debra called Perwaiz’s office for a prescription to help with the pain. When the medicine didn’t work, she called again. According to Debra, she spoke with Perwaiz directly. “Women all over the world go through this,” he told her. “You are just going to have to get used to the pain.” She was so out of it that she let the comment go. “I didn’t have the wherewithal to chew his head off,” she told me.  

One day a friend called to check on her and was alarmed to hear Debra cursing and not making sense. The friend drove to Debra’s house, and when nobody came to the door, she persuaded the landlord to open it. Inside, Debra was lying down; her skin was turning blue, and her stomach was so distended that she looked nine months pregnant. Her friend called 911, and an ambulance rushed Debra back to Chesapeake Regional.

Debra wondered if she was dying. In her head, she could hear a hymn her grandmother used to sing: 

I know it was the blood,

I know it was the blood,

I know it was the blood for me;

One day when I was lost

He died upon the cross,

I know it was the blood for me.

At the hospital, Debra learned that Perwaiz had removed more than her ovaries: Her uterus, cervix, and fallopian tubes were gone too. A diagnostic scan showed that a large amount of fluid had built up in her abdomen, and labs indicated that she had severe acute renal failure. There was also a perforation in her bladder—one of six, she later learned, made during her surgery. She was in sepsis.

Debra remained in the hospital for several days. She slipped in and out of consciousness. At one point she thought she saw Perwaiz at the foot of her bed. He looked nervous to her; his hands were clasped. “He might have been praying, ‘Please live,’ ” Debra said.

Debra knew about the history of coerced sterilization in America, of doctors persuading women of color to undergo unnecessary hysterectomies or performing the surgeries against their will. She couldn’t help but see her case in that context.

She did live. She had to wear a catheter for several weeks, but she got better. The long recovery gave Debra time to think on what she wanted to do about the man who had hurt her. “I’m gonna get this motherfucker—that’s how I was feeling in my head,” she said. “You don’t want to mess with me. I got teeth. I spit sulfuric acid.”

She requested her medical records and was stunned to find discrepancies with what Perwaiz had said to her during appointments. Most glaringly, she didn’t see any mention of precancerous cells on her cervix; the tests Perwaiz performed on her had come back normal. “If I was normal,” Debra said, “why did I have a surgery?”

There were other inconsistencies. One form from an appointment described Debra complaining of back and pelvic pain, which she told me she never did. Another document dated the day before her surgery stated that she “insisted on having those ovaries removed through the abdominal wall incision and not vaginally,” and that the “consent obtained after entirely counseling the patient [was] for abdominal hysterectomy.” In fact, she had requested the opposite surgical approach, and she recalled no such conversation with Perwaiz; the only time she’d spoken with him in the lead-up to her procedure was in passing in the hospital hallway.

Debra was sure she had a malpractice case. She went to several lawyers, but none of them would take her on as a client. “So many men—man after man saying, ‘You had a decent amount of care, and that’s all you’re afforded,’ ” she said. Frustrated, she came up with a new plan: “I said, ‘Alright, I’m going to learn how to sue this bastard myself.’ ” (Perwaiz declined to comment for this story.)

Debra enrolled in a paralegal program at Tidewater Community College. She learned how to research case law, how to write briefs, and how to file a suit. She didn’t have an Internet connection at home, so she used a law library at a nearby university to access everything she needed. She meticulously highlighted key phrases in her medical records and made notes in graceful cursive. When requesting materials for her case from health care providers, she signed emails “respectfully,” but she was not sorry to bother anyone. She followed up. She was tenacious. To get anything done, she knew that she had to rely on herself. “I was now acutely aware that people can’t be trusted,” she said.

As it is in much of the U.S., the statute of limitations for malpractice in the state of Virginia is two years from the date of occurrence. Debra filed her suit on December 23, 2014, six days shy of the cutoff. She asked for $1.5 million in punitive damages and to be compensated for loss of enjoyment of life, loss of the ability to reproduce, and diminished sexual intimacy, as well as lost wages and medical expenses.

Someone told her to file the suit in state court, but Debra declined. She knew about the history of coerced sterilization in America, of doctors persuading women of color to undergo unnecessary hysterectomies or performing the surgeries against their will. She couldn’t help but see her case in that context. She believed that the suit belonged in federal court because Perwaiz had violated her most fundamental rights.

A judge disagreed. In January 2015, Debra was asked to provide a valid reason why hers should be a federal case, and not one decided by a lower court. She responded with documentation explaining her position, but that May her case was dismissed for lack of jurisdiction. She appealed the decision, until one day she missed a filing deadline. According to Debra, she hadn’t received paperwork she needed to complete until the day before it was due, and there was no way she could get it to the court on time.

Just like that, her legal campaign to hold Perwaiz accountable was finished. But there were more patients like Debra, more women Perwaiz had injured. There were numerous dots waiting to be connected—someone just had to come along and do it.

2.

Javaid Perwaiz was born in a village in Pakistan that had no electricity or running water. He went to college, then medical school, graduating in 1973. He moved to the United States the following year, alone and knowing very little English. He worked as a surgical assistant at a hospital while he applied to be a medical resident. After completing his residency, he took a job at a private practice in the Portsmouth area, sharing an office with two other physicians. He struck out on his own in 1982.

If his online reviews were any indication, over the next thirty-plus years Perwaiz amassed a devoted following of patients. “Dr. Perwaiz is amazing. I had an issue that previous Dr’s kept putting off and he scheduled surgery for it immediately,” one review read. “He listens, he’s very understanding, and I’d never go anywhere else.” Some reviewers stated that Perwaiz had delivered both them and their children. “I love you and my family does as well,” another wrote. Perwaiz, that reviewer continued, will “go down in history as the best.”

All of Perwaiz’s staff were women, and they were fond of him, too. It helped that his practice did very well: He saw a lot of patients, many of whom underwent surgery, and money rolled in. Perwaiz took his staff to nice restaurants. He wrote their names in red ink on their birthdays in his appointment book so he wouldn’t forget to buy them gifts, often expensive flower arrangements. He sometimes paid for employees’ vacations or bought them chic accessories. The staff joked that after insurance clerk Diane Coleman became visibly upset about something that happened in the office, she could expect a new purse from Perwaiz in the next few days.

If Perwaiz had a deputy in the office, it was Margo Stone, who graduated from nursing school in 1985 and started working for Perwaiz a few years later. For a time, Stone and Perwaiz were romantically involved, and Perwaiz became close with Stone’s two sons. The romance didn’t last, but Perwaiz remained an important part of the lives of Stone and her boys. They celebrated holidays and birthdays together. Perwaiz had the license plate for one of his cars customized to bear the boys’ initials. One of the sons recorded the outgoing message on Perwaiz’s phone. “You have reached Henry and John’s papa,” he said.

Perwaiz regularly gave Stone gifts, including several watches worth about $2,000 apiece. The pair also shared an American Express card, and Perwaiz helped pay for Stone’s sons’ education. Over the years that they worked together, the gifts, tuition, and other financial assistance Perwaiz gave Stone added up to several hundred thousand dollars. (Stone declined an interview request.)

In addition to seeing patients in her capacity as a nurse, Stone took on administrative duties at Perwaiz’s practice, including maintaining the payroll and keeping medical supplies stocked. The staff treated her as a go-between, someone they could talk to if they wanted something changed at the office. Perwaiz respected Stone’s opinion; he listened whenever she made suggestions.

It was Stone the staff turned to about Perwaiz’s approach to sanitizing medical devices. One of the procedures he often performed on patients was a hysteroscopy, which involves inserting a long, thin tube with a light at the end through the vagina and cervix to examine the uterus. Hysteroscopies are used to diagnose and, when necessary, remove polyps, fibroids, and other growths that cause gynecological issues, including abdominal pain and vaginal bleeding. Per office protocol, the scopes Perwaiz used in these procedures were supposed to be sterilized between uses, a process that took 12 to 15 minutes. But Perwaiz sometimes didn’t want to wait that long. According to Lisa Strong, a medical assistant, on busy days Perwaiz told her to just rinse the scopes between appointments.

The staff approached Stone about the matter, and she took it to Perwaiz. He agreed to abide by the rules. Above the sink where the scopes were cleaned, an employee placed a yellow sticky note with “soak for 12 minutes” written on it in large bubble letters.

Time was of the essence because Perwaiz performed a lot of hysteroscopies—so many, in fact, that he became the subject of an insurance inquiry. In July 2012, a week prior to Debra’s first appointment with Perwaiz, an employee at Optima Health raised an internal alert: The insurance company had recently received two suspicious requests from Perwaiz’s office for approval of hysteroscopies. In one instance, the patient had undergone the same procedure three weeks prior, yet nothing in Perwaiz’s clinical notes acknowledged it or indicated a change in the patient’s status that would necessitate another so soon. In the second instance, Optima denied the request because the patient’s medical records showed no justification for the procedure: There wasn’t documentation of heavy bleeding, for instance, or of the failure of more conservative treatments to resolve the patient’s issues. The same day Perwaiz received Optima’s reply, he asked the insurer to reconsider, and he provided a note that mirrored its concerns exactly. He said that the patient was bleeding all the time, and that neither oral contraceptives nor anti-inflammatory pain relievers were helping.

Optima, which has since changed its name to Sentara Health Plans, opened an investigation into possible “overutilization,” the insurance industry’s term for medically inappropriate care. Over the next several months, the company compiled some troubling data on Perwaiz’s practice. Nearly 11 percent of Perwaiz’s patients received a diagnostic hysteroscopy (an examination), and 12 percent underwent a surgical hysteroscopy (the removal of tissue), while other ob-gyns in Virginia who took Optima plans performed those procedures on just 1 percent of their patients. While 44 percent of Perwaiz’s patients who had a diagnostic hysteroscopy went on to have a surgical one, among his peers this happened so infrequently that the figure wasn’t statistically significant. Optima also reviewed the medical records of 20 of Perwaiz’s patients, chosen at random, and found that half contained discrepancies between Perwaiz’s notes and observations about procedures, and the pathology reports that came back from outside labs.

According to the National Health Care Anti-Fraud Association, “Performing medically unnecessary services solely for the purpose of generating insurance payments” is one of the most common types of medical scams. Another is “falsifying a patient’s diagnosis and medical record to justify tests, surgeries, or other procedures.” But was Perwaiz committing fraud, or was he just a bad doctor—sloppy perhaps, and overzealous too?

Greg Merti, a medical director with Optima, visited Perwaiz’s practice in May 2013 to speak with him about the investigation’s findings. The pair met in Perwaiz’s private office. Hanging on the wall were photos of Stone’s sons. Perwaiz had a massive wooden desk with a file tray and lamp. Notably absent was a PC—Perwaiz refused to use one, preferring to keep patients’ files in paper form. His staff were tasked with anything that required a computer, including filing insurance claims, updating hospital records, and renewing Perwaiz’s credentials with the state.

The two men spoke for just under an hour. Merti told Perwaiz that he was an outlier in terms of the number of hysteroscopies he performed. Perwaiz defended his decision-making, but he also expressed an interest in improving patient care and being transparent with Optima. When Merti suggested implementation of an “improvement plan,” Perwaiz was receptive. Merti later stated under oath that he took Perwaiz “at his word.” Whether or not the topic was broached, an improvement plan likely would have saved Optima money, since Perwaiz billed the company every time he performed a procedure on a patient covered by one of its plans.

Two years later, in 2015, Optima ran numbers on the costs and performance of its in-network providers. The results showed that Perwaiz was still an outlier: He was in the 97th percentile of doctors doing hysteroscopies, hysterectomies, and transvaginal ultrasounds, meaning that only 3 percent of providers in Optima’s network performed those procedures more often than he did. Merti spoke with Perwaiz again and told him that if he wished to change his approach to patient care, he could reach out for assistance. According to Merti, Perwaiz never did.

In a statement, Dale Gauding, a spokesperson for Sentara Health Plans, said the company “followed best practices” in its communications with Perwaiz. “There are strict criteria for peer review interventions,” Gauding said, “and utilization issues are not reportable to the state Board of Medicine.”

Perwaiz performed hysteroscopies at his private practice, but more complex procedures required using facilities at a hospital or surgery center. On Saturdays, Perwaiz had surgical privileges at Chesapeake Regional, meaning that his background and credentials had been screened and he was approved to operate at the hospital. It was a standard arrangement: Chesapeake Regional made money by billing a patient’s insurer for costs associated with Perwaiz’s use of its facilities.

One of the nurses Perwaiz worked with at Chesapeake Regional was Lisa Atkinson. At first, Atkinson had a good impression of Perwaiz, finding him pleasant and professional. She also saw that he worked much faster than other surgeons. His hysterectomies took between 20 and 30 minutes, while other providers required at least an hour. He packed his schedule too; no ob-gyn came close to performing as many surgeries at Chesapeake Regional. According to data compiled by the hospital, in 2017 Perwaiz performed 220 surgeries there. The next-highest number for an ob-gyn operating at the facility was 150.

By then, Atkinson’s opinion of Perwaiz had shifted. It started with a concerning encounter she had with him in 2014. One of Perwaiz’s patients came in for what was described on the day’s surgery schedule as the removal of her uterus, cervix, fallopian tubes, and ovaries. This conflicted with the patient’s consent form, on which she had agreed to have only her uterus and cervix taken out. “We are not doing the ovaries?” Atkinson asked the woman directly. “Nope,” she replied. Atkinson assumed that there was an error on the surgery schedule, the kind of thing that’s usually cleared up before an operation begins.

After the patient was under anesthesia, Perwaiz completed his pre-op paperwork, then the surgical team assembled for what’s known as a time-out: Before an incision is made, everyone in the operating room discusses the specifics of the procedure, whether the patient has any allergies or known health risks, and other crucial matters. It was during the time-out, when Atkinson was looking at the paperwork Perwaiz had just finalized, that she noticed a change on the patient’s consent form. Since she’d last seen it, the words “bilateral salpingo-oophorectomy”—the medical terminology for the removal of the ovaries and fallopian tubes—had been added in small, swooping letters in the right margin. The handwriting was Perwaiz’s.

When Atkinson asked about the addition, Perwaiz readily admitted to making it. Legally, Atkinson knew she needed either the patient or a designated proxy to sign off on the change to the form before surgery began, so she went to the waiting room to speak with the patient’s husband. According to Atkinson, the husband assumed that ovary removal was part of a hysterectomy. Atkinson explained that it was not. “Well, if it has to be done,” the man replied. He deferred to his wife’s doctor and signed the form.

After the surgery, hoping to gain more clarity about what had happened, Atkinson spoke with two pre-op nurses who had worked with the patient. They told her that the patient had been adamant that she wasn’t having her ovaries removed—not casual about it, like when Atkinson spoke with her, but definitive. The next day, Atkinson sent an email to her supervisor. “I feel as though we performed an assault on the patient if she truly did not want to have her ovaries removed. This just really bothers me,” Atkinson wrote. “I suppose we are covered by having her husband sign the consent, but it should have never come to that.”

Atkinson never learned what if anything the hospital did with the information she provided, or what happened with the patient. All she knew was that Perwaiz kept operating at Chesapeake Regional, which meant that she kept working with him. (The hospital declined to comment for this story.)

Other nurses raised red flags about Perwaiz. On alternating Fridays, he operated at a facility called Bon Secours Surgery Center at Harbour View. Some doctors who use Harbour View have an ownership share in the business, and Perwaiz was among them; his photo was mounted on an interior wall. Nurse Jean Kennedy found Perwaiz’s routine chaotic. He’d regularly perform between ten and fourteen surgeries per day, while other surgeons at Harbour View typically did two or three. Patients tended to arrive at the same time, early in the morning, as if they’d all been scheduled simultaneously, and it was left to the nurses to figure out how to slot the procedures. Perwaiz was known to work in two or three rooms at a time, shuttling from one anesthetized patient to another, and to begin filling out post-op charts before surgery.  

The staff called these operating days “Perwaiz-a-thons.” The pace worried Kennedy. “To me, it was an open[ing] for risk of mistakes, errors,” she later stated under oath. Kennedy and other Harbour View employees spoke to their supervisors about their concerns, and around 2009 there was a staff meeting where nurses reported that they didn’t like how fast they were asked to work when Perwaiz was on the schedule. They also said that some of his patients didn’t seem to know what kind of surgery they were having.

Perwaiz wasn’t at the meeting, but the administrator of Harbour View was. So was his boss, the regional coordinator for United Surgical Partners International, which owned the facility. Afterward, according to hospital staff, the Perwaiz-a-thons continued. Staff were told to fill out incident reports when something happened that seemed like cause for concern.

In a statement, a spokesperson for Harbour View said the facility was “unaware that Perwaiz was performing medically unnecessary procedures on his patients,” and noted that “his medical license, as granted by the state of Virginia and subject to review by the Medical Board of Virginia, was unrestricted and in good standing” for the duration of his time working at the surgery center.

Jen wanted to start seeing a gynecologist, but as anyone who’s ever been to one knows, the initial appointment can be especially stressful. You have to take off your clothes and open your body and your life to a stranger.

Perwaiz wasn’t just performing surgeries on a lot of patients—in some cases, he was performing a lot of surgeries on a single patient. Carol White, a nurse at Harbour View, saw this pattern plainly. Before the surgery center switched to computerized charts, staff added a sticker to a patient’s file when they came in for a procedure. White found it odd that there were long rows of stickers in the records of some of Perwaiz’s younger patients, who were statistically less likely to require multiple gynecological surgeries.

One of the patients who had multiple surgeries with Perwaiz was Jen*, who moved from New York City to Virginia in 2006. She wanted to start seeing a gynecologist, but as anyone who’s ever been to one knows, the initial appointment can be especially stressful. You have to take off your clothes and open your body and your life to a stranger. Topics of discussion are immediately intimate: Do you want to have children? How many sexual partners do you have? Have you ever had a sexually transmitted infection?

Jen felt like she’d be in good hands when a coworker recommended Perwaiz. The coworker had been a patient of his for years; he had delivered her kids. Jen made an appointment.

Jen was glad to see a diverse group of patients when she arrived at the office: old and young, pregnant and not, white and also Black like her. She liked Perwaiz right away. “He was super cool, very easy to like,” she told me. Over time she noticed that he had expensive taste in cars. She’d see his Mercedes in the parking lot, or his Jaguar.

Her first surgical procedure with Perwaiz took place about a year after she became his patient. After doing an exam, he told her she had HPV and recommended removing abnormal tissue he’d identified. He set up an outpatient appointment for her.

A few years later, in 2012, Jen told Perwaiz that she was experiencing abdominal discomfort, and after she had an ultrasound, he told her that she had a fibroid. He put her on birth control, a common treatment for the symptoms of fibroids, which include pain and bleeding. When that didn’t help, Perwaiz suggested that she might have endometriosis, a condition where tissue similar to the kind lining the uterus grows elsewhere in the body. Endometriosis can cause intense pain as well as infertility, and sometimes the only way to diagnose it definitively is via a surgical procedure known as a laparoscopy: A doctor makes a small incision in the abdomen, then inserts a scope to look for evidence of the disease.

According to a recent study in the journal Obstetrics and Gynecology, it can take patients as long as 11 years to finally be diagnosed with endometriosis. In part, researchers found, this is because of the normalization of gynecological pain: Patients and health care providers alike often see this kind of discomfort as a fact to be tolerated, not a condition to treat. Moreover, some doctors lack sufficient knowledge of endometriosis to help patients who suffer from it. Yet here was Perwaiz taking what Jen said seriously and offering to help her. She agreed to have the laparoscopy.

Not long after scheduling the procedure, Jen had an appointment at her general practitioner’s office. She told the medical assistant that she was having a laparoscopy soon. The assistant asked who her doctor was. After Jen gave Perwaiz’s name, the assistant said something she found strange: “Everybody I know who goes to him has to get that same surgery.”

Based on the laparoscopy, Perwaiz diagnosed Jen with endometriosis. From then on, it felt to Jen like every time she saw Perwaiz, he told her she needed another procedure. She got fibroids and cysts removed. She began to feel anxious whenever she had an appointment, to the point that she sometimes had to take a Xanax to calm down. “I was just afraid that he was going to tell me I needed surgery again,” she said.

In 2018, when Perwaiz told her that she had another cyst, Jen said she didn’t want it removed. She was done with surgeries. She asked what would happen if she didn’t have the procedure. Perwaiz told her that he could monitor the cyst to see if it grew. Jen hadn’t realized that this was an option; she couldn’t recall Perwaiz informing her about it during previous appointments.

About a year later, she had an ultrasound at Perwaiz’s office. Afterward he told her that the cyst was gone. Jen was glad, but later she wondered: If a cyst could resolve on its own, had Perwaiz really needed to remove all the others?

In mid-2019, a patient came into the waiting room and began yelling that all Perwaiz wanted to do was cut people open. The woman was put in an empty exam room, and Perwaiz told staff that she just wanted more pain medication, that she was an addict.

The medical technician who performed the ultrasound on Jen was Courtney Ciccone. But Ciccone was more than Perwaiz’s employee: She was also his patient. In fact, Perwaiz treated several of his staff. He also treated some of their family members. Lisa Strong, the medical assistant Perwaiz once instructed to rinse scopes instead of sterilizing them, recommended that her mother start seeing him.

Strong would later testify that she did this in spite of growing unease about her boss. She was often in the room when Perwaiz saw patients, and she noticed that he sometimes put a detail in a chart that didn’t correspond with what had happened in an appointment: He’d write that a patient’s menstrual cycles lasted longer than they reported, for instance, or list a lower blood pressure reading than what Strong had measured. Still, she thought Perwaiz was a good doctor. “I felt that he would take good care of my mother, which he did,” she said under oath. “And with me being there to, I’ll just use the word oversee things, not that I even really had to with her, I felt comfortable.”

In 2016, Strong’s adult son died. She took time off work to grieve, and her mindset about Perwaiz changed. She felt guilty for sensing that things weren’t right at the practice and not acting, and she decided that she had to quit. It was a difficult choice; she needed the job. But she finally gave notice in the summer of 2018.

Before she left, Strong spoke regularly with Diane Coleman regarding her concerns about Perwaiz. Coleman, who handled insurance claims for the practice, had some of her own. From her desk, she sometimes heard patients in the hallway make comments about having to get yet another surgery. She knew that most of the patients who had repeat surgeries were on Medicaid. In mid-2019, a patient came into the waiting room and began yelling that all Perwaiz wanted to do was cut people open. The woman was put in an empty exam room, and Perwaiz told staff that she just wanted more pain medication, that she was an addict.

Coleman later stated under oath that Chesapeake Regional at one point asked Perwaiz to start scheduling and billing abdominal hysterectomies as inpatient procedures, since they usually required an overnight stay post-op. Perwaiz didn’t want to do this, because insurance companies took longer to authorize inpatient procedures; calling them outpatient made for less hassle. According to Coleman, Perwaiz said that if Chesapeake Regional didn’t like his approach, he’d take his surgeries elsewhere.

The sheer number of procedures Perwaiz performed meant that Coleman sometimes worked seven days a week doing data entry and filing insurance paperwork. On weekends, when Perwaiz was done with his surgeries, he’d typically text Coleman to let her know, so she could use her work laptop to enter post-op information into the hospital’s computer system. Doctors usually did this themselves, but Perwaiz had Coleman do it because of his aversion to computers. Among other things, he would tell her when he’d altered a surgical plan in some way, since it affected the bill sent to the patient’s insurance provider. Coleman noticed that Perwaiz’s changes almost always involved adding components or complexity to surgeries. A vaginal hysterectomy became an abdominal one; ovaries were taken out along with a uterus. In general, the more complicated a surgery, the larger the insurance reimbursement.

Coleman took issue with the way Perwaiz worked, and she thought that he didn’t always give her the respect she deserved. She was feeling particularly stressed and underappreciated in September 2019, when an FBI agent knocked on her door. The bureau wanted to talk to her about her boss. Coleman immediately said that Perwaiz was an asshole.

By then federal agents already knew that at least one other person felt the same way: Debra.

3.

The FBI declined to comment for this story, and the bureau has never revealed exactly why it started investigating Perwaiz. All it has said is that, in 2018, an anonymous tip came in from someone at Harbour View—a nurse, perhaps, or another staff member suspicious about the Perwaiz-a-thons at the surgery center.

As the FBI began to dig into Perwaiz’s past, it found a complaint Debra had filed with Virginia’s medical board as part of her quest to hold Perwaiz responsible for performing surgery on her that she didn’t want. In February 2019, Debra got home from work and found a business card on her front door from an FBI agent, along with a note requesting that she get in touch. Debra didn’t know what the feds wanted with her, but she figured it must be serious. She called right away and made an appointment to visit the bureau’s Norfolk office.

When she arrived, Debra found a district attorney and two investigators waiting for her; all three were women. When they told her they wanted to speak with her about Perwaiz, Debra broke down. One of the women handed her a tissue and told her to take her time. “They patted me on the back, they comforted me, and then they gave me hope,” Debra said.

It had been several years since her surgery, years when she’d felt utterly alone and furious that Perwaiz was getting away with malpractice. “I thought nobody was listening to me. I felt like the system had failed me,” Debra said. “But these three women picked up the ball and they ran with it. They made me feel like I was a part of it.” She told them her story and agreed to cooperate going forward.

By the time the FBI got to Diane Coleman’s door several months later, investigators were looking for current patient records. They wanted to prove that Perwaiz was still doing the kind of thing Debra claimed he’d done to her. At first, Coleman was hesitant to cooperate, but at the end of her conversation with the agent who visited her, she walked to her car and grabbed some documents; she was often so busy that she had to bring work home with her.

Coleman shared the documents with the agent. It felt like the right thing to do. Over the next several weeks, she provided investigators with additional materials, including at least one document Perwaiz had planned to destroy.

Perwaiz kept a bin under his desk, and whatever he put in it was supposed to be shredded by an employee once a week. The document Coleman came across was a standard patient-intake form; it had been filled out, but there was an X drawn across it. Coleman checked the patient’s file and found another copy of the form. She later testified that Perwaiz had “rewritten” the form, filling it in with “different” information: The version he wanted shredded indicated that the patient had no gynecological complaints, while the one on file described them reporting pelvic pain and pressure, persistent cramps, and irregular periods. Any of those symptoms might justify gynecological surgery. Coleman shared both versions of the intake form with the FBI.

Coleman also told agents about Layla*, a patient who in the past few months had experienced some serious health issues. Intermittent but severe uterine bleeding had landed Layla in the ICU, where she required transfusions. After her hospital stay she followed up with Perwaiz, who had been her ob-gyn since 2014. Based on a physical exam and an ultrasound in February 2019, Perwaiz told Layla that she had fibroids that needed to be removed, because they were large and might be cancerous. (The vast majority of fibroids are benign.) Perwaiz performed a procedure known as dilation and curettage to scrape the fibroids from Layla’s uterine wall.  

Layla went back to Perwaiz that September. She wasn’t having her period, which meant that she might not be ovulating, and she wanted to have a baby. Layla underwent an ultrasound on September 26, after which Perwaiz told her that she had a small fibroid he wanted to remove before it got any larger. (Fibroids can disrupt a person’s menstrual cycle.) Layla agreed to have the procedure the following month. 

But while reviewing Layla’s file, Coleman noticed that, in fact, her most recent ultrasound didn’t show any fibroids at all. Perwaiz had scheduled Layla for a procedure to remove a growth there was no evidence she even had. In the plainest of terms, he seemed to be lying. Coleman provided the FBI with a copy of the surgical plan for Layla’s procedure, along with the conflicting ultrasound results.

On October 10, investigators visited Layla at her home. They said that they had reason to believe Perwaiz was performing unnecessary procedures on patients, including her. They talked about what was in her medical file, the information that didn’t match up. In addition to the normal ultrasound results, Perwaiz had noted in her file that she was experiencing heavy, painful periods, when in fact she wasn’t menstruating at all.

The investigators asked Layla to call Perwaiz to talk about her upcoming surgery, to see what he said. The FBI would record the conversation. Layla was on hold with a receptionist for a few minutes before Perwaiz picked up the phone. “I have some quick questions for you,” Layla said.

She told him that her boyfriend wanted to know more about the surgery she was scheduled for. Could Perwaiz explain the procedure? Perwaiz told her that it was for fibroid removal. Layla then asked how long she’d need to be off work, since she was starting a new job. He told her one week. She asked why the recovery was longer this time than it had been for her last surgery.

“Because we’re making a bikini incision,” Perwaiz said, referring to a type of surgical cut in the abdomen.

“You didn’t cut me in that area last time, so why are you cutting me in that area this time?” Layla asked.

“Because we are removing the tumor. These are big tumors, you cannot remove them through [a] belly-button incision.”

Perwaiz was describing multiple large fibroids, not a single small one, contradicting what he previously told Layla about why she needed surgery. She had caught him in a lie.

“Are there any other options as far as the surgery?” Layla asked. “That sounds kind of scary.”

“Then don’t do it,” Perwaiz said. “We’ll cancel it and hopefully you get pregnant. How about that?”

Layla agreed, they said their goodbyes, and she hung up the phone.

On Monday, October 28, two special agents from the Department of Health and Human Services and the Virginia Medicaid Fraud Control Unit arrived unannounced at Perwaiz’s practice. The agents, Tamika Williams and Paul Hastings, were shown to Perwaiz’s private office, where they introduced themselves and showed him their credentials. They said that they had a complaint they needed to resolve, which required asking Perwaiz some questions.

They started off with a basic one: How many patients did he see in his practice? “Thousands,” Perwaiz replied. “I’ve been in practice for 39 years. One hundred patients a week, 400 maybe a month, maybe 5,000 a year.” The agents asked some more general questions about Perwaiz’s office and the types of procedures he did there, including hysteroscopies. Perwaiz described the procedure and answered questions about the equipment he used. Then he excused himself to see a patient.

When he got back to the office, Perwaiz abruptly ended the interview. “If there’s any complaint, I absolutely want that addressed,” he said. “But I don’t think I should answer these questions anymore. I have already probably answered too many.”

The next day, the FBI raided his office. Agents took medical devices and the contents of trash cans. They snapped photos. And they seized medical records, loads of them. They took more than 3,400 files from shelves in the front office and from a storage space in the attic. The material filled 80 bankers boxes.

After the raid, authorities assumed that because he was under investigation, Perwaiz would voluntarily stop seeing patients. But he didn’t. One of the women still in his care was Tessa*.

Tessa is an exuberant person—she likes to sing and is quick to laugh. She was once in an abusive marriage but got out with her three children. She went back to school and remarried, and soon she wanted to have a child with her new husband. Tessa was in her forties then, but other women in her family had had kids later in their reproductive years, so she thought she could, too. Then her general practitioner identified what might be a tumor in her uterus and referred her to Perwaiz.

At her first appointment, according to Tessa, Perwaiz looked at an ultrasound from her GP’s office and confirmed that she had a tumor. He told Tessa that if she didn’t have a hysterectomy soon, she would get cancer. She asked if there were other options, since she wanted to have another baby. Perwaiz said no.

Tessa’s mother, grandmother, grandfather, and uncle had all died within two years of each other. Her father had just survived his second bout with cancer. She was overwhelmed by the stress of all the illness and loss around her, and she worried about her kids being left without a family if something happened to her. She agreed to have a hysterectomy but decided to keep her ovaries. Her surgery was scheduled for October 19.

Tessa had complications from the operation almost immediately. She called Perwaiz’s office to let him know that she was going to need more than a three-day prescription for pain medication. She could tolerate a lot—she had delivered three kids, after all—but this was too much. Perwaiz told her to take two Tylenol.

Tessa didn’t get mad, just like she hadn’t when she was still in the hospital and Perwaiz told her, “Good luck having more babies.” However intended, it seemed like a cruel thing to say to someone who’d just had her uterus removed. But Tessa didn’t want to come off as a stereotypical angry Black woman, so she kept her mouth shut.

On October 26, Tessa’s postoperative pain got so severe that she went to the emergency room. When she explained her situation, staff members remarked that she’d seen “the weekend doctor.” Tessa didn’t know what that meant, so someone explained that they were talking about Perwaiz, “because he does so many surgeries over the weekend.”

Tessa went home the next day, but the pain didn’t go away. She also felt faint and short of breath. Her husband took her to the general practitioner who’d referred her to Perwaiz, and the doctor expressed surprise that Tessa had undergone major surgery so soon after Perwaiz first saw her.

The GP did an ultrasound, then sent Tessa back to the ER, where she had a CT scan. After reviewing the imaging, her doctor told Tessa that her ovaries were gone. Perwaiz had removed them, forcing her into early menopause. 

A few days later, in early November, Tessa was at home in bed recovering from the ordeal when Perwaiz’s face appeared on the local news. She screamed. Her husband, who was cooking dinner, ran into the room.

“What’s wrong?” he asked.

“This motherfucker is on TV!” Tessa said.

Perwaiz had been arrested. He was charged with just two counts: health care fraud and making false statements relating to health care matters. The prosecutor’s office expected that there would be more charges, but it decided to proceed with the first two to compel Perwaiz to cease practicing.

4.

One by one, Perwaiz’s patients learned of his arrest. Jen looked at a news site on her work computer and saw his face on her screen. Another patient got a text about Perwaiz from her cousin and thought, That’s weird—that’s my doctor’s name. It took a second for it to click: He was her doctor. Brittni DuPuy-German was one of the last patients Perwaiz ever saw; she had an appointment with him on November 7, the day before his arrest, and he’d scheduled her for surgery. She found out that he was behind bars when a friend texted her a news article.

Debra hadn’t told anyone she was talking to the FBI, but her loved ones knew about her effort to sue Perwaiz. When they heard about his arrest, they celebrated with her. Got him! they said. Debra agreed to be a witness at Perwaiz’s trial: She was ready to do everything she could to make sure he never saw another patient.

Within weeks of Perwaiz’s arrest, the FBI was contacted by hundreds of people he’d treated. Some were sure they’d had surgeries they didn’t need. Others were just now realizing that might be the case. Many didn’t know what to think, but were scared. “This man may have very well taken any ability I had to bear children of my own forever,” one email stated. Another read, “I have recently learned that I’m missing a fallopian tube and an ovary.” The flood of contacts became so great that the government set up a hotline for potential victims.

The following June, the prosecutor’s office filed a new indictment against Perwaiz, expanding its case against him. It listed 26 counts of health care fraud and 32 counts of making false statements relating to health care matters. There were also three counts of aggravated identity theft: Perwaiz was accused of using patients’ names and Medicaid information to try to obtain insurance money.

The details in the indictment were shocking. The government accused Perwaiz of “routinely” lying to patients and falsifying medical records in order to perform unnecessary surgeries. He told numerous patients that they had cancer when they didn’t, scaring them into hysterectomies insurers reimbursed him for. He told other patients, including Layla, that they had fibroids or cysts that would become cancerous if entire organs weren’t removed immediately, when in fact the accepted standard of care for those conditions called for far more conservative treatments, such as monitoring or medication, before surgery. One woman who began seeing Perwaiz after she had an abnormal pap smear in 2012 told investigators that she underwent no fewer than seven procedures, including a diagnostic hysteroscopy and a laparoscopy, in just nine months. Later she had a hysterectomy. Perwaiz told the patient’s insurer that the reason for the hysterectomy was uterine prolapse, a condition the patient was never diagnosed with.

Perwaiz was also accused of inducing labor before 39 weeks so patients would give birth on days he was already scheduled to perform surgeries, thus ensuring that he, and not some other doctor on call at the hospital, received the insurance payments associated with the deliveries. Of the more than 80 births Perwaiz billed Medicaid and Tricare, another insurer, for in 2019, at least 33 involved patients induced before 39 weeks with no medical indication that they needed it. (Early induction is not recommended unless the health of a fetus or the person carrying it is at risk.) According to the indictment, to avoid dealing with questions from insurers, Perwaiz sometimes falsified a patient’s estimated due date so it appeared they were past 39 weeks when he induced them.

Many of the patients listed in the indictment described suffering “serious bodily injury” as a result of what Perwaiz did. But there were also allegations of crimes involving no bodies at all. The indictment stated that, between 2010 and 2019, Perwaiz billed insurers for more than $2.3 million in procedures and surgeries, including “hysteroscopies and colposcopies, that he did not actually perform.” In other words, there were procedures he’d simply made up.

The more money Perwaiz made, the more the hospitals where he performed surgeries benefited. According to trial testimony, from 2010 to 2019 Chesapeake Regional made $18.4 million from Perwaiz’s use of its facilities, while Harbour View made $3.1 million.

Perwaiz’s trial began in October 2020, and lasted four and a half weeks. Former employees, coworkers, and patients took the stand to testify about what they’d seen and experienced at Perwaiz’s practice or while under his care. A nurse described complications suffered by babies Perwaiz delivered via unnecessary early induction. Women described the trauma of realizing that they’d had organs removed without their consent or surgeries based on false diagnoses. One former patient said that she was so scared when Perwaiz told her she would likely get cancer if she didn’t have surgery that she left his office and immediately bought life insurance.

During Debra’s testimony, the prosecution shared documents related to her surgery, including her consent form, where someone had scribbled “possible abdominal hysterectomy.” Debra didn’t remember seeing those words on the form when she signed it. Perwaiz’s progress notes on the procedure also contradicted what he and Debra had talked about in her appointments. “Patient wants to have ovaries removed through abdominal incision,” Perwaiz wrote. “Risks/benefits, including need and risks of hormones, explained at length. All her questions answered.” Meanwhile, the post-op report stated that after Perwaiz closed her up, he was alerted to blood in Debra’s urine, but he decided it wasn’t enough to worry about and sent her to recovery.

“I did not tell you to cut my guts,” Debra said on the stand. “That wasn’t what was agreed upon.”

Some of Perwaiz’s staff who were also his patients described seeing procedures they hadn’t consented to described in their own medical files. Additionally, employees testified that they were instructed to write details of patients’ medical histories and complaints on Post-it notes during appointments, leaving Perwaiz to transcribe them himself into the patients’ files later.

Margo Stone, the longtime nurse in Perwaiz’s office who was also his ex-girlfriend, agreed to testify against him in exchange for immunity; she had never reported the financial support he gave her to the IRS. Many former patients and staff learned at the trial that Perwaiz himself had a history of tax problems. In April 1996, he was convicted of filing false returns after he claimed the value of personal items, including a Ferrari and a Mercedes, as business expenses. He was put on probation and in-home confinement, and his medical license was briefly revoked. Two decades later, he lied on a form required by an insurance provider: When asked if he’d ever been convicted of a felony, Perwaiz indicated that he hadn’t—he characterized what happened in 1996 as merely “tax issues.”

Perwaiz told the same insurance provider that he’d never had his clinical privileges revoked by a medical facility, but investigators discovered that this also wasn’t true. In October 1983, Perwaiz lost his staff membership and surgical privileges at Maryview Hospital in Portsmouth after administrators found that he’d performed unnecessary procedures. That December, the CEO of Maryview, J. Bland Burkhardt, wrote a signed letter to his counterpart at Chesapeake General Hospital, Donald Buckley, alerting him that Maryview had cut ties with Perwaiz and explaining why. Chesapeake General would later be renamed Chesapeake Regional. (Buckley retired from the hospital in 2005 and now teaches at Eastern Virginia Medical School. He declined to be interviewed for this story.)

On June 22, 1984, the Virginia Board of Medicine sent an official notification to Perwaiz that he was being investigated regarding his time at Maryview. The letter detailed 11 instances in 1982 when he had performed a hysterectomy despite there being no medical indication that the patient needed the procedure. The same went for a diagnostic laparoscopy Perwaiz performed on a 17-year-old girl. The letter also noted that he’d had a sexual relationship with one of his patients, which Virginia law defines as unprofessional conduct that might be grounds for discipline.

Members of the medical board met on July 27 to determine Perwaiz’s professional fate. Based on evidence from the investigation, they had four options: They could exonerate him, reprimand or censure him, place him on probation, or recommend a formal hearing, where the question of revoking his medical license would be considered. The board chose to censure Perwaiz for poor record-keeping and for lack of professional judgment. The censures became part of his permanent record, and he continued treating patients and performing surgeries at hospitals where he had privileges.

In the ensuing years, there were at least four complaints about Perwaiz filed with the Virginia Department of Health Professions. One of them was submitted by Debra and had led the FBI to her door. At Perwaiz’s trial, the prosecution revealed a complaint from 2010 filed by a woman who felt Perwaiz had coerced her into inducing birth. WAVY, an NBC affiliate in Virginia, found another complaint about Perwaiz, this one filed by a woman named Linda Jackson on August 15, 2013, after a series of surgeries and complications. She believed that Perwaiz had harmed her and that Chesapeake Regional was covering for his mistakes. “Please help me!” Jackson wrote in her complaint. “I don’t know what to do!” In all three cases, the Virginia Board of Medicine did not pursue disciplinary proceedings. (The board declined to comment for this story, citing a Virginia law prohibiting it from doing so.)

The other known complaint, also found by WAVY, predated the others by at least two decades. On June 4, 1991, Susan Pullem wrote a letter asking the medical board to investigate Perwaiz. He had operated on her six times between April 1987 and July 1988, then performed a partial hysterectomy in October 1988. The following February, Pullem went to a new gynecologist, who told her that the hysterectomy had probably been unnecessary; had Pullem been his patient, he would have treated her symptoms with medication. The new doctor also told her that the lining of her vagina was “paper thin” because of the numerous procedures she’d had in such a brief span of time.

When bills arrived from Perwaiz’s office, Pullem refused to pay them. “The way I figure it, you owe me!” she wrote in an October 1990 letter to Perwaiz. “I am sure all of my surgeries bought you at least one or two more of the Mercedes that you are so fond of.”

Perwaiz sued Pullem for payment. In a letter submitted to the court, Pullem described what had happened to her and said that she’d spoken with dozens of other women who’d had similar experiences with Perwaiz. One woman told Pullem that Perwaiz had cut her bladder while performing a hysterectomy. “He didn’t even notice it and completed the surgery,” Pullem wrote. “This same woman was recently hospitalized again with complications from that surgery.” The situation sounded remarkably similar to what Debra endured beginning in 2012.  

“I hope that the courts will look at all of the evidence presented and come to the same conclusion that I have. Dr. Perwaiz is a disgrace to his profession and has taken advantage of trusting women for too long,” Pullem’s letter to the court continued. “Between the monies paid him by myself and the insurance companies, I feel he has been paid very well indeed for ruining my life.”

The court sided with Perwaiz. Pullem later filed her complaint with the state medical board. She said she never got a reply.

As Pullem professed, Perwaiz’s patients made him rich, a fact all the more disturbing because so many of them were Medicaid recipients, which by definition meant that they earned very little money. In the years immediately leading up to his arrest, Perwaiz made about $1 million annually. (Per the Bureau of Labor Statistics, the average estimated salary of an ob-gyn in the United States in 2020 was about $239,000.) And the more money Perwaiz made, the more the hospitals where he performed surgeries benefited. According to trial testimony, from 2010 to 2019 Chesapeake Regional made $18.4 million from Perwaiz’s use of its facilities, while Harbour View made $3.1 million.

Throughout the trial, Perwaiz maintained that he was a good doctor who did right by his patients. In testimony, he said that the surgeries he performed were justified, even if his approach to paperwork left something to be desired. He said that he saw the number of patients he did because he didn’t want to turn people away, especially those who might not have reliable access to transportation. “I had a standing policy and instruction to my scheduling people that if a patient calls, new or an established patient, bring her in the day she wants to come in. And if it [was] that day, we made it happen,” he said. “It was never a[n] ‘I’m too busy’ kind of office.” Perwaiz attributed his rate of surgeries to his “patient mix,” as he put it. “Seventy-five or probably more close to 80 percent of my patients are Medicare/Medicaid patients,” he testified. “They’re [at] higher risk when they are pregnant, and they have more gynecological issues because they don’t do preventative things, and so forth.”

But the evidence against Perwaiz was overwhelming. On November 9, 2020, a year and one day after he was arrested, a jury found him guilty on 52 counts. He was sentenced to 59 years in prison and ordered to pay restitution of more than $18.5 million to the insurance companies he defrauded.

His former patients got nothing. Legally speaking they weren’t victims in the case—only the insurance companies were. In the eyes of the court, Perwaiz’s victims were witnesses, testifying about the wrongs done to insurers through the harm done to their bodies.

At the sentencing hearing, Tessa gave a statement addressing this fact. “Women have been fighting all of our lives to matter … just to be smacked in the face, a reality that we aren’t as important,” she said. Tessa described how she and other patients hurt by Perwaiz needed help: medical care, mental health support, financial compensation. But many of them couldn’t file a lawsuit even if they wanted to, because of Virginia’s statute of limitations on medical malpractice suits. “The fact that we have yet to find assistance,” she said, “is a clear statement that we still don’t matter.”

Perwaiz’s most recent patients were able to file suit, and more than a dozen did. Tessa was among them, and she eventually settled with Perwaiz out of court. When Brittni DuPuy-German filed her own suit, she named the Chesapeake Hospital Authority, the governing body of Chesapeake Regional, as a defendant alongside Perwaiz. DuPuy-German alleged that the hospital administration had been negligent in failing to properly evaluate his credentials and in granting him surgical privileges. Attorneys for the hospital argued that it wasn’t liable for Perwaiz’s actions.

In April 2021, a judge sided with DuPuy-German, but in the appeals process the hospital invoked sovereign immunity, a legal concept derived from English common law that prevents public entities from being sued. The Chesapeake Hospital Authority was established by the state legislature, and its members are appointed by the Chesapeake city council. In February 2022, a judge ruled in the authority’s favor and dismissed it from the lawsuit.

There is longstanding precedent in Virginia for the court’s decision. The legal logic is that public bodies must be able to perform their essential functions without fear of lawsuits. But according to critics of sovereign immunity, this can leave victims of institutional wrongdoing without recourse. “At Safeway, if there is a salad bar, and somebody slips and falls because an employee didn’t pick up the salad off the floor, then Safeway is vicariously liable for the actions of the employee—that’s a very typical arrangement,” said Anya Bidwell of the Institute for Justice, a public-interest law firm in Virginia. “But when it comes to government entities, they are somehow special, they are exempt from this…. What ends up happening is a culture of unaccountability.”    

DuPuy-German said that she feels Chesapeake Regional is “hiding behind sovereign immunity.” (She settled separately with Perwaiz.) “They pretty much got away with this,” she told me, “even though in my opinion they were just as negligent as him, because they were notified by multiple different people in their own facility, and they didn’t do anything about it.”

More than a half dozen suits are still working their way through the legal system, including one filed by Layla, who’d let the FBI record her phone call with Perwaiz. (She declined to be interviewed for this story on advice of her attorney.) But most of Perwaiz’s victims, of which there are likely hundreds, have been left without a clear path to restitution. The FBI designated a victim coordinator to connect former patients with mental health services and to communicate information about the investigation and trial to people requesting it. The bureau told potential victims that, as a first step in addressing any harm done to them, they could request their medical files from Perwaiz’s office.

Jen, who underwent multiple surgeries with Perwaiz, drove to his office to get her file. She recognized the female employee who was handing out documents to the former patients coming in the door. Jen also requested her records from Chesapeake Regional. She took everything to a new gynecologist, who didn’t see any evidence to validate the endometriosis diagnosis Perwaiz had given her. It was hard to hear, even harder to sit with. “I realized there really wasn’t going to be much I could do about it,” Jen said. When she sees a doctor now, Jen’s anxiety still spikes, but she also feels like she has a better understanding of what good care looks like.

Others haven’t been so lucky. Former patients who spoke at Perwaiz’s sentencing hearing or were interviewed for this story said they’ve struggled to find doctors to support them. When one woman told a new gynecologist what Perwaiz had done to her—a hysterectomy based on a false cancer diagnosis—the doctor said she should see it as a good thing, because it was a permanent form of birth control. “I let her finish her exam, I cried, and I left,” the woman said. Other former patients, including Tessa, said that they’d encountered health care providers who seemed to be on Perwaiz’s side. Tessa was in the middle of an exam when her new ob-gyn said that they’d heard Perwaiz was an awesome doctor.

“If an insurance company dies, nobody gets hurt,” Debra said. “But if I die, my sons grow up without a mom.”

After Perwaiz’s arrest, Tessa slipped into depression. She had panic attacks; she felt paranoid. She also experienced the effects of the early menopause—mood swings, specifically—brought on by a surgery she hadn’t consented to. “I have been battling through the stages of grief as if I lost someone, because I have. I’ve lost myself,” she said in her witness statement. “I’m not the woman I was before, and it’s a daily challenge trying to find myself again.”

When the trial ended, Tessa sent email messages to local politicians requesting support for Perwaiz’s victims. She asked that hospitals be held responsible when people are hurt in their facilities. She asked that laws be changed to protect women like her.

She never heard back.

Jen has talked to her therapist about Perwaiz, and she sees what he did as an all too common betrayal. “It’s somebody that you trusted. Somebody that you’re taught to trust your entire life. Somebody that you put your life in their hands,” Jen said. “As a woman, and on top of that as a Black woman, it’s always this way, you know? We have to face so many barriers.”

Other former patients I spoke with felt similarly, and some believed that Perwaiz specifically targeted poor Black women. In their comments were the echoes of history: of the Tuskegee experiments, when the U.S. Public Health Service left Black people to suffer and die from syphilis so doctors could study the effects of the disease; of Henrietta Lacks, whose cervical-cancer cells were taken without her permission for biomedical studies; of the enslaved Black women whom J. Marion Sims performed experimental surgeries on—surgeries that would earn him the moniker “the father of gynecology.”

These echoes pushed Debra to fight to be heard, even when it seemed like no one cared to listen. She still mourns the children she can never have because of what Perwaiz did. And while she’s glad she finally got to tell her story in court, she’s angry that the legal system’s priority wasn’t to help Perwaiz’s victims. “If an insurance company dies, nobody gets hurt,” she said. “But if I die, my sons grow up without a mom.”

Debra, who now lives in Mississippi, has more she wants to say and do. She’s channeling some of that momentum into a new career: She recently took a job at the Department of Justice, as a program specialist focused on initiatives to de-escalate police violence. “In my little life,” Debra said, “I want to be in a position where I can bring some kind of equity to people’s lives, to help them.”

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