The Medical Board of California has accused a Beverly Hills fertility doctor of a pattern of gross negligence that led to the birth of Nadya Suleman's 14 children, including the world's longest-surviving octuplets, and created a "stockpile" of unused frozen embryos which serve "no clinical purpose."
The 13-page accusation filed in December against Dr. Michael Kamrava paints a picture of 11 years of medical care in which Suleman returned to Kamrava's office again and again to undergo fertility treatments. Often, she would return three or four months after giving birth.
Kamrava transferred an excessive number of embryos -- a number beyond what is considered acceptable by fertility standards -- on six occasions, according to the accusation. The number of embryos Kamrava transferred in July 2008 was so outside the norm that they "should not be transferred into any woman, regardless of age," the document said. That transfer, which resulted in the octuplets, went "beyond the reasonable judgment of any treating physician," the board wrote.
Kamrava also failed to refer the single mother for a mental health evaluation and repeatedly helped her create fresh embryos even though she already had a number of them frozen, according to the accusation. The board also alleged that Kamrava kept shoddy records and negligently provided Suleman with high doses of fertility drugs.
Kamrava, whose medical license could be revoked if the accusations are proved, could not be reached for comment. However, attorney Peter Osinoff spoke on the doctor's behalf.
"I think it's safe to say he's been devastated by all this," Osinoff said. "It's a very traumatic thing for him to go through this very public episode and scrutiny, starting with the public opprobrium and culminating now in the state board action."
Kamrava was following his patient's demands, Osinoff said.
"The question is -- and society may not approve -- but if it's satisfactory between patient and physician, that is something to be weighed very significantly," Osinoff said.
Osinoff said that medical guidelines on embryo transfers are guidelines only, and not law. He also said there were no standards requiring patients to be referred for mental health evaluation.
"Guidelines don't necessarily apply to each individual case," Osinoff said. "Patient history has to be taken into account. Patient desire has to be taken into account. Patient demand has to be taken into account. I can assure you that in all respects, Dr. Kamrava was attempting to comply with patient preference."
In the months after the octuplets' birth at Kaiser Permanente Medical Center in Bellflower, Kamrava and Suleman were the subject of intense scrutiny. Although the births were briefly heralded as a medical miracle, a backlash occurred almost immediately as more details were disclosed.
Fertility experts criticized Kamrava for excessive embryo transfers. The American Society of Reproductive Medicine expelled him in September.
And Suleman, it turned out, was a 33-year-old single, unemployed woman -- and already the mother of six children conceived through in vitro fertilization.
She lived with her mother, whose house was in foreclosure, and was supported, in part, by public money. Angry taxpayers criticized behavior they deemed irresponsible; even her publicists were subject to death threats.
In her only interview with a mainstream news organization, she told NBC's Ann Curry that she returned to Kamrava that final time because she had unused frozen embryos and did not know what to do with them.
"I couldn't live with the fact that, if I had never used them, and, you know, I'll be 70 years old and regret the fact that I didn't allow these little embryos to live or give them an opportunity to grow," Suleman told Curry in the "Dateline NBC" interview.
Disposing of them was not an option, she said.
"I believe children are blessings from God. And to allocate that role to a doctor, to dispose of a life is incomprehensible to me," Suleman said.
But the chain of events laid out in the medical board accusation calls Suleman's explanation into question.
In 2008, despite a "stockpile" of embryos frozen from seven separate egg retrievals, Suleman underwent additional fertility treatment to create fresh embryos -- a pattern that was repeated multiple times.
Suleman's attorney, Jeff Czech, declined to comment, as did her mother, Angela Suleman.
Fertility doctors said that it's difficult to judge whether fresh or frozen embryos should have been used, but that the medical board seems to be "throwing the book at him," said Dr. Arthur Wisot of the Redondo Beach-based Reproductive Partners.
Fighting the accusations could prove difficult, experts said.
"There's no doctor that I've talked to that would get on the stand and feel comfortable defending his actions," Wisot said.
Times staff writer Jessica Garrison contributed to this report.