A doctor testifying on behalf of "Octomom" Nadya Suleman's fertility doctor repeatedly defended the in vitro treatments she received, saying it was appropriate considering her impaired fertility and desire for a very large family.
Dr. Jeffrey Steinberg took the stand in a hearing that resumed Wednesday in Los Angeles, where closing arguments are expected to begin by Thursday in the Medical Board of California's licensing hearing for Dr. Michael Kamrava.
The state licensing agency is seeking to revoke or suspend the Beverly Hills physician's license to practice medicine, accusing him of gross negligence in his treatment of Suleman and two other patients.
Steinberg, a longtime professional acquaintance of Kamrava's and a fertility doctor, said Kamrava had to take into account his clinic's low success rate when treating patients for fertility.
Steinberg's testimony conflicted in several instances with earlier testimony from the medical board's expert witness, University of California San Francisco's fertility chief Dr. Victor Y. Fujimoto.
Kamrava's treatment in one attempted pregnancy, when he implanted eight embryos, was "aggressive" but "I can't fault his judgment, to be honest," Steinberg said. Suleman's hormone levels indicated she had the decreased fertility of a woman over 40 years of age before she was 30 years old, he noted.
All 14 of Suleman's children were conceived through in vitro treatments provided by Kamrava.
Fujimoto had testified that the number of embryos Kamrava implanted in his repeated treatments of Suleman exceeded the standard of care, which is to implant one or two embryos.
It is unheard of for a patient to be implanted with 12 embryos, as Suleman was in the conception of the octuplets she birthed in 2009, said Fujimoto.
Kamrava, in earlier testimony, has said he regrets implanting Suleman with 12 embryos, which, in his own words, resulted in the "very risky, unhealthy pregnancy" of the octuplets.
Steinberg also seemed to easily read and understand Kamrava's medical records and notations, which Fujimoto said were substandard and difficult to decipher.
Kamrava had gone out of his way to warn Suleman of the risks of implanting all 12 embryos, Steinberg said.
"(Kamrava) clearly spelled out over and over and over again that number one, he disagreed with her decision, and that she understands everything, that she's insisting he transfer all the embryos," said Steinberg.
Steinberg said, had he been in Kamrava's position, he would not have found it necessary to recommend Suleman for a mental health evaluation after she came back for repeated treatment, despite already having two children through in vitro fertilization.
He later added that in hindsight, she needed mental evaluation but no doctor has the "crystal ball that everyone expects us to have."
Fujimoto testified last month that providing unabated fertility treatment to a single woman should have raised questions, and resulted in mental health consultations before each additional pregnancy going forward.
Under cross examination, deputy attorney general Judith Alvarado asked Steinberg if doctors have an obligation to the welfare of existing children when they're considering providing fertility treatments.
"No, I think the mother has that obligation. To imply that fertility physician should assume responsibility for families of all their patients is way beyond our expectations and abilities," Steinberg said. "None of us would be able to practice medicine."
The hearing is expected to resume Thursday, with the state calling one more witness before closing arguments.
After this week's hearings, the administrative law judge overseeing the case will draft an opinion and submit it to the Medical Board, which will make the final decision on whether Kamrava can legally keep practicing medicine in California.