CHESAPEAKE, Va. (WAVY) — Linda Jackson has been in pain for nearly a decade.

“I have scarring, and [it’s] still painful at times, even after all these years,” she said. “Sometimes it feels like a stabbing, hurting pain. Like I said, the incision is from side to side, so if I rub my hand across it, it just hurts. It’s just a hurting feeling.”

Jackson’s pain started in her abdomen and pelvis in July 2012. Her longtime gynecologist, Dr. Javaid Perwaiz, diagnosed her with a cyst on her left ovary. He performed surgery to remove the cyst, her left ovary, and part of her left fallopian tube the following month.

But after the surgery, her pain wasn’t gone. It was worse.

Jackson complained to Perwaiz about the pain during several follow-up appointments. She said he prescribed her antibiotics for recurrent infections and performed another surgery to remove a knot that was growing in her vulvar area.

Then, during a November 2012 examination, Perwaiz told Jackson another mass was growing on her left fallopian tube and that her right fallopian tube was blocked with bacteria. He wanted to perform another surgery.

“I just broke down and started crying because I’d been through one surgery, been through another surgery, had multiple infections,” Jackson explained. “I just said, ‘Something’s not right here. Why do we have to keep doing all of these surgeries?'”

Jackson sought a second opinion from another gynecologist. That doctor confirmed there was an issue and performed surgery on Jackson in 2013, removing her right and left fallopian tubes, as well as a mass that was growing where her left ovary had been.

Immediately following the surgery, the gynecologist told Jackson’s family that they’d removed her left and right fallopian tubes, along with her left ovary. That initial report left Jackson and her family confused because Perwaiz said he’d removed her left ovary during her 2012 surgery.

The second gynecologist changed their report during a follow-up visit after the surgery. The physician told Jackson that a pathology report showed the mass didn’t have ovarian tissue in it, and that it was actually a fibroid tumor.

Confused by the changed report, unsatisfied with her treatment, and concerned about the procedures she’d endured, Jackson decided to write a letter to the Virginia Department of Health Professionals asking them to investigate Perwaiz.

“There are a series of events that has happened to me over the last few months that has devastated my life,” Jackson wrote.

“This has really been a nightmare for me. I have gone through months of being in constant pain,” she added.

The Virginia Board of Medicine wrote Jackson back, informing her that the agency would not initiate disciplinary proceedings against Perwaiz based on her complaint.

“I am writing in regards to the complaint regarding Javaid Perwaiz,” a Virginia Board of Medicine representative wrote. “I am writing to advise you that the Board of medicine has completed its review of the investigative report in this matter. Based upon the information available for its thorough review, the Board has determined that it will not initiate disciplinary proceedings.”

The Virginia Board of Medicine responded to Jackson about six years before Perwaiz was charged with, and ultimately convicted of, performing unnecessary procedures and surgeries on women as part of a health insurance fraud scheme. It’s unknown if Jackson’s treatment was appropriate and if the procedures Perwaiz performed on her were necessary; however, 10 On Your Side discovered that Jackson wasn’t the only person who reported the OB-GYN to the Virginia Board of Medicine.

Another woman named Susan Pullem — now Anderson — reported Perwaiz to the Virginia Board of Medicine in 1991 after undergoing a series of procedures that ultimately resulted in her getting a hysterectomy. 10 On Your Side investigators will share more of her story in Chapter 9 of “The Patients v. Perwaiz,” which airs on April 1.

A decade before Pullen reported the OB-GYN to the Virginia Board of Medicine, a hospital that Perwaiz operated at terminated his surgical privileges. Maryview Hospital in Portsmouth told the Virginia Board of Medicine that its administrators suspended Perwaiz’ privileges because they believed he performed unnecessary hysterectomies on about a dozen women. Maryview Hospital administrators also wrote a letter to Chesapeake Regional Medical Center staff to inform them that the Portsmouth institution had stripped Perwaiz of his privileges. CRMC granted Perwaiz surgical privileges at their hospital shortly after receiving that letter. Maryview Hospital reinstated Perwaiz’ surgical privileges in 1985.

The Virginia Board of Medicine investigated Perwaiz based on the Maryview Hospital complaint in 1984. Ultimately, the Virginia Board of Medicine “censored” him for “lack of documentation of patient records” and “lack of judgement in regards to a sexual relationship with a patient,” according to a letter written to Perwaiz by the Board’s secretary treasurer on Aug. 15, 1984.

The Board of Medicine’s decision resulted in a public record of the incident on the Board’s website and that the OB-GYN meet some community service requirements, but Perwaiz kept his medical license and continued to operate.

Patients and Maryview Hospital administrators weren’t the only people raising red flags during Perwaiz’ career. 10 On Your Side investigators interviewed three nurses who worked with the OB-GYN at CRMC. They were also suspicious of the physician and said that they elevated their concerns to hospital leadership.

10 On Your Side provided CRMC’s attorney Dr. Nick Oberheiden with a detailed list of allegations made by the nurses that our investigators interviewed. Oberheiden provided the following statement on behalf of the hospital:

“From the moment of his unexpected arrest, Chesapeake Regional has closely cooperated with law enforcement to assist in their investigation. As the trial established, Dr. Perwaiz was not an employee of the hospital, but an independent provider, who saw patients and made many surgical decisions at his own office. With his medical license continually in good standing, Dr. Perwaiz was one of many doctors performing surgeries on his patients at the hospital — without any preferential treatment. The jury found Dr. Perwaiz guilty of his own actions, and there was no finding or implication that Chesapeake Regional committed any wrongdoing.”

Dr. Nick Oberheiden, attorney at law

Ashley McDilda was a nurse manager who worked at CRMC for four years. She managed a 30-bed post-operative unit where nurses cared for urology and gynecology surgical patients. As 10 On Your Side investigators discovered, Perwaiz performed surgeries at CRMC every Saturday. Although McDilda was scheduled to work Monday through Friday, she was often called in on Saturdays to help staff with the high volume of patients being discharged from Perwaiz’ operating rooms.

“[The patients] would come back to back,” McDilda said. “We would often have what we would call situations where we would bottleneck from the PACU [post-anesthesia care unit] because of the patients coming up from procedures with our patients being discharged. We would kind of be stuck.”

McDilda was also in charge of the unit’s budget and productivity reports. In early 2018, she began to notice a steady rise in the number of patients having scheduled surgeries on Saturdays. She also noticed an increase in revenue coming from Medicaid and Medicare patients. She analyzed the data and found that the increases could be traced back to Perwaiz, who she said admitted “at least” five or six patients to her unit from the PACU every Saturday.

“There’s just something not right that we have all these patients coming in on weekends,” she said. “They’re always the same type of patients. What I mean by that is, they’re normally Medicaid [or] Medicare patients, and it normally wasn’t their first or second surgery.”

McDilda took her concerns to a manager in April 2018. She wanted to make the manager aware of the increasing numbers of surgeries on Saturdays, and to inform them that her unit would need more staff to manage patient care under those conditions.

“I didn’t really get a response. The only response I got is, ‘It’s great that your productivity is up,’” she said. “It was more about the money. My thing is, they were just seeing dollar signs, where I’m seeing patients that are sick, and patients that may have not even needed a surgery.”

Another nurse, who worked as an auditor at CRMC, also expressed concerns about Perwaiz to hospital administration. 10 On Your Side is calling her Kara because she agreed to interview with us under the condition of anonymity.

Kara’s job as a nurse auditor was to review documentation submitted by doctors after they performed procedures and surgeries to make sure that the paperwork supported the bills CRMC sent to insurance companies. Kara said it’s critical for doctors to provide supporting documentation after they perform a procedure or surgery so that insurance companies will foot the bill. Documentation should include operation room reports, a patient’s physical history, a list of supplies used during a procedure, and any medication given to a patient in post-op.

Kara first became aware of issues with Perwaiz’ documentation when a colleague asked her to look at one of his bills in 2018. She realized that some information was incorrect or had been improperly removed from the documentation.

“That brought a red flag up to me, and so I started digging and looking, and I started finding things I wasn’t happy with,” Kara said.

Kara began auditing Perwaiz’ documentation and quickly realized that the OB-GYN wasn’t providing much information to support the procedures and surgeries he was performing. During her audit, Kara identified between 200 and 300 of Perwaiz’ cases that had documentation issues.

“[The documentation] just wasn’t there,” Kara said.

“He kept patients overnight for pain management, but we had no record of what kind of drugs they were given, and what care they were given,” she added. “[The documentation] was pretty much the surgery he performed, and then that it was successful, and then that the patient was discharged.”

Kara said she reported her findings through the chain of command at CRMC. She also identified other colleagues who noticed issues with Perwaiz and said they’d attempted to report him seven or eight times over the decade before he was arrested.

Kara said that she believes hospital administration looked at Perwaiz’ surgery schedule as a numbers game — the more procedures he performed, the more money CRMC made.

“Things were said, and they were reported, but nobody did anything about it because he was a large money-maker for the hospital and that’s why it was overlooked,” Kara said.

Another CRMC nurse also became suspicious of Perwaiz and said she attempted to report him to hospital administration. We’re calling her Roxanne because she agreed to interview with 10 On Your Side under the condition of anonymity.

Roxanne worked with patients who had Medicaid insurance. Perwaiz was one of the only OB-GYNs in Hampton Roads who accepted patients with Medicaid insurance, meaning that he treated many women with that type of health coverage. The federal government has very strict rules relating to the Medicaid insurance program, and it was Roxanne’s responsibility to make sure that CRMC was in compliance with the law.

About five years before Perwaiz was arrested, Roxanne was looking at charts for some of the OB-GYN’s planned surgeries and reviewing procedures he’d already done. She began to notice boilerplate language in the reporting and a lack of oversight in Perwaiz’ post-operative patient care.

“I realized that they all had a lot of things in common,” Roxanne said. “You would have expected for them to have had some kind of oversight by quality or some kind of managed care follow up, and his didn’t have that. They were all done without input from anyone else, so that was kind of odd.”

Roxanne also noticed that Perwaiz was not classifying his patients correctly, per Medicaid guidelines. Medicaid makes determinations about whether procedures should be classified as inpatient or outpatient based on patients’ needs and symptoms. Inpatient surgeries require preauthorization through Medicaid. Roxanne said Perwaiz skirted the need for preauthorization by classifying most of his procedures as outpatient, even when they should have been classified as inpatient according to Medicaid.

“It became apparent that there was a huge volume and nothing was authorized. That, for me, was the big thing. That’s not a normal occurrence,” Roxanne said.

Roxanne said that Perwaiz was performing procedures that, based on Medicaid documentation, weren’t necessary. She also noticed discrepancies between the first diagnosis given to patients and the procedures Perwaiz actually performed on them.

“A lot of times, he final procedure wasn’t close to what the initial planned procedure was,” she added.

Roxanne reported her findings to a supervisor. The nurse said she was hopeful her manager would review the documentation and clear Perwaiz of any wrongdoing, but that’s not what happened. The manager acknowledged the same issues Roxanne identified, and did a deeper data analysis looking over a longer time period. Roxanne and the manager reported their findings to CRMC administration and waited for someone to step in and correct the issue.

“I would ask periodically at first, ‘How are things going? What’s going on?’ and I was told, ‘I’ll let you know as soon as we hear something,’” Roxanne said. “Those months turned into years, so here we are multiple years down the line and nothing had occurred until he was arrested.”

Routine checkups often led to invasive surgeries for Perwaiz’ patients. Some women believed they were perfectly healthy when they stepped into the OB-GYN’s Chesapeake office, but they found themselves going under the knife just days after their appointments.

How did Perwaiz persuade women into having life-altering surgeries? Our investigators will tell you in Chapter 5 of “The Patients v. Perwaiz,” which will air on March 4. Stay tuned.

The U.S. Attorney’s office is accepting victim impact statements for consideration at Perwaiz’ sentencing from anyone who believes they were hurt by the OB-GYN’s criminal actions. To learn more about how to submit a victim impact statement, click here.