Workers Tell of Stress, Chaos at Fertility Clinic : Scandal: Many UCI staffers were alarmed about ethics violations years ago, they say. But fear kept most silent.

In the back rooms of UCI’s Center for Reproductive Health, it didn’t take long for even the lowest level staff members to conclude that the famed fiefdom of Dr. Ricardo H. Asch was a frenzied and scary place.

Up to 700 patients a year, drawn from across the globe, streamed through the doors of the tiny clinic, touted by the financially teetering medical center as a crown jewel. It was by all appearances a model practice, offering the most advanced techniques by the fertility industry’s best and brightest.

But employees knew better.

Records obtained from investigations into the center’s operations by a UC physician panel and auditors hired by the university portray a clinic in chaos, where basic medical and ethical standards were tossed aside by a team of surgeons who increasingly believed themselves untouchable.

Out of the earshot of their bosses, clinic employees told investigators, they would speak among themselves of eggs being taken from women without their consent and given to others. They talked of key records mysteriously disappearing, then turning up again, and of the doctors’ erratic ways.

The three fertility specialists--center director Asch, Jose P. Balmaceda and Sergio C. Stone--have each denied wittingly engaging in any misconduct. Asch’s attorney, Ronald G. Brower, said Asch, far from playing God, was a victim of shoddy record-keeping by UCI employees.

“He never knowingly did unconsented transfers,” Brower said.

But employees told investigators that embryos of well-heeled clients at times were used however Asch saw fit. Medical assistant Della Morrison told investigators that Asch had been giving away women’s eggs without their consent for five years.

Sharon Gray, another medical assistant, told investigators that she quickly reached the alarming conclusion in the early 1990s that if she didn’t have backup sperm donations ready for cases where the husband could not donate, Asch would simply give the wife’s eggs to another couple.

But it wasn’t just the eggs, workers said. There were so many patients that physicians and staff members at times forgot who was who, according to university records and interviews with employees by The Times. During the busiest times, dozens of patients a day packed the clinic, seven days a week from 7 a.m. to 1 p.m.

The clinic “was out of control and the doctors wanted it that way,” former lab director Teri Ord told investigators. Ord, who had been with the doctors for more than a decade, quit last July because of the clinic’s increasingly stressful environment.

Screaming matches were common and turnover was high, clinic workers said. Stone was accused by employees of throwing things, kicking walls and referring to staff as “pigs.” Asch would take morning calls from his horse trainer, and, if his horses were running at the racetrack, would abruptly leave, said Marilyn Killane, the clinic’s former office manager turned whistle-blower.

Asch denies ever leaving patients in the lurch, and Stone’s lawyer called the allegations about abusive behavior “ludicrous.”

Some former employees said the problems had been going on for years. A few said they tried to take the secrets outside clinic walls.

But, in an interview with The Times, one former clinic worker said fear of the doctors kept most of them silent. “We were freaked out, crawling out of our skins, afraid of everything,” said the employee, who spoke on the condition of anonymity.

Others were reluctant to turn against the doctors, who in at least two cases helped staffers conceive children.

It was only when investigators began poking around last year that the workers’ long-held silence crumbled. Since then, the clinic’s private scandal has been broadcast internationally and its scope has broadened almost daily, implicating not only the doctors but top UCI medical center management.

The medical center’s executive director, Mary Piccione, and her chief deputy were fired two weeks ago for lax oversight of the clinic. The three-physician clinical panel confirmed eggs were misappropriated there, and KPMG Peat Marwick auditors substantiated allegations that the doctors had underreported their income.

And last week, university officials announced that at least 30 women at the UCI clinic and at its now-closed predecessor in Garden Grove might have been victims of unapproved egg transfers between 1988 and 1992. Perhaps seven babies have been born as a result.

It has been a free-fall for a clinic and doctors who seemed to have reached the pinnacle of prestige.

And that has not been lost on those who worked there. A shaken Gray this year lamented to investigators what she considers a perversion of Asch’s initially noble purpose.

“He used to care,” Gray told investigators looking into the scandal. “Now he views it all as a game.”

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The clinic workers were for the most part nothing like their hotshot bosses--rich, famous doctors used to giving orders. Workers at the Center for Reproductive Health were accustomed to doing what they were told.

So, when at first things appeared out of whack, the employees scurried to make it right, documents and interviews show.

But several workers quickly pieced together what became an alarming collage: At least one of the clinicians, they suspected, was stealing eggs.

“Employees figured it out and discussed it among themselves,” Morrison told investigators.

The first inklings that basic procedures, such as obtaining consent forms from patients, were not in place occurred to Gray shortly after she was hired in 1990, according to investigative reports.

Patients who did not have eggs were given the eggs of women who never agreed to donate, Gray told investigators. Frozen embryos were used without consent, she said.

Morrison began getting consents using forms that a nurse from another office provided, Gray said.

But no one ever checked “yes” for donation on those forms, Gray told investigators. Everyone chose to freeze their eggs since they did not know whether they would get pregnant and might want the eggs for themselves later, she said.

In one case where eggs were later given away, Gray said she had served as a witness when the woman declined to donate her eggs.

To Gray, Asch’s behavior during procedures involving men whose sperm had to be surgically extracted also was troubling. After the first or second time a group of such surgeries was undertaken, Gray told investigators, she discovered that if the man lacked usable sperm, “Asch would take some eggs from that woman and give them to another woman whose husband did have sperm.”

After that, Gray said, she arranged for patients to have backup sperm donors, so that their eggs wouldn’t be taken.

Gray said she did not quit her job when she noticed problems because Asch had performed a fertility procedure on her that had resulted in her becoming pregnant. Asch also performed a procedure on Morrison; she conceived too.

Brower, Asch’s attorney, questioned the accuracy of Gray’s allegations because, he said, nearly all of the men Asch saw could produce sperm.

Asch also has denied responsibility for consent forms. He told the physician panel that he has “never reviewed consents” and he was “not involved in consents.” He said they were obtained and witnessed by nurses.

The alleged egg misuse dawned on Morrison gradually. She told investigators that she did not realize improper egg transfers had been going on until two years ago--but she now suspects the practice had been going as long as five years.

She knew patients who wanted to donate would have to go through the donor coordinator at Saddleback, she said. But some “donors” never did that, she told investigators.

“If the [recipients] did not go through the donor program and did not have eggs, the eggs must have come from someone [else],” she told investigators.

Gray and Morrison shared their concerns with operating room nurse Norbert Giltner, who had suspicions of his own. Giltner, who worked with the doctors in both Garden Grove and at UCI, decided to take his concerns outside clinic walls.

In early 1992, he showed a university auditor copies of records that documented improper egg transfers, according to his testimony before a state Senate committee last month. But the auditor, he said, rebuffed him.

“I’m an accountant,” Giltner recalled the auditor saying. “I have no idea what to do with that.”

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At the Center for Reproductive Health there were rules--but not many, clinic and other UCI employees said.

Thomas Garite, chairman of the obstetrics department at UCI, told investigators that Asch and two other doctors at the clinic acted as though the normal “rules don’t apply.”

It seemed to some employees that wrongdoing was not only tolerated but there for all to see.

In her interview with investigators, Morrison recalls being enlisted by Asch against her will to dispense the unapproved fertility drug from Argentina, HMG Massone, to cash-paying patients from overseas.

“The drugs [HMG] were dispensed for about two years on and off and were kept in a location where all physicians could see the drugs,” she said.

The clinical panel later confirmed nine instances in which Asch dispensed the drug.

Morrison told auditors that she complained about HMG Massone to Killane, but she said pressure from Asch and fear of losing her job kept her from refusing to dispense the drug.

“If Asch wants someone gone,” Morrison told investigators, “they are gone.”

It was this flagrant violation of drug rules that drove Killane to blow the whistle on the clinic, she said. The complaints of Killane and two other former UCI employees led to the university’s investigations of the center.

“That was it,” she said, referring to the time she noticed another employee preparing the drug for shipment to Florida. “I had had it. I could not handle it anymore.”

Asch has admitted to dispensing the drug in two cases, but says he only did so to spare patients the expense of the almost identical American version.

In addition to prescribing the illegal drug, employees told investigators, Asch ran his practice as if he owed nothing to the patients who made him famous.

Both Giltner and Gray told investigators that Asch frequently showed up at 9:30 a.m. for appointments scheduled 1 1/2 hours earlier. And once patients were anesthetized for surgery, Giltner and others alleged, Asch sometimes would leave the room for up to 45 minutes at a time to answer telephone calls or attend to other business.

Killane told the physician panel that Asch’s tendency to cancel appointments so he could go to the racetrack left patients irate. And it left Morrison, who worked under Killane, “in tears,” Killane said.

Asch, who owned racehorses, would call his trainer in the morning and would leave if his horses were running, Killane said.

“Doctors couldn’t get their schedules together,” Killane said in an interview with The Times. Patients sat for hours waiting, she said, while doctors “flitted” off to private pursuits. By her account, some patients had to be canceled four times, or doctors would let the residents see them.

Asch denies leaving patients for outside pursuits, Brower said. “He only did that if there was another emergency that he had to attend or to answer a question in an emergency and only if there was another physician present.”

Brower also said that Asch never “failed to keep an appointment or left an appointment because of racetrack obligations.” He said the doctor would know in advance when his horses were running and didn’t need to interrupt his work schedule.

Employees had other complaints, some of which the doctors shared. They alleged--and UCI’s internal auditors confirmed as early as 1992--that records had a tendency to disappear. During one mysterious 1992 break-in at the clinic, egg logs were taken, then later returned, lab director Ord told investigators.

It was the behavior of Stone, however, that ratcheted up stress levels at the center, employees told investigators.

Morrison and Gray told investigators that Stone was abusive to patients and staff. The doctor “throws charts, kicks walls,” and nurses at two other facilities have refused to work with him as a result, Morrison said. In written complaints Killane made to university officials, she said that Stone had brought her and other employees “to tears.”

“He screams uncontrollably, clenches his fists, bangs on things and puts me in complete fear that he could physically harm me,” Killane wrote.

Karen Taillon, an attorney for Stone, denied the allegations about her client’s behavior.

“I think Dr. Stone had a tremendous frustration with the university’s failure to provide adequate staff support, which they were responsible to do,” Taillon said.

But Taillon said Stone never lost his temper in the way employees described. The physician panel did not substantiate allegations that Stone engaged in abusive or hostile tirades toward patients. The panel apparently did not, however, address concerns about Stone’s behavior toward staff.

The private drama of the fertility doctor stars and the bit players who worked at the clinic now is on an international stage. And the kinds of things the employees say they observed as long as five years ago in the back rooms of a tiny clinic in Orange likely will result in a major overhaul of the way such practices are run.