NORFOLK, Va. (AP) — The website of a Virginia gynecologist describes his surgical skills as “unparalleled.”

But federal prosecutors say many of the procedures Dr. Javaid Perwaiz performed on unsuspecting patients were unnecessary and unwanted, including hysterectomies and tubal ligations.

Perwaiz, of Chesapeake, Virginia, was ordered held without bond on Thursday on charges of health care fraud in a case that has prompted outraged patients to swamp his offices demanding their medical records. A prosecutor said 173 women have come forward since his arrest to report similar experiences, including repetitive surgeries that they never asked for.

An arrest warrant affidavit written by an FBI agent alleges that Perwaiz, an obstetrician-gynecologist, has a long history of performing unnecessary surgical procedures on his patients without their knowledge or permission.

In one case, Perwaiz is accused of performing annual surgeries on a woman who had diagnosed herself with endometriosis. When she went to see a fertility specialist in 2014, she learned that “both fallopian tubes were burnt down to nubs,” making natural conception impossible.

“Perwaiz had removed J.L.’s fallopian tubes without her knowledge or consent,” FBI agent Desiree Maxwell wrote in the affidavit.

Another patient sought treatment in 2012 after an abnormal Pap smear. The affidavit says Perwaiz advised her to undergo a hysterectomy, but she objected, agreeing only to outpatient laparoscopic surgery, to remove just her ovaries.

When she awoke, she was “shocked” to learn Perwaiz had performed a total abdominal hysterectomy and had perforated her bladder during the surgery, the affidavit states. The woman developed sepsis and was hospitalized for six days.

During Perwaiz’s detention hearing in U.S. District Court on Thursday, Assistant U.S. Attorney V. Kathleen Dougherty said the affidavit focuses on just four women, but there are many more. She said prosecutors have interviewed dozens of additional women and heard from nearly 200 who allege similar experiences.

“That’s just the tip of the iceberg,” she said of the initial allegations.

Perwaiz is accused of submitting fraudulent claims to health care benefit programs — including Medicaid — seeking reimbursement for the procedures.

Prosecutors said he performed the surgeries “for his own financial gain.” Dougherty said Perwaiz owns five luxury automobiles, including one Bentley and four Mercedes-Benz vehicles — and claimed on a 2016 loan application that he has $200,000 in “Gold/Art” in his home.

Perwaiz’s lawyer, Lawrence Woodward Jr., said he has received a flood of unsolicited emails from patients who have described Perwaiz’s “fine qualities” and “how he helped them.”

“There is a multitude of them,” he said.

Woodward said Perwaiz, a native of Pakistan, has devoted 40 years to his medical practice in Virginia.

“His life has been his work,” Woodward said.

Woodward urged Magistrate Judge Robert Krask to allow Perwaiz to be released on bond while he awaits trial. He said Perwaiz is in the process of shutting down his medical offices in Chesapeake and will not be performing surgery.

The judge rejected that request, calling the allegations “deeply disturbing.”

“If those allegations are proven, that would be a gross abuse of patient trust — to put it mildly,” Krask said.

Several of Perwaiz’s former patients attended his detention hearing. One woman left the courtroom in tears.

Shamai Watkins, 44, of Portsmouth, said Perwaiz performed eight or nine surgical procedures on her between 1998 and 2013, including a hysterectomy when she was in her mid-30s. She said Perwaiz led her to believe she had cancerous cells and could not conceive a child.

“Every time I think about it, I think, what if I never went to him? I could have had our baby,” she said gesturing to her husband, who accompanied her to the court hearing.

Authorities said Perwaiz has been named in at least eight malpractice lawsuits that allege he falsified patient records to justify medical procedures, failed to use less invasive techniques and provided substandard care that caused permanent injuries to three patients and life-threatening injuries to two patients.

The investigation began in September 2018 after the FBI received a tip from a hospital employee who suspected Perwaiz was performing unnecessary surgeries on unsuspecting patients.

The tipster said Perwaiz’s patients would tell hospital staff they were there for their “annual clean outs.” In many cases, the patients were not aware of the procedures that were being done on them, the affidavit said.

“Witnesses also alleged PERWAIZ routinely used the ‘C-word’ (Cancer) to scare patients into having surgery,” Maxwell wrote in the affidavit.

Perwaiz has had a history of disciplinary problems.

In 1982, he lost his privileges at Maryview Hospital in Portsmouth because of “poor clinical judgment” and for performing unnecessary surgeries, Dougherty said.

He was previously investigated by the Virginia Board of Medicine for performing surgeries — mainly hysterectomies — “without appropriate medical indications and contrary to sound medical judgment,” the affidavit states. He was only censured for poor record-keeping.

In 1996, Perwaiz pleaded guilty to tax evasion. His medical license was temporarily revoked but was reinstated in 1998.

Perwaiz is either 67 or 69; his exact age is unknown. Prosecutors said agents searching his medical office found documents indicating he had instructed his staff to falsify his date of birth when filling out certain paperwork.

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