He told the women he operated on that the surgeries were medically necessary. Here's how to handle a doctor who pressures you to have surgery you're not sure you need.

By Korin Miller
November 11, 2020
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A former gynecologist in Virginia has been found guilty of fraud after performing a series of unnecessary surgeries on his patients. Javaid Perwaiz was convicted of 52 counts of defrauding health insurance programs out of millions of dollars and falsely telling women that they needed surgeries, according to the United States Department of Justice.

Among the surgeries Perwaiz pushed his patients to do: hysterectomies, where the uterus is removed, and tubal ligations, a surgical and permanent form of birth control.

Perwaiz's deception dates back to 2010, according to the DOJ. "In many instances, Dr. Perwaiz would falsely tell his patients that they needed the surgeries to avoid cancer in order to induce them to agree to the surgeries," says a press release from the agency.

It wasn't just unnecessary surgeries that Perwaiz pushed. He also falsified records for his obstetric patients so that he could induce their labor early, to make sure that he would be able to do the deliveries and get paid for them. He also violated the 30-day waiting period Medicaid requires for elective sterilizations like hysterectomies and tubal ligations by submitting backdated forms to falsely make it appear as if he had complied with the waiting period. He even billed insurance companies hundreds of thousands of dollars for diagnostic procedures that he pretended to perform at his office.

Perwaiz's trial included dozens of former patients, some of whom testified that they suffered complications as a result of the unnecessary surgeries the former doctor performed. One patient told a scary story of how Perwaiz insisted that she needed several surgeries between 2006 and 2015. Her medical chart said that she had complained of pelvic and back pain, bad cramps, frequent and long periods, or something growing in her vagina, but the woman said during the trial that she never said she experienced those symptoms, per The Washington Post.

According to the woman, Perwaiz said she had an abnormal growth in her uterus that could be cancer. "I was told this lump will keep on growing each time it was removed," she said, per the Post. "If I do not take care of this, then it would spread very rapidly and cause cancer."

Perwaiz operated on her in 2006, 2007, 2010, 2012, and 2015. During the 2012 surgery, he performed a hysterectomy, removing her uterus and left ovary, but did not remove her right ovary. He insisted that she needed to have the right ovary removed in 2015, even though she didn't report any symptoms during a checkup that year.

Nurses who worked at hospitals where Perwaiz performed his surgeries also testified that they repeatedly complained about his practices to their bosses.

"Dr. Perwaiz preyed upon his trusting patients and committed horrible crimes to feed his greed," said G. Zachary Terwilliger, US Attorney for the Eastern District of Virginia, in a statement. "Dr. Perwaiz has a history of fraud, including having his medical license and hospital privileges revoked. Nothing was going to stop him but the brave victims who testified against him and law enforcement."

"Doctors who take advantage of the trust their patients put in them must be brought to justice," said Mark R. Herring, Attorney General of Virginia, in a statement, noting that his team would continue to hold "dangerous individuals accountable."

Perwaiz faces up to 465 years in jail. He's scheduled to be sentenced on March 31.

Hearing about a doctor who does fertility-ending surgeries on his patients for no reason is infuriating and terrifying, and it's only natural to wonder if something like this could happen to you. Here's what you need to know.

Why do doctors typically perform hysterectomies?

A hysterectomy is a big deal; afterward you no longer have periods and can't become pregnant. If you have both ovaries taken out during a hysterectomy, you will enter menopause. Reasons your doctor may recommend a hysterectomy include suffering from fibroids, having endometriosis that isn't eased by medicine or surgery, having a uterine prolapse (where your uterus has dropped into your vagina), and experiencing chronic pelvic pain that hasn't been helped by other treatments. Women who are diagnosed with cancer of the uterus or cervix might also be advised to have a hysterectomy.

"A hysterectomy may be recommended if all other management fails or if there's cancer," Christine Greves, MD, ob-gyn at the Winnie Palmer Hospital for Women and Babies in Orland, Florida, tells Health. But it's often considered a last resort. "We try to exhaust all medical management options before proceeding with surgery," she says.

What about tubal ligations?

Tubal ligation, aka having your "tubes tied," is an invasive surgical procedure that prevents pregnancy. During the surgery, the fallopian tubes (which lead from your ovaries to your uterus) are blocked or cut.

Like a hysterectomy, a tubal ligation has ramifications. "Tubal ligations are performed for permanent sterilization," Michael Cackovic, MD, a maternal-fetal medicine physician at The Ohio State University Wexner Medical Center, tells Health. In other words, you can't have kids afterward.

A tubal ligation is "most often used to prevent pregnancy but it can be used to decrease the risk of ovarian cancer," women's health expert Jennifer Wider, MD, tells Health. Though it's possible to reverse a tubal ligation that was done to prevent pregnancy, this doesn't mean that a woman will be able to become pregnant afterward, according to the Mayo Clinic.

How is the decision to perform a hysterectomy or tubal ligation made?

It depends. If it's more of an emergency situation, say you have placenta accreta, a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall, or there is an underlying complication during delivery like uncontrolled bleeding, a hysterectomy may be "strongly recommended by the doctor," Dr. Wider says.

A tubal ligation is usually only discussed if a patient doesn't want to have children or is done having children and has tried other birth control methods, Dr. Greves says. "We strongly advise long-acting reversible contraception first to avoid surgery," she says. "There are plenty of options to choose from." Even a vasectomy, a male sterilization procedure, may be advised first if a woman and her partner want to avoid future pregnancies. "It's much less complicated than a tubal ligation," she explains.

But in the vast majority of cases (as in non-emergency situations), "doctors and patients will most often discuss treatment options, and procedures should always be done with full transparency and consent of the patient," Dr. Wider says.

What to do if it feels like your doctor is pushing surgery on you

The surgeries Perwaiz performed were technically done with the consent of his patients—but they were misled about the need for them or pressured to have them done.

If you feel like your doctor is urging you to undergo a procedure you're not comfortable with, and you're not in a life-threatening situation, Dr. Cackovic recommends sitting on it. "Talk to your support people, do your homework, even if on the internet, and discuss your 'homework' with the surgeon," he says.

Dr. Wider also advises that you be wary if the topic of surgery keeps coming up, even though it feels unnecessary. "This is definitely a red flag," she says. "Women should always feel 100% comfortable with their health care provider and should be able to discuss any procedure that is recommended," she says.

If you have any doubts, Dr. Greves recommends seeking a second or even third opinion. "You can always go back to your original doctor if you want, but it never hurts to get another opinion," she says.

Above all, Dr. Wider urges advocating for yourself. "Speak up and voice your concern," she says. "It is your body and you should always have 100% control over all procedures affecting you."

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