The Irresponsibility of Dr. Michael Kamrava

There was a very disturbing entry in today’s LA Times and it’s high time we all get a whole lot more outraged at the irresponsibility of Dr. Michael Kamrava.

In an excellent article by Alan Zarembo, a current patient of Kamrava’s is quoted:

"If anything, this incident has increased my confidence in the doctor," said the 41-year-old [Rosalind Saxton], who has been preparing to do in vitro fertilization with Kamrava since three other doctors turned her down, telling her to lose weight first.

Dear readers, I am going to tell you why I believe this “doctor” needs to be stopped immediately. There are two very problematic things going on in that quote.

It’s true that women are putting off having children longer, but that does not mean that doctors have found a way to prevent the complications of pregnancy in older women—they have learned how to treat them to the point women don’t die of those complications, but they cannot stop these complications.

The quoted woman goes on to say that three other doctors turned her down for IVF because of her weight. The nurse in me says a couple of things here: one, that this woman could be having conception problems due to her weight, and two, given her age and the fact she is overweight, she very well could already be hypertensive or diabetic.

Here’s a nice little study from 2008 I found on PubMed. I will translate (red font) when necessary.

…Obesity during pregnancy is considered a high-risk state because it is associated with many complications. Compared with normal-weight patients, obese patients have a higher prevalence of infertility. Once they conceive, they have higher rate of early miscarriage and congenital anomalies, including neural tube defects [spina bifida, anencephaly, which means the baby is born without most of its brain]. Besides the coexistence of preexisting diabetes mellitus and chronic hypertension, obese women are more likely to have pregnancy-induced hypertension, gestational diabetes, thromboembolism, macrosomia [baby with excessive birth weight due to maternal diabetes], and spontaneous intrauterine demises in the latter half of pregnancy [baby just dies in utero, no known cause]. Obese women also require instrument [forceps] or Cesarean section delivery more often than average-weight women. Following Cesarean section delivery, obese women have a higher incidence of wound infection and disruption. Irrespective of the delivery mode, children born to obese mothers have a higher incidence of macrosomia and associated shoulder dystocia, which can be highly unpredictable [baby’s shoulder gets hung up in the birth canal, and those deliveries are scary and very messy!]. In addition to being large at birth, children born to obese mothers are also more susceptible to obesity in adolescence and adulthood. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During preconception counseling, they should be educated about the complications associated with high a BMI. Obese women should also be screened for hypertension and diabetes mellitus. In early pregnancy, besides being watchful about the higher association of miscarriage, obese women should be screened with ultrasound for congenital anomalies around 18 to 22 weeks. The ultrasound should be repeated close to term to check on the estimated fetal weight to rule out macrosomia. Obese pregnant women are screened for gestational diabetes around 24 to 28 weeks. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pregnancy-induced hypertension.… When Cesarean section is performed, many obstetricians prefer an incision above the pannus [hanging flap of tissue, no bikini cut!] to avoid skin infection…. Peripartum, special attention is given to avoid thromboembolism by using compression stockings and early ambulation.

The fact that this doctor is putting another woman at risk is ridiculous. Yes, I feel for him in that there are concerns about saying “no” to patients, especially a nice cash-paying patient like an IVF client. But doctors are first supposed to “do no harm,” and there is no way any sort of medical practitioner could say that placing multiple embryos into an obese, “elderly” mother is a reasonable thing to do.

I just hope that this third woman (that we know about anyway) has her health insurance premiums paid up, or that she is wealthy enough to pay outright for her hospitalizations prior to delivery and that she can pay for time her no doubt multiple babies will need to spend in the NICU.

Maternal obesity and pregnancy

Octuplets draw critical eyes to fertility industry

Who Should, and Will, Pay?

Updated!

(Photo of a very preggers Nadya Suleman retrieved from TMZ)

I am going to follow a path we don’t normally follow here at Trials & Tribulations.

We pride ourselves on writing about horrible crimes usually involving death and the worst of human behavior. With today’s “case,” no one has yet died and as of yet there are no charges for breaking any sort of “law,” but certainly this case is worthy of our discussion. It does indeed include the worst of human behavior, selfishness and plenty of delusional thinking.

Because the certifiably crazy mother of 14 Nadya Suleman has retained public relations counsel, consider this writer the PR counsel for the fine bankrupt State of California. I also encourage the reader to simply Google “Nadya Suleman” and be prepared to learn more than what I’ve offered here. To totally cover this story would take too much space, and I know you are here to read about Spector 2.0 (as am I!).

Thirty-three years ago, Angela Suleman gave birth to her only child, a girl named Natalie Doud. Today that girl calls herself Nadya Suleman because changing her surname to Suleman would “simplify things.” Suleman’s father Edward is from Iraq and works in Iraq as a translator or driver to support his wife, daughter and grandchildren.

Suleman claimed she had a lonely, dysfunctional childhood as an only child, and she always wanted a big family from the time she was a teen. Nevermind that she grew up with the undivided financial resources of her parents, was a an above-average student and a cheerleader in high school, and has lived with her parents since January 2000. In worker's comp documents she described her upbringing as "loving and supportive," not dysfunctional, as she claimed to NBC. Today her “dysfunctional” mother is a-okay to take care of Nadya’s collection of kids.

Nadya Suleman obtained a psychiatric tech license and began a career at Metropolitan State Hospital in 1997. Her career was short-lived because she was hurt at work during what is described as a riot in November 1999, suffering a back injury which she has successfully milked for nearly 10 years. She was dating and ultimately married a man named Marcos Gutierrez from August 1996 to January 2000. The couple completed a divorce in January 2008, and the divorce papers stated there were no children as a result of the marriage.

Marcos Gutierrez is not the sperm donor for any of Suleman’s children. Presumably insurance provided by Gutierrez paid for the births of the six older children?

IVF is not a Kaiser benefit; that treatment occurred in Beverly Hills at the West Coast IVF Clinic owned by Dr. Michael M. Kamrava. Unable to conceive naturally due to what has been described as three ectopic pregnancies, Suleman had a batch of babies cooked up in a petri dish with semen obtained from a male friend who is at times described as her boyfriend. Suleman’s oldest child is 7 years old. Her IVF pregnancies all occurred after her on-the-job injury when she was too disabled to work and unemployed, though she also claims prior to injury she worked double-shifts at the mental hospital in Norwalk, saving money or the IVF treatments. Suleman self-reports having spent nearly $100K on IVF alone.

Thus far media accounts do not say if all 14 of Suleman’s children were cooked up at the same time, in other words, multiple ovum were harvested and combined with the boyfriends’ baby batter and then a huge batch of embryos were frozen for future use.

After her work-related injury she attended Cal State Fullerton and graduated with a B.S. (fitting initials, don’t you think?) in child development in 2006. She also found time to give birth to the first six children (including a set of twins) with the help of a full-time child care provider, her mother Angela. Suleman continued college to finish a master’s degree in counseling, but quit in the spring of 2008, presumably to implant a half-dozen embryos into her eager lonesome uterus.

Actually Nadya is said to have wanted “just one more girl” as the reason for this last pregnancy. Did you know it is possible to determine the sex of the embryo? Why wasn’t that done in this case?

After filing for bankruptcy in March 2008 due to what has been described as a bad real estate debt, Angela Suleman presumably downsized into the 1500-square foot Whittier home that she has so generously converted into a child care facility.

Let me go off on a bit of a tangent here. The university Nadya Suleman attended is a California State University, and the fees are nowhere near $50K for a four-year degree. As I write this, fees at Fullerton are $1,260 for 6.1 or more units; graduate fees are $1,551 for 6.1 or more units. There is simply no way that a person, attending a CSU school, needs that kind of money to attend college unless they are also living on those loan proceeds. (Tuition is paid for by taxpayers’ dollars, hence the relatively low cost of attendance.)

This is from the Fullerton State website regarding college costs:

Typical school year budgets for California residents vary widely. Room and board allowances for nine months range from $3,474 for students living at home to $9,035 for students living on campus and $9,792 for students living off-campus. The allowance for books and supplies is $1,116. Total yearly costs include allowances for registration fees, books and supplies, room and board, transportation and miscellaneous personal expenses and range from $11,470 for a student living at home to $16,761 for a student living on campus and $17,788 for a student living off campus. Nonresident students must also allow for nonresident tuition in addition to the costs listed above.

No doubt Suleman lied about where she was living, claiming she needed a housing allowance yet living with parents since January 2000.

Because the back injury was suffered at work, Nadya Suleman was eligible to receive temporary total disability until such time as she is able to go to work or is declared permanent and stationary (P&S), meaning the injury has improved as much as it’s going to. At that point, a percentage of total disability is determined and the injured worker receives a cash award paid in installments.

As far as this writer can tell, for whatever reason, Suleman has never been declared P&S and had been receiving non-taxed TTD for nearly ten years. TTD was cut off last summer, but not before she’d received $165,000. Her TTD had been cut off in July of 2001 but she appealed to the Worker’s Compensation Appeals Board claiming she was still disabled due to pregnancy and a car accident she claims to have had while driving somewhere for treatment.

If a person is injured for more than one year (on-the-job or not), he or she is eligible for social security. That payment currently is around $900 a month. Thus far no one is talking about Suleman receiving this benefit, but she’s eligible to apply (and the government is likely to deny the claim, but there is a nice long appeals process that favors the persistent claimant). There is also SSI, supplemental security income, which is given regardless of work history to people with no income. I believe she is also eligible for CALWORKs, which means financial assistance for herself and her children while she is learning a trade. I’m not saying she’s getting it, but she certainly could go looking for it.

Three of Suleman’s children receive SSI; one is said to be autistic, and Suleman claims that the other two kids receiving SSI are receiving it “temporarily” and that their conditions are treatable/curable (one has attention deficit hyperactivity disorder and another speech delays characteristic of mild autism).

According to one newspaper source, a low-income family can receive payments of up to $793 a month for each disabled child. Three disabled kids equals $2,379. She also receives food stamps valued at just under $500 a month.

Nadya Suleman does not consider any of those checks she receives in the mail welfare of any sort, and she claims the aid is only temporary. As if a crazy person working as a counselor will ever earn enough money to support herself and 14 kids!

When the octuplets were born in January, Kaiser Bellflower and Suleman claimed that the bill was being paid. Yes indeed it was.

In California, pregnancy and labor equals instant emergency Medi-Cal coverage. Kaiser wasn’t donating services at all; it saw a wonderful opportunity for publicity and also the right to bill the fine taxpayers of California for this pregnancy, birth and neonatal ICU costs.

In 2006, according to the U.S. Department of Health and Human Services, the average cost for a preemie infant’s hospitalization was $164,273. A singleton c-section cost $22,762. Nadya Suleman has been hospitalized on strict bedrest since October 2008. She is said to have stopped paying Kaiser premiums in November 2008.

Nadya Suleman is a case study in knowing how to manipulate a system fully to her benefit, and I predict the times may be ‘a changin’ in California.

There are “guidelines” that fertility specialists are supposed to adhere to, and every single fertility physician who has spoken to the media since the birth of these babies has said that Dr. Kamrava did not follow those guidelines. Physicians may implant large numbers of embryos in older mothers, hoping at least one “takes,” and those doctors strongly counsel women to undergo selective reduction should more than three implant. Any doctor who would stick six embryos into a woman who happily carried six prior babies after IVF is plain insane. The doctor no doubt knew Suleman was not only unemployed and single, but also supposedly disabled.

One physician did admit that he would have referred Suleman to counseling had she presented to his office after having the first six babies, but he also noted that the remaining embryos were hers to do with what she wished, and that a threat of a lawsuit could be enough to prod a doctor into doing something he or she knew was not ethically the right thing to do.

Nadya Suleman is said to be in hiding with her first 6 kids due to “death threats,” according to her PR team.

So what do you think will come out of this case? Mind you, I hate the government having to butt into so many things that should be a personal choice, but when taxpayers end up paying for those personal choices, I feel we deserve a say in things.

1. I believe that the fertility clinic “guidelines” which are in no way legally binding will be passed into law, giving real consequences to doctors who implant so many embryos into women, and especially into unstable women with no source of income other than taxpayers. That doctor needs to determine well before a pregnancy occurs just who is paying for the birth and support of a resulting baby.

2. If you are too disabled to work, you are no doubt too disabled to carry a baby. A singleton birth is tough enough if you have a bad back, and heck, if you didn’t have a bad back prior to pregnancy you will afterwards! Worker’s compensation will find a way to disqualify injured workers from TTD payments if they get pregnant while on TTD. Yes, it is a bit “big brotherish” but well within their rights to deny treatment if the injured worker goes against a physician’s advice. What physician in his or her right mind would advocate a gravely disabled woman risk her life by carrying multiple fetuses?

3. If Nadya Suleman is indeed collecting Social Security Disability for herself, no doubt the Social Security Administration will make things more difficult for legitimately injured people who absolutely cannot work.

4. Kaiser hospital had plenty of time to transfer Nadya Suleman and her gravid uterus to a county hospital. But I believe the hospital saw what they thought could be great PR and also knew it would be able to bill the state for the cost of hospitalization of Nadya Suleman and the eight babies. Because the hospital had time to transfer her to a public hospital that is by law required to take medically indigent patients, the state of California should not give Kaiser Bellflower a dime in reimbursement.

What laws would you like to see put on the books to prevent cases like this happening again, and what should the consequences be for Nadya Suleman, Kaiser Bellflower or Dr. Kamrava? Notice I didn’t even go into what is presumed to have been plastic surgery to make Suleman look more like another famous child collector, Angelina Jolie, who can afford to birth and adopt as many children as she wishes, at no cost to California taxpayers, or talk about Suleman’s perfectly-manicured nails that are clearly visible during the NBC interviews.

Taxpayers may have to cover octuplet mom's costs

Birth of Octuplets Puts Focus on Fertility Clinics

Octuplet Mom Filed Worker’s Compensation Claim

LA police to investigate threats to octuplet mom


Nadya Suleman's Excuses in Her NBC News Interview - Blame It on a 'Dysfunctional' Childhood

Normal Births Don't Require a Publicist - What's Wrong With Octuplet Mom Nadya Suleman

Update!
Addendum—readers, please check out this article at the LA Times:

Octuplets fertility doctor at center of another multi-pregnancy

Dr. Michael Kamrava is at it again: a 49-year old woman is pregnant with quads; she is now hospitalized on bedrest at County-USC after being transferred from Good Samaritan because she is uninsured.

And yet another update:

Octomom doesn’t have a PR rep anymore; she’s got an agent!

SoCal octuplets mother now has agent, no publicist

Wes Yoder, who represented the McCaughey 7 and controversial pastor Rick Warren, claims to be the oldest Christian-based talent agency in the United States.

I am Christian, and I’m not falling for it. Interesting tactic though, to play on the publics' faith. I hope it doesn't work. I'm assuming he took on the case because somewhere there is indeed money other than the welfare she's bilking out of the state and federal governments.

The pro-bono PR agency got sick of dealing with death threats (and I believe it was wrong to make any sort of death threats to anyone in this incident!).

UPDATE! Updated story links:

The Irresponsibility of Dr. Michael Kamrava

The "Crimes" of Nadya Suleman

No "Jon & Kate" Deal for Octo-Mom"