Nadya Suleman's fertility doctor endangered the mother of 14 by implanting her with a dozen embryos in the pregnancy that gave her octuplets, a state attorney said.
The accusation disclosed at Dr Michael Kamrava's licensing hearing conflicts with Suleman's earlier assertions that only six embryos were implanted and two split, leading to the eight children who were born in January 2009.
Kamrava "knew that a 12-embryo transfer was unsafe and below the standard of care," state Deputy Attorney General Judith Alvarado said in opening statements at the Medical Board of California hearing.
The board could suspend or revoke Kamrava's license if it concludes that the Beverly Hills physician was negligent. The hearing is expected to take two weeks.
Suleman, a 33-year-old unemployed single mother, has said Kamrava implanted her with six embryos for each of her six pregnancies - an apparent violation of national guidelines that specify no more than two embryos for a healthy woman under 35.
High orders of multiple births can result in long-term developmental delays, cerebral palsy and various life-threatening ailments.
The guidelines aren't hard-and-fast rules, but fertility specialists have criticised Kamrava's methods, saying he endangered Suleman's health and the long-term health of the babies.
Suleman's babies, born nine weeks premature, are the world's longest-surviving set of octuplets.
Mental health evaluation
Besides fertility medicine claims, Kamrava is accused of failing to refer Suleman for a mental health evaluation before giving her fertility treatments.
Dr Victor Y. Fujimoto, an expert witness for the medical board, testified that Kamrava should have referred Suleman to a mental health evaluation after she went to Dr Kamrava to say she wanted twins.
Her request, Fujimoto said, came in October 2002, after Suleman had borne two children through Kamrava's treatments who were only 17 months and 4 months.
"For me it raises a huge red flag," said Fujimoto, who reviewed her medical records. "It's a very unique request for twins after having just had a second child. In my opinion at that point it would have been reasonable to ask the patient or to request a mental health evaluation."
Though other doctors in the field say they're not impressed with it, Kamrava has long touted a method of in vitro fertilisation that implants an embryo - or sometimes sperm with an unfertilised egg - directly into the uterine lining.
Kamrava suffered a blow to his prestige last year when he was kicked out of the American Society for Reproductive Medicine, but the non-profit group does not have legal authority to prevent him from practicing medicine.
Records obtained, show that before 2001, Suleman was treated with Celexa and Sonata for depression and sleeplessness, and Clonopin for anxiety.
Before the octuplets' birth, the divorced and unemployed Suleman and her six children lived with her mother, relying on food vouchers, school loans and disability payments for her two autistic children to get by.
More recently, Suleman has tried to use her notoriety for income through the tabloid media, but she struggles to pay rent and is facing a $450,000 (about R3 million) payment on her home.
Below the radar
Unlike Suleman, Kamrava has kept a low profile and declined repeated requests for interviews.
However, Kamrava made a rare appearance in an ABC "Nightline" interview, defending his treatment of Suleman by saying it was "done the right way."
The board's accusation says Kamrava was also negligent in his treatment of two other patients.
Kamrava is accused of implanting too many embryos in one patient, resulting in the death of a foetus, and failing to refer another woman to a cancer specialist after finding cysts on her ovaries.
(Sapa, Shaya Tayefe Mohajer, October 2010)
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