The California Medical Board should revoke the license to practice of Dr.Michael Kamrava
, the fertility doctor for La Habra single mother of 14Nadya Suleman
, the "Octomom," a state prosecutor urged today.
State Deputy Attorney General Judith T. Alvarado contends revocation is the only way to protect the public from Kamrava.
But his attorney urged the panel to accept an administrative law judge's previously rejected recommendation that Kamrava receive probation with no revocation.
The six-member board, which met in a Los Angeles area hotel for a final hearing this morning, has 30 to 60 days to render a decision on the fate of the Beverly Hills physician's medical license. That ruling can be appealed through the court system.
Kamrava is accused of negligence in treating Suleman and two other patients. Henry Fenton, his lawyer, said his client is very sorry and has cleaned up his act, changing his entire staff. He wouldn't dare practice such negligence given the worldwide public scrutiny of the case, Fenton claimed.
But Alvarado argued such scrutiny since the birth of Suleman's last delivery of eight babies did not stop Kamrava from following up on an abnormal biopsy on a 42-year-old patient who received fertility treatment from him, delaying her diagnosis of ovarian cancer for months.
"Public scrutiny," Alvarado reportedly said, "doesn't work with him."UPDATE, JAN. 24, 3:58 P.M.:
Administrative Law JudgeDaniel Juarez
has found Dr. Michael Kamrava committed gross and repeated negligence in his care for Octomom Nadya Suleman of La Habra--but not so much that the Beverly Hills fertility doctor should lose his state license to practice medicine.
Juarez's recommendation is not binding; the California Medical Board can still disagree with the judge's finding and strip Kamrava of his license.
At the center of the medical board probe are: Kamrava's treatment of Suleman, a single mother who conceived all 14 of her children through his care; a 48-year-old who suffered complications after becoming pregnant with quadruplets; and a 42-year-old diagnosed with advanced ovarian cancer after receiving fertility treatments.
Juarez found no lack of qualification, ability or fitness on Kamrava's part based on the evidence presented.
The judge added he suspects the doctor will not-so-aggressively treat another patient given the national exposure of the Octomom case.
Kamrava used 16 of Suleman's eggs to create 14 embryos before implanting a dozen of them in July 2008. The judge recommended Kamrava be allowed to continue practicing while undergoing monitoring and participating in ethics and medical-training courses. The medical board is expected to consider the recommendation at a Thursday meeting in Burlingame. The octuplets, who were born nine weeks premature, remain the world's longest-living group that size.
UPDATE, NOV. 22, 2010, 5:26 P.M.: A state prosecutor claims Octomom Nadya Suleman of La Habra was being used as a "human guinea pig" by her Beverly Hills fertility doctor.
Funny, but except for the "guinea" part, it's also how many of Octomom's harshest critics have described her.
The doctor on the spot, Michael Kamrava, claims Suleman knew she was taking part in a fertility study.
Deputy Attorney General Judith Alvarado made the "human guinea pig" claim during closing arguments before the California Medical Board, which could suspend or revoke Kamrava's license to practice--and it was picked up by scores of media outlets, including the Orange County Register.
Kamrava is accused of gross negligence for implanting 60 embryos in Suleman, including 12 in her last treatment that resulted in the single mother of six giving birth to another eight children.
Besides Alvarado, Food and Drug Administration investigator Donna Tartaglino Besone accused Kamrava of conducting human experiments on Octomom and another woman.
The doctor has testified that he always shoots for single births from each set of embryos he implants, and that while he thought it was unusual Suleman wanted to have 10 children, he did not believe it was his place to judge. Kamrava also testified she was taking hormones to encourage fertility before they met in 1997.
An administrative law judge has two months to make a recommendation to the full medical board, which has three months to render a decision.
UPDATE, NOV. 17, 2010, 5:56 P.M.: The California Medical Board hearing that could result in the revocation or suspension of Beverly Hills fertility doctor Michael Kamrava's license to practice resumes today in Los Angeles.
Damning details have already come out, including the admission by the in-vitro fertilization "internationally recognized leader" that he implanted 12 embryos into imbalanced Octomom Nadya Suleman of La Habra because she wouldn't consent to anything else. Still, it's amazing there have been proceedings against Kamrava at all.
The state board rarely takes action against a doctor and it's rarer still for physicians to lose their medical licenses. As reported by the San Francisco Chronicle:
- Out of 6,539 complaints in fiscal year 2009, only 276 "accusations" (medical board jargon for charges) were brought against doctors. And less than 2 percent of those lead to the loss of medical licenses.
- It takes about 2 1/2 years for a complaint to be resolved--and potentially dangerous doctors continue practicing in the meantime.
- California ranks 43rd among states in taking serious disciplinary action against doctors, according to Washington, D.C.-based Public Citizen consumer advocacy group.
Compared to other cases facing the board, the action against Kamrava has moved fairly quickly, taking about 10 months for the investigation to wrap up. On average, the Chronicle reports, it takes about a year to complete an investigation and another 18 months to resolve a complaint. An appeals process adds more time.
Needless to say, California disciplines fewer doctors than the national average. And a 5-year-old law aimed at speeding the process has only shaved a month off the average completion time, which is 878 days. The state has a new plan to trim the timetable to 540 days by 2013, but it depends in part on adding new positions during a hiring freeze.
Former state Sen. Liz Figueroa, the Alameda County Democrat who sponsored the 2005 legislation, called the medical board "the ultimate good old boys" network that over the years has used its influence within state government to beat back efforts to more strictly regulate and penalize doctors.
Meanwhile, the Boston Globe editorial board says the California Medical Board "should take the harshest disciplinary action" against Kamrava--while warning the physician and even Suleman are only symptoms of a larger problem: the $3 billion in-vitro fertilization industry.
Kamrava's testimony that he implanted a dozen embryos into Suleman because she would accept now fewer "speaks to the very real impact that patient pressure can have on how many embryos a doctor implants during IVF," according to the Globe. "Every doctor in the fertility industry knows patients can push very hard to have more embryos implanted than is recommended, especially when they're paying out of pocket for the expensive procedure."
The Beantown daily pointed to a recent Yale University study that found states without mandated insurance coverage of IVF have higher rates of embryos implanted and twin and triplet pregnancies. Also worth noting: more embryos are implanted on average in the United States than in many European countries, where stricter policies and laws exist.
"U.S. fertility guidelines are, at the moment, just that," the Globe finds, "and have tended to be ignored by many physicians."
"In a year when the father of IVF, Dr. Robert Edwards, won the Nobel price in medicine for his breakthrough, the story of a barely capable mother of octuplets reminds us that even the best discoveries can do harm when the wrong incentives take precedent over what is best for patients."
UPDATE, OCT. 26, 2010, 12:37 P.M.: Dr. Michael Kamrava, the Beverly Hills fertility specialist who over nine years implanted 60 embryos in Octomom Nadya Suleman of La Habra, cried on the stand again yesterday.
Facing a California Medical Board that may revoke his license to practice, Kamrava tearfully admitted he was never board certified in fertility medicine, that he failed his oral exam and that he was kicked out of the American Society for Reproductive Medicine.
Kamrava was shunned after single mother of six Suleman gave birth to the octuplets on Jan. 26, 2009.
An expert witness for the state previously testified that her treatments could have cost as much as $15,000, but the judge stopped Kamrava from disclosing how much he was paid for the in-vitro treatments that resulted in 14 children.
Kamrava again apologized and wiped away tears as he testified in the hearing that could result in the loss or suspension of license due to "gross negligence."
"I'm sorry for what happened," he said (as reported by RadarOnline). "When I look back at it, I wish I had never done it and it will never happen again."
The hearing continues today.
UPDATE, OCT. 25, 2010, 8:27 A.M.: Love means never having to say you are sorry, but implanting 12 embryos in a single mother of six who would go on to bring eight more children to term apparently does.
As its hearing that could result in Beverly Hills physician Michael Kamrava losing his medical license continues today, the California Medical Board has already got an apology from the fertility doctor of Octomom Nadya Suleman of La Habra.
"At the time that I did it, I thought I did the right thing," Kamrava told Administrative Law Judge Daniel Juarez last week in Los Angeles. "When I look back at it, even with all those circumstances, I was wrong."
Having assisted Suleman in her previous pregnancies, Kamrava claimed he believed in 2008 that Suleman only wanted four embryos implanted, but that she went on to steadfastly insist on a dozen.
The doctor testified earlier that Suleman had it in her head that she would have a total brood of 12 (give her points for being an over-achiever), and that she was desperate to crank out babies ASAP because she was showing signs of premature menopause.
Much as she is now, Suleman was experiencing severe financial woes at the time.
Kamrava told Juarez he has since cleaned up his practice to national standards, including restricting the number of embryos he will implant in a patient.ORIGINAL POST, OCT. 19, 2010, 2:46 P.M.:
is the one facing a Medical Board of California this week that could revoke or suspend the Beverly Hills fertility specialist's license to practice medicine, but it seems as if La Habra'sNadya Suleman
is on trial in Los Angeles as well.
Today's bombshell: Octomom's medical records show Kamrava consulted with her on several occasions about the dangers of bearing multiple babies.
That's the contention of Kamrava's lawyer, who would note the medical problems experienced after the January 2009 birth of only the second full set of live octuplets in the United States
director of the UC San Francisco In Vitro Fertilization Program, told the medical board Kamrava's scribbled notes are indecipherable and it's unclear what advice he gave the mother of six before she birthed eight more children.
The latest allegation comes a day after the medical board proceedings began with the disclosure from Fujimoto's testimony that revealed Octomom lied in an interview in January when she said she did not have any frozen embryos left.
In fact, Fujimoto testified Monday, Kamrava implanted 12 embryos in Suleman before she birthed the octuplets and that the 35-year-old Cal State Fullerton graduate still has 29 frozen embryos stored.
"I cannot imagine any colleague of mine transferring that many embryos," Fujimoto reportedly told the board.
Suleman has a history of bad accounting when it comes to frozen embryos. She said a year before the octuplets were born that she had six left over from her previous in-vitro fertilization treatments. She said she requested that all of the remaining embryos be implanted, despite the norm for a woman her age have two or three implanted at the most. (In his testimony, Fujimoto said no more than three is the national fertility standard.)
Octomom has said part of her reasoning for attempting a sixth pregnancy was so that the frozen embryos would not be destroyed, and she claimed the six remaining embryos were implanted and two split into twins, resulting in a total of eight embryos.
Fujimoto's testimony reveals that was a lie, and Kamrava has previously stated that Suleman insisted on "fresh" cycles of embryos.
Kamrava has also said that when five fetuses were evident a month after the embryos were implanted, he offered Suleman the option of selective reduction. She declined, according to the doctor.
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The advice, lack of mental health screening and number of implanted embryos Kamrava provided Suleman and another patient--neither of whom is identified by name in the proceedings because of doctor-patient confidentiality--form the crux of the case against the physician, who claimed in a July Nightline appearance that his treatment of Octomom was "done the right way."
Previous Weekly coverage of Nadya Suleman and Michael Kamrava: ocweekly.com