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
Illustration by Matt BorsFollowing an OCWeeklyinvestigation that spanned six stories and two years, the U.S. Attorney indicted a Laguna Beach physician on charges he injected AIDS patients with bogus drugs.
Dr. George Steven Kooshian and his nurse, Virgil Opinion, committed "conspiracy, 25 counts of health-care fraud and three counts of making false statements relating to health-care matters," said Cindy Lozano, a spokesperson for the U.S. Attorney's office.
According to Lozano, an FBI investigation began shortly after OCWeeklypublished the July 2001 article "My Conscience is Killing Me", R. Scott Moxley's first story in the series. That article relied in part on Opinion's 13-page wrongful-termination lawsuit. In the suit, Opinion alleged that Kooshian fired him for complaining about workplace illegalities.
Opinion had agreed to speak with Moxley because, he said, "My conscience has been killing me."
Moxley began his research in May 2001, when Irvine attorney Eric Lampel said he had a client, Virgil Opinion, with a dramatic story. For the next four months, Moxley pored over documents; spoke with legal, accounting and medical experts; and talked at length with federal health officials, as well as current and former Kooshian clients.
But Moxley's greatest challenge was the gay community itself. Beyond the most general denial, Kooshian refused to speak on the record. And others told Moxley, whose investigative work also led to the 2004 arrest of ex-Assistant Sheriff George Jaramillo on public-corruption charges, to back off.
Dr. K. ducks out.
Photo by Jack Gould
"You have to understand that Kooshian was—still is, to some extent—huge in the gay community," Moxley says now. "He's warm, rich and bright. He was a fun guy, too, athletic, good-humored and generous. He seemed legitimately to have the trust of the community. He had a good bond. And back then, on AIDS, Kooshian had marketed himself as the AIDS expert, not just in Orange County, but in Southern California. He was like a god.
"So when my first story hit, there were two reactions in the gay community," Moxley recalls. "One was, 'Oh, my God, this is terrible.' And the other was, 'This can't be true.' That latter crowd said I was embarrassing the gay community. My response was that Kooshian was embarrassing himself."
That first story opened with Opinion's account of what the federal indictment calls "'subdosing' patients, that is administering to a patient a dose of medicine that contained less than the prescribed amount of medication that the patient was supposed to receive."
Opinion recalled a gravely ill Costa Mesa man who had come to Kooshian in February 2001, seeking help in his battle with AIDS and anemia from hepatitis C treatments. 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 nurse says he protested again but was ordered to "go prepare the shots."
Opinion, a soft-spoken Filipino immigrant who arrived in the U.S. in the late 1980s 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 Moxley. "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 nurse 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."
That Epogen episode was merely one in a series of alleged frauds Opinion claims drove him to psychiatric care and the unemployment line. When he spoke with the Weekly,he was on state disability. He alleged 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."
"Those shots made him a lot of money," Opinion told the Weekly.
The federal indictment alleges "Kooshian bilked health insurance companies, including Medicare, out of approximately $1.2 million in fraudulent claims relating to these medications."
"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.'"