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A Commentary on the Case of Ricardo AschIn 1995, a scandal erupted at the Center for Reproductive Health at the University of California, Irvine's Medical Center (UCIMC). The accusations of mail fraud, tax evasion, and unconsented use of human ova were serious in nature, though more than 10 years later few people actually know or understand what occurred at the clinic, despite claims to the contrary. Patients, lawyers, state senators, and university administrators quickly and publicly placed the blame for what went wrong on Doctors Ricardo Asch, Jose Balmaceda, and Sergio Stone in order to self-aggrandize or deflect responsibility. The rush to judgment precluded any opportunity for the physicians to adequately engage in preparing or presenting information in their own defense. With the certainty of imprisonment looming and the low probability of receiving a fair trial, Asch and Balmaceda made the logical choice to leave the United States in the best interest of their personal and profession lives before the federal indictments were released. That federal prosecutors have chosen to pursue extradition at this late date may represent pure folly and more than likely is tinged with vindictiveness. In the case of Dr. Asch, the effort to return him to the United States to stand trial is particularly vexing. The Influence of Media CoverageThe odds that Asch would receive a fair trial are diminished by previous and current media coverage that has tainted public opinion. The newspaper and television coverage of the alleged fertility scandal was widespread, though in-depth and unbiased perspectives were antithetical to the cause that further spurred the anger dredged up in the court of public sentiment. The Orange County Register, for example, saw the story as a means to a Pulitzer Prize and published more than 230 articles on the subject in 1995 alone (Dodge and Geis, 2003). Patients, who garnered a great deal of sympathy, appeared on national syndicated shows; including, for example, Tom Brokaw, Oprah Winfrey, Maria Shriver, Maury Povich, and Phil Donahue. Narrative from the Oprah Winfrey clearly demonstrates the media created hysteria: Her September 5, 1995 program began with a barrage of overblown rhetoric: ‘It is an extraordinary tale, all the makings of a terrifying science-fiction thriller.’ ‘Is it a high-tech baby kidnapping too bizarre and horrifying to be real?’ she asked. Later in the program the story became ‘unimaginable’ and the show’s presentation, notably sketchy, was [incorrectly] heralded as ‘the first in-depth’ coverage (Dodge & Geis, p. 15). The case also became fodder for a third-rate television drama on Lifetime that veered far from any factual data, despite the network's purchase of so-called "insider" stories. The hyperbole surrounding the events at the University of California's Medical Center was designed to arouse readers and promote circulation and television ratings-not discover the truth. The University's CulpabilityOver the past ten years, the UCIMC in Orange County, California has been plagued with scandals, administrative battles, and bad press. Amid plans to open a new $371 million hospital, calls for accountability among programs and hospital personnel arose as a series of clinical catastrophes occurred; partially attributable to a climate that put fiscal concerns over patient care and promoted pervasive institutional deviance. In 1997, the Food and Drug Administration discovered that a lab at UCI’s Chao Cancer Clinic illegally charged patients and Medicare for experimental drugs and asked for donations from patients who wanted to participate in clinical trials. In 1998, Doctor Darryl See was forced to resign after allegations arose that he improperly used patients’ blood samples and failed to follow appropriate protocol in the treatment of laboratory animals. In 1999, the director of the UCI’s Willed Body Program who handled donated cadavers was fired for allegedly marketing body parts to other research institutes. In 2004, Dr. Hoda Anton-Culver, a cancer researcher at the university, was accused of mishandling $2.3 million in state and federal funding. In 2005, the liver transplant program was halted after the withdrawal of Medicare funding. An article in the Los Angeles Times reported that 32 peopled died waiting for liver transplants, partly because doctors had refused available organs—the program lacked a full-time transplant surgeon. In 2006, questions also arose about the low number of kidney and bone marrow transplants that appeared to threaten patient care. Additionally, two primary physicians in cardiology were rebuked for not having state licenses and appropriate board certifications. Allegations of ethical lapses emerged in the department of anesthesiology along with accusations of nepotism in hiring. Recently, Dr. Ralph Cygan, chief executive of the hospital and medical school dean, Dr. Thomas C. Cesario resigned their positions (events and timeline presented in Ornstein & Berthelsen, 2006). Clearly, UCI failed to provide proper oversight to “ensure good medical practice” in clinics under its purview and staffed by university employees. When push came to shove rather than accept responsibility for the series of unfortunate events, university administrators and lawyers found individual scapegoats. The misdeeds of many, however, were overlooked and only the physicians involved with the Center for Reproductive Health were targeted for individual prosecution. Selective ProsecutionThe federal indictment charged Asch with mail fraud that included issues connected to insurance billing, egg transfers, and the distribution of an unapproved drug into interstate commerce. Ironically, the accusations of insurance fraud were peripheral to the case and represented a widespread problem at the hospital. In fact, the billing practices handled by university staff and administrators, not physicians, appeared to be standard operating procedures. In the late 1990s, the University of California system paid $22.5 million to Medicare after a federal investigation of billing errors at all five teaching hospitals. The report noted that a major issue was “whether medical faculty inappropriately billed the government for care actually provided by residents or doctors in training, person who are not eligible to bill Medicare.” Charges regarding the use of a non-FDA-approved drug were, by all accounts, insignificant. The only hard evidence that could substantiate the transfer of eggs without consent is DNA evidence that confirms the genetic parents in suspected case—an unlikely legal scenario. A California Court of Appeal, for example, rejected any attempt by a former patient to obtain blood and DNA samples. The judge dismissed the case after reviewing a donor/recipient list and declaration by a former clinic biologist which he deemed to be hearsay. A case ruling that wisely was based on the best interest of the children (Ofgang, 2002; Prato-Morrison v. Doe). ConclusionsAfter his relocation, Dr. Asch began practicing in Mexico City until he was detained by customs in Argentina. In the ten years during his exile from the United States he has treated, quite successfully, scores of patients who placed their trust in the physician, despite the accusations and insinuations that continued to haunt his reputation. Internationally, Asch’s reputation flourished and he has continued to lecture worldwide as a leader in the field of reproductive medicine. His positive contributions have continued, despite the UCI ordeal, and without apparent complaints by patients and peers. The need to bring Asch to trial in the United States on mail fraud charges undermines the credibility of federal prosecutors and represents an enormous waste of financial resources. The contextual background of the case, abundant hearsay, and lack of documentation regarding “who did what” at the Center for Reproductive Health will certainly hinder justice and diminish the possibility that Ricardo Asch will be treated fairly in the United States. ReferencesDodge, M. & Geis, G. (2003). Stealing Dreams: A Fertility Clinic Scandal. Boston: Northeastern University Press. Ofgang, K. (30 October, 2002). C.A. Rejects Bid by Couple Caught Up in UCI Fertility Scandal to Determine Relationship with Children.” Metropolitan News. Ornstein, C. & Berthelsen, C. (17 February, 2006). “UCI Medical Center Tried ‘Too Much’ - The Scandal-Plagued Orange Hospital had Inadequate Resources to Match its Ambkitions, a Panel of Outside Investigators Concludes.” Los Angeles Times. MARY DODGE, Ph.D.
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