Photo by Jack GouldOrange County physician G. Steven Kooshian confessed during an April court deposition that he secretly ordered his nurse to inject an AIDS patient with liquid vitamins rather than an expensive and medically critical drug, documents obtained by the OC Weekly show.
Kooshian made the admission during an emotional April 25 deposition arising from a multimillion-dollar malpractice lawsuit filed by Bryan Noble, a past Kooshian patient and prominent AIDS activist. Noble—who suffered from severe peripheral neuropathy, a condition that hampers vital nerve functions—asserted in August 2001 that the doctor committed assault and battery as well as fraud by repeatedly lying about the contents of intravenous injections.
In hopes of relieving pain that made work nearly impossible, Noble went to Kooshian from December 1999 until July 2001, expecting regular doses of intravenous immunoglobulin (IVIG). His lawsuit alleges he never received a single dose.
Noble has offered a key witness to support his claim: Kooshian's longtime nurse Virgil Opinion. In February 2001, Opinion says, he quit the doctor's practice because of Kooshian's systematic misrepresentations to AIDS patients. Later, Opinion contacted Noble because, he said, his "conscience was killing" him. When Opinion and Noble told their stories to the press, Kooshian strenuously denied wrongdoing.
"I am truly upset, saddened and disturbed [by the allegations]," Kooshian told the Weekly in July 2001. Kooshian attorney Eric E. Davis added at the time, "They really don't have any evidence. . . . It looks to me like they are just trying to blackmail somebody out of money. I don't think [Kooshian] has done anything wrong."
But a new story emerged after Kooshian's April deposition, a grueling, sometimes testy three-and-a-half-hour examination conducted by Eric Lampel, Noble's Irvine-based attorney. For the first time, the doctor acknowledged his complicity in the injection subterfuge and confirmed that Noble's IVIG had never even been ordered from a pharmacy.
"I told him [Opinion] to go ahead and give, you know, the vitamin infusion," Kooshian testified. "And, you know, I, you know, chose to give him the vitamin packs because it actually was, you know, it wasn't something I planned. It's just sort of by the spur of the moment."
When Lampel asked him why he had erroneously recorded in a medical file that Noble had received IVIG, Kooshian explained that he was "swamped" with work and that he was "very embarrassed" that the drug had not been injected.
According to Lampel, the fake IVIG treatments caused Noble additional pain that was not relieved until another doctor, Jorge Rodriguez of Newport Beach, applied real doses. Today, under Rodriguez's care, Noble says he no longer suffers the severe effects of peripheral neuropathy.
"When you go to a doctor, you put your life in his hands," said Noble. "You would hope he's not playing God."
Kooshian—who lives in a $3.6 million, five-bedroom mansion on 17,300 square feet in exclusive Newport Coast and has created a highly profitable practice that relies in considerable part on the gay community—isn't accepting responsibility.
His deposition suggests Kooshian will build his August trial defense on his assertion that he didn't orchestrate the fake injections but ultimately approved them because, though medically insignificant, they might produce a placebo effect.
It's also likely Kooshian will blame his nurse. Opinion, he said during his deposition, "deceived" him about the application of what should have been the initial use of IVIG for Noble. Kooshian asserted that he didn't know about the fake injections until Noble showed up for the second of four treatments and Opinion confessed privately that he had failed to obtain the drugs.
"Virgil said, 'Oh, by the way'—I mean, that's a quote; I remember this perfectly—'Oh, by the way, doc, you know I don't have the IVIG.' And my exact response to him was, 'What are you talking about?' And he said, 'Well, I wasn't able to get it.' . . . I was very angry."
Despite that anger, Kooshian never told Noble IVIG was unavailable. Instead, for four appointments, Noble sat in the doctor's exam room for two hours each visit believing that the IV hooked up to his arm was delivering powerful and expensive drugs. Nor did Kooshian enter a reprimand in Opinion's personnel file regarding the alleged drug mixup or even mention the scandal to his office administrator—even though Kooshian had fired other employees for such infractions as personal use of the office telephone. Instead, the ruse was by all accounts continued.
"Virgil was standing at [my office] door, and he said, 'Doctor, do you want me to give the vitamin?'" Kooshian recalled in the deposition. "I said, 'Yeah, Virgil. Go ahead. Let's give it to him again,' and that's how it occurred."
The key word in Kooshian's upcoming civil trial might prove to be "again": whatever was going on behind-the-scenes, Noble thought he received four treatments of IVIG; he never received even one. And he was increasingly suspicious: at the time, he was puzzled by the lack of progress in his health. And he knew from experience that something wasn't quite right with Kooshian's IVIG treatments. IVIG has a short shelf life once mixed. Noble's previous doctor had always prepared the costly drug in his presence. But according to Noble, Kooshian always claimed he had mixed the IVIG before his patient's arrival.
Candis Cohen, spokeswoman for the Medical Board of California, said doctors are required to act ethically. "I can't think of a single situation where it would be legally appropriate to deliberately lie to a patient," she said.
But Kooshian downplayed the medical ramifications of the scandal: "I was not, you know, completely convinced the IVIG would help Bryan." Though he doubted the drug's benefits, he said under oath, he deceived Noble in the hopes of producing a placebo effect. "I thought that there might be a psychological aspect," he said.
Opinion—who worked for Kooshian for 11 years—disputes the doctor's version. He says Kooshian ordered him to fake all the shots.
"He promised me that he would try to bring me down if I ever told anyone," said Opinion, who has since filed a wrongful-termination claim against the doctor.
The doctor did not respond to several requests for an interview. However, sources familiar with Kooshian's office have confirmed that Opinion complained bitterly about questionable office practices—giving patients fake drugs, suboptimal doses and selling expired narcotics as well as charging for samples—before he quit but was ignored. In April 2001, when the nurse contemplated telling Noble about the fake injections, Kooshian sent Opinion a greeting card. On the front was a drawing of a red heart; inside, Kooshian wrote, "I just want you to know how much I appreciate you for all you do. Thank you again. We all miss you. I miss you."
Opinion says he "knew Kooshian was being nice just to keep my mouth shut." Instead, the nurse hired Lampel to sue for emotional distress, confessed to Noble, and then gave his story to the Weekly ("'My Conscience Is Killing Me,'" July 27, 2001). The story was picked up by The Orange County Register, several television and radio stations, and various LA-based gay publications, but it was ignored by the Los Angeles Times.
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Kooshian, a Virginia native, has been hailed for his community service, Southern charm and warm bedside manner. But this isn't his first legal brawl. In 1991, state police raided two of his Orange County medical offices after an undercover narcotics sting. According to law-enforcement files, authorities confiscated various drugs related to illegal steroids production and arrested Kooshian. He eventually was charged with 14 felony counts, including prescribing drugs without a legitimate purpose and prescribing drugs to individuals who were not his patients. The doctor blamed his crimes on emotional distress in his personal life and received a reduced sentence of three years' probation and a $20,000 fine.
Sources say state medical board investigators are looking into Kooshian's practice. If the board determines that the allegations against the doctor are true, he could lose his license.
Kooshian expects exoneration. His "reputation and integrity have been the brunt of plaintiff's allegations as they have been played out ad nauseam with the media," said Kooshian attorney Terrence Schafer.
"The plain and simple truth is that [Kooshian] is a criminal," countered Lampel. "He has been engaged in crimes, and we intend to hold him responsible for his despicable conduct."