The Beverly Hills fertility doctor who assisted Nadya Suleman in conceiving octuplets and six previous children repeatedly failed to screen her for mental health issues and to limit the number of embryos she had implanted, an expert witness testified Monday at a medical board hearing in Los Angeles.
Dr. Michael Kamrava implanted Suleman with a dozen embryos before she conceived octuplets, an expert said at the hearing — twice the number of embryos Suleman has said in the past.
Kamrava could have his medical license revoked if it is determined that he was grossly negligent in his treatment of Suleman and two other female patients: a 48-year-old who suffered complications after she became pregnant with quadruplets and a 42 year-old diagnosed with advanced ovarian cancer after receiving fertility treatments.
The hearing on the accusation is before Administrative Law Judge Daniel Juarez and is expected to last all week. While Kamrava plans to testify, Suleman and the other two patients probably will not, lawyers said.
The sole witness for the state, Dr. Victor Y. Fujimoto, director of UC San Francisco's In Vitro Fertilization Program, testified Monday that Kamrava failed to use Suleman's previously frozen embryos and instead allowed her to undergo fertility treatments more than a dozen times to create and implant multiple new embryos. Suleman, of La Habra, still has 29 frozen embryos, Fujimoto said.
Each round of fertility treatment cost about $18,000, he said, while frozen embryos could have been used for a fifth of the cost.
"What's the point of freezing embryos if you're not going to use them?" Deputy Atty. Gen. Judith Alvarado asked Fujimoto.
"I'm not sure," he said, calling the treatments Suleman underwent "well outside the norm even under extraordinary circumstances."
Fujimoto called the fertility treatments an "extreme departure" from the accepted standard of care established by the American Society for Reproductive Medicine.
"Doesn't a physician have to do what the patient wants?" Alvarado asked.
"No," Fujimoto said, not "when it is beyond the reasonable standard of care."
"You have to protect the patient from themselves?" Alvarado said.
"Sometimes," Fujimoto said. "More is not necessarily better."
Fujimoto said Suleman's medical records show Kamrava used 16 of Suleman's eggs to create 14 embryos and implanted a dozen of them on July 19, 2008. The babies were born nine weeks premature and remain the world's longest-living group of octuplets.
Suleman was 33 at the time, an unemployed single mother of six. Fujimoto said national guidelines would have required Kamrava to implant no more than two embryos, ideally one, given Suleman's age and previous pregnancies.
"I cannot imagine any of my colleagues transferring that many," Fujimoto said.
He said Suleman's medical records show that Kamrava had recommended implanting four embryos, but that was still too many.
The patient who conceived quadruplets had been implanted with seven embryos when Kamrava should have used no more than two, Fujimoto said.
Fujimoto also faulted Kamrava for not doing a better job of screening the third patient for cancer and instead proceeding with her fertility treatments. But he said Kamrava was not grossly negligent in her case.
Alvarado said it was unclear what will become of Suleman's frozen embryos. "There's no legal guidelines or standards," Alvarado said. "She is free to use those."
Kamrava's attorney, Henry Fenton, tried to get Fujimoto to concede that Suleman struggled with infertility for years before consulting Kamrava and agreeing on a course of treatment. Fujimoto said that medical records showed Suleman had trouble conceiving, but that Kamrava's recordkeeping was too poor to verify whether she needed in vitro and was aware of the risks.
Fenton said he had difficulty finding experts to testify on his client's behalf but does plan to call at least two doctors to the stand: Dr. Tien C. Chiu, Suleman's previous fertility doctor, and Dr. Jeffrey Steinberg, who has fertility clinics in Los Angeles, Las Vegas and New York and has publicly defended Kamrava.
Kamrava has already been expelled from the American Society for Reproductive Medicine for a pattern of behavior detrimental to the industry, although his license is current.
Kamrava, who declined to comment Monday, has remained largely silent since the birth of Suleman's octuplets but defended his actions in a "Nightline" interview last year. He said that Suleman's case "was done the right way … under the circumstances."