By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
In his attorney's office, Virgil Opinion—a longtime medical technician for a prominent Newport Beach doctor —uttered a patient's name and then bowed his head and wept. After half a minute, the 42-year-old wiped tears from his eyes, shifted in his seat and stared out the window at the distant Saddleback Mountains. He repeated the patient's name and said, "My conscience has been killing me."
The patient was a gravely ill Costa Mesa man battling AIDS and anemia from hepatitis C treatments. In February, he made an appointment with Dr. G. Steven Kooshian, Opinion's boss. The patient was in line for a liver transplant; badly fatigued, he hoped to make office visits temporarily unnecessary. He wanted a month's supply of Epogen, an expensive drug that helps replenish critical red blood cells. Kooshian assured the patient he would fill the request, according to Opinion.
But there was a problem.
"We don't have a month's supply of Epogen," Opinion remembers reminding the doctor in front of the patient.
"Yes, we do," Kooshian allegedly replied.
The technician says he protested again but was ordered to "go prepare the shots."
Opinion, a soft-spoken Filipino immigrant who arrived in the U.S. 14 years ago after graduating from a Manila medical school, says he reluctantly went to the office's laboratory and prepared 28 syringes.
"Only a few of the shots had a little bit of Epogen. Most of them had none. The patient basically just got saline or water," Opinion told the OC Weekly. "Kooshian knew the patient was getting suboptimal doses, but he didn't care. The bottom line for him was the money. Those shots made him a lot of money. I became even more depressed when that patient told me how appreciative he was of what we were doing for him."
Opinion says he confronted the doctor once more. He claims Kooshian promised to "destroy me and make sure I'd never work in the medical field again" if the technician revealed the fake injections to the patient or authorities. A few days later, Opinion—suffering stomach cramps, headaches, depression and the early stages of insomnia—quit.
"I couldn't take it anymore," he said. "I didn't like what was happening."
The Epogen episode was merely the latest installment in a series of alleged frauds that Opinion claims drove him to psychiatric care and the unemployment line. Now on state disability, he alleges that Kooshian cheated patients—gave them useless shots of water but billed them for costly drugs—for much of the 11 years they worked together. He said the doctor made "many millions of dollars this way."
"Dr. Kooshian told me, 'Never, never, never give the proper dose,'" recalled Opinion. "He always wanted the patient shortchanged, especially HIV and hepatitis patients with good insurance. It happened all the time. 'Virgil,' Kooshian said to me, 'you know I have a business to run.'"
Key sources familiar with Dr. Kooshian's office confirmed that Opinion had repeatedly protested the doctor's practices. "You can bank on what Virgil has told you," said one source who spoke on condition of anonymity. "He just didn't concoct these things."
This week, Opinion filed a 13-page wrongful-termination lawsuit in Orange County Superior Court. The suit alleges that Kooshian effectively fired his technician for complaining about workplace illegalities.
"The evidence proves that Dr. Kooshian has little or no concern for his patients and employees and the gay community that he purports to serve," said Eric Lampel, Opinion's attorney and a partner in Lampel & Rivers, an Irvine-based firm specializing in discrimination and civil rights cases. "He is only concerned about his own profits."
In 1999, I commended Dr. George Steven Kooshian in the Weekly's Best of OC issue for his community service. The doctor had impressed me by the way he treated a sick, uninsured friend of mine. Despite the length of the office visit and the tests performed, Kooshian —a recipient of numerous appreciation awards, the subject of several positive medical journal articles and a generous contributor to charities—had taken into account my friend's low-income status and charged him only $30 or $40.
That's not to suggest that medicine has not been financially rewarding for the 50-year-old doctor. His Ocean View Internal Medicine practice has highly profitable offices in Laguna Beach, Garden Grove and Long Beach. In 1997, he built a $3.6 million, five-bedroom mansion on 17,300 square feet in Newport Coast, one of Orange County's most exclusive gated communities; a real-estate expert said the Pelican Hill estate, with its sweeping view of the Pacific Ocean, might fetch almost $4 million today. His 900-square-foot garage houses a fleet of cars: a black Z8 convertible BMW; a maroon Mercedes SUV; a silver Mercedes sedan; and yellow-, black- and eggplant-colored Porsches. One source said the doctor refers to his vehicles affectionately as "my toys."
Five days after I first attempted to contact him about the allegations, Kooshian called. "I am truly upset, saddened and disturbed, and I want to be forthcoming," he said with a strong native-Virginian accent. "But to be quite honest, I haven't seen any complaint."
After being reminded that Opinion's attorney had provided him with a draft of the complaint two months earlier and that attorneys for both sides had had several contacts, the doctor amended his answer. "I am aware of some very, very vague allegations," he said. "But I haven't seen the complaint to know the specifics of what is on the table."
I offered to enumerate the allegations in the complaint. But Kooshian—who described Opinion as a "very good employee"—asked me not to. Instead, he told me to contact his legal counsel, Eric E. Davis.
"They don't really have any evidence," said Davis. "It looks to me like they [Opinion and his lawyers] are just trying to blackmail somebody out of money. I don't think he has done anything wrong. Nothing is going to come of this. . . . He is not a bad doctor."
Davis also asserted that Opinion is a disgruntled former employee and—contrary to what Kooshian said—was an increasingly bad worker. "There was never a problem until Mr. Opinion's personal life got out of control, and it affected his work," said Davis. "He was doing a poor job. He wasn't even fired. He just left. I think he saw the writing on the wall."
The doctor's attorney said he is so convinced Opinion is fabricating the allegations in an "effort to take my client for a ride" that he repeatedly threatened that Kooshian might sue the Weekly for libel if it published this article.
Said Davis, "I would be very, very, very cautious if I were you."
Though Kooshian would not agree to an interview, his medical philosophy can be culled from part of his full-page advertisement in the July issue of the Orange County Blade: "We will empower you with the knowledge to make informed decisions to improve the quality of your life. We are dedicated to meeting and exceeding your health goals as well as providing a comfortable atmosphere. You know of our reputation for caring. Come and experience it for yourself."
Bryan Noble, a 42-year-old HIV-positive Long Beach resident and energetic AIDS Walk fund-raiser, scoffs at the ad. He went to Kooshian last year in hopes of curing his peripheral neuropathy—a painful, disabling side effect of prescribed AIDS drugs. He wanted to continue intravenous immunoglobulin treatments started by his previous physician. Kooshian, he said, agreed.
"I was in a lot of pain," said Noble. "It was like walking on needles, and I was having trouble working [because of] the numbness. The drug helps treat the damaged nerves in my feet."
From June to October, Noble says, Kooshian prescribed for him four treatments of immunoglobulin, which can cost more than $2,000 per treatment. But what was really injected into Noble's veins? According to Opinion, who administered Noble's shots, it wasn't the expensive drug.
"Bryan thought he was getting immunoglobulin," said Opinion. "But Dr. Kooshian ordered me to give him only saline. We didn't even have any immunoglobulin in the office. I think that happened three or four times, and Bryan never really felt any better."
Noble has not spoken to Opinion since last year, but this month he told the Weekly that he is now suspicious of his encounters with Kooshian. "I don't think I was given immunoglobulin," he said.
Immunoglobulin, which is packaged in a dehydrated form, is one of those rare drugs that must be mixed with saline before it is injected into a patient. Once it is mixed, it has a shelf life of less than 24 hours. If it is premixed and the patient doesn't show up for the appointment, the doctor loses thousands of dollars.
"My previous doctor always mixed the immunoglobulin in front of me," said Noble, who is on the board of directors of the Laguna Beach clinic and a member of the Orange County AIDS Walk steering committee. "At Kooshian's office, they never mixed it in front of me. I asked him about it, and the doctor said not to worry. He said it was premade. I should have known something was wrong then."
Recently, Noble reviewed billing statements from Kooshian and found no mention of the immunoglobulin treatments he was supposed to have received.
"I think he was running his own test program on me without my knowledge. Maybe he wanted to see if I could get better on my own," said an angry Noble, who says he is contemplating legal action against Kooshian. "When you go to a doctor, you put your life in his hands. You would hope he's not playing God."
Opinion's complaint is not Kooshian's first problem with the law. On March 27, 1991, dozens of officers with the California Department of Justice's Bureau of Narcotic Enforcement raided two of his Orange County medical offices after an undercover sting operation. According to law-enforcement files, authorities confiscated various drugs related to illegal steroids production and arrested Kooshian.
The doctor was eventually charged with 14 felony counts, including prescribing drugs without a legitimate purpose and prescribing drugs to individuals who were not his patients. Prosecution records show he could have received a maximum sentence of five years and eight months in prison. But the charges were reduced to misdemeanors, and Kooshian was sentenced to three years' probation and a $20,000 fine.
Opinion was present during the raids. He says Kooshian emerged from the incident with his confidence unscathed: "He still believed he could get away with anything."
On a recent afternoon, Opinion sat in a corner booth at a Costa Mesa Denny's and sipped a Pepsi. He wore short pants, sneakers and a tank top, and he spoke again in excruciating detail about the allegations without contradicting previous interviews. Nevertheless, one key question loomed: If he believed Kooshian had been defrauding and jeopardizing patients for 11 years, why didn't he quit earlier?
"It [the questionable practices] started out small, but his greediness grew worse and worse. And I did complain to him to stop," said Opinion. "But I was always threatened. Kooshian told me he would use all of his power to make sure I never worked again in medicine, and he said he would bring me down, too, if anyone ever found out. He has influence and money, and I was afraid."
In the parking lot after the interview, Opinion added, "When your article comes out, will people know the truth?" he asked. "Or will Dr. Kooshian get away with it again?"
Research assistance by Alex Roman