The Retrievals - Ep. 4
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The patients had generally two kinds of questions about what went on to the clinic. The first kind of questions were about the system.

How could this huge system fail in such a way that this could happen? The fact that somebody was able to walk out with bags of fantail in their purse and no one batted an eye, how does that even happen?

The second kind of questions were about the people in that system.

You wonder what each person, you know, the doctor or the nurse in the room, what what their experience of this was, what were they thinking?

But most of the patients never got to ask those questions. Staffer's were told not to talk with patients about what happened with the fatal. And for some of the patients, IT was hard to bring up to.

I remember going into the clinic, I never spoke with anyone about IT, but and I remember that I remember that feeling of kind of going into the clinic and kind of looking around and first of all, sitting in the waiting room, which of course, was not very full because of covered. So there is maybe one or two other people around waiting for appointments are waiting in line, but thinking like, uh, you know, kind of resisting the urge to say, where are you part of this? no.

Did this? Did you have a procedure without fingal? And then going in and seeing my nurse team and also emphasizing with them and thinking, like, did you know this is going on? You know like what's your perception of this? What was your experience of this? But knowing that, i'm sure they were very sternly told not to talk anybody about.

yeah. But then you will also I think for me, IT was also not understanding where the failure in the system was. So not really knowing what to ask or who who to ask even like IT. You know, it's thinking about IT now IT feels like I would have been gossiping, but it's not gossiping, really to say, to your care team, this happened. Are you making sure this isn't going to happen to me again?

Why do they not care that there were numerous women who are in excruciating pain and they didn't care?

I get stuck there. The staff as I spoke to did care. And yet this happened.

how? From serial productions in the new york times. I'm Susan burton and this is the retrieval. This is episode four, the .

clinic.

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IT was hard to find staffers who are willing to speak about what happened at the clinic. Some of the redco had to do with the fact that there's an ongoing lawsuit. Six months after donor was sentenced, several patients filed a complaint against yo.

We have another big story we're following right now. Seven women have filed a lawsuit against yale university medical school.

and this is really unbelievable. The women they were given sAiling instead of final over .

the next few months. After that, more and more patients joined first one, five.

sixty thousand and nine dozens more women are coming forward to zoo yale university, nearly a year after a former yale nurse sentenced for tempering .

with the almost seven patients in the but the lawsuit d says about how long da was doing. This is a lot longer than what he says about how long he was doing. IT Donna told investigators that he started stealing fate no and replacing IT with sAiling in june twenty twenty when the clinic was located in a suburb of new haven. But patients and their lawyers believe that he began doing IT before then when the clinic was located in .

new haven in proper.

About half the patients in the lawsuit say they experienced severe pain before june twenty twenty, some as far back as twenty seventeen. Here's lin, a special ed teacher who had, maybe you remember this number from the first episode, eight painful retrieval at .

the clinic when I did find out the dates that he had admitted to I was angry you I am confident that this was happening um while they were still in a new habit in office and again, it's too coincidental that I experience this excruciating pain um I know with my heart that he was doing this a new haven and affected a lot what more women than you know during that five month period that .

he admitted to again.

danna did not respond to my request to speak for the story. Two hundred patients may have been affected during the five month period. Dona admits to stealing vennel. If SHE started earlier, SHE could have affected hundreds more. One of the lawyers who represents lean in other patients is named josh koh.

He's well known for his suit against the gun manufacturer in the Sandy hook school shooting and the related case against alex Jones early on when judge started getting calls from a lot of patients who said this had happened to them before june twenty twenty, he felt like he should share that information. He contacted the U. S. Attorney office. And I think .

more importantly is what I did was also notified you once we started to hear from a lot of women outside this time period, I thought, well, yl deemed IT appropriate IT to notify the women that they knew might have been exposed in the six month period. So surely they would want to notify IT would be important for them to know that I that I believe this is going on for longer. And I notified them and ask them what they were going to do about that. I I share that information and to my knowledge, they didn't act when I presented .

this to yield, they responded that the department of justice had conducted a thero investigation and concluded that this took place specifically from june to october twenty. Yael declined to make anyone in a position of oversight available for an interview with me, but I did talk to staffers, people who worked at the clinic alongside side dona. You won't be hearing from them on tape.

None of them wanted to be identified for fear of being retaliated against or losing a job. I don't think it's going to come as a surprise that I didn't talk to any doctors who were like, yeah for months patient after patient was screaming and crossing me out and looking back, I guess I should have done something about that. If there is such a canales doctor, they did not respond to me.

The people I talk to you were talking to me because they were troubled by what had gone on at the clinic. Some of them had left, but this wasn't about a then data. As one staffer put IT to me, this was about telling what happened to prevent that from happening again.

I wish I could write about the staffers like i've written about the women as a cohort with a shared experience, and also as individuals whose identity shaped the way they made sense of IT. But I can't offer details about anyone I spoke to. This makes the way I approach the story of the clinic a little more forensic, a little more procedural, a little more like a case study in drug diversion, which is what stealing drugs in a medical setting is called.

And this clinic could be a case study in how that happens and how IT is missed. I'm going to start the story in an office, the clinic occupied for years in office, in an older building, in a medical complex of ninety five, the long worth exit. And i'm going to start in the retrieval room with the drugs they use there.

Final imada m. These drugs are one of the first things most staffers I talk to wanted to make sure I understood. There's a lot of variation in the way patients responded these drugs.

Some were out of IT, some were alert, even getting singing along to the pop songs, playing at a low volume on the radio. And for some patients, the drugs were not effective enough. Even the maximum dosa henno was not enough to manage their pain.

Even when that fenno was actually fanno, the highest might not be enough for a bunch of reasons like existing tolerance to our codex, chAllenging anatomy. Sometimes the patient would be in so much pain that you would be kicking and screaming. How often would something like that happen one or two times a year was one answer.

I got another person said, even less so. That kind of extreme response was unusual, but not unknown. But these drugs didn't treat pain one hundred percent for all patients with the medication approach that was used at long worth one, stafford told me this procedure can hurt.

Maybe twenty five years ago, moderate sedation like this federal imada m combo used to be standard for retrieval, but it's not anymore today. What's more common is deprecated ation with prophete administered by an anesthesiologists or nursing esthetics. At long north, a fertility nurse gave the drugs, and there was a limit to how much they .

were allowed to administer.

When I told one fertility doctor from another clinic what yale had used, a long war, SHE said, i'm shocked they do that with fan al mada. M, in my opinion, that is not enough for this procedure. SHE wondered if I was a money saving thing, but another doctor who done hundreds of retrieved with fan, no.

Imada, I am back in the day and sometimes still does, said in her experience this combination was absolutely fine, that as long as I was working properly, there wasn't anything wrong with using IT. And staff ers, at long worth, said that retrieval were generally fine, but they wanted the precedence. The bottom line is that you want patients to be comfortable for their own sake.

And because comfort is necessary for safety, there's a long middle inside the pelvic cavity. Sudden movement presents a risk. I wondered why long worth didn't have the precedence.

Staff has had different and often vague understanding of the reason, something about the oxygen access, one staffer said. But whatever the practical reason for not getting Better in athegither was there was also a cultural one. There's a ton of just inertia and trying to get things done at yale, the staffer said. And I think if someone in a position of administrative leadership decides that something is not .

that important and IT just doesn't happen.

So this is the baseline. This is the context. For years and years, yellow is giving these drugs that offer a relatively light level of sedation for this procedure. Patient responds to these drugs varies. Some pain has been Normalized.

One of the things I wanted to know from staffers was if there was a point when they started seeing more pain than usual, nobody could identify an exact date, but some people did remember something changing before june twenty, twenty, the date on a confessed to as one staff were put IT. I remember a shift in feeling like we were doing things reasonably well and pretty much achieving our goals of minimising pain. And then gradually, IT didn't seem like we were a nurse recalled.

I remember distinctly times a patient would say, oh my god, I feel everything. I looked at the physician and said, I gave the max. What can I give? Whether IT was water? I don't know.

In hindsight, IT makes you think I had in water. Not everyone was seeing this retrial. Els were divided up among a lot of different doctors and nurses at the clinic.

Often doctors were even doing retrieval on their own patients, but staffers who did register that something seemed off started coming up with theories to explain IT stories. The way everyone here did. One theory was just the basic, we need Better in athegither. Another, there was a new manager and there was a lot of frustration with her. Nurses were leaving the clinic, and those who remained were spread then.

Could that have something to do with IT? But also, and this was the theory I heard most consistently, maybe IT was because of this one doctor, someone who didn't have great hands as one staff had put IT to me, or a great bedside manner. One staff, er, told me that all of the nurses were talking about how in retrieval this doctor would be.

Like, if you don't stop yelling, i'm just gonna leave another record of the doctor that quote, the response was more often kind of an impatient, I can't do this unless you start moving, kind of almost scolding the patients for the discomfort that they were having. During this time, a doctor from yielders family planning service was invited to the clinic to speak to staffers about how to be more gentle during procedures. Some staffers were offended by the idea that they needed a refresher course.

One said, we had this very sort of condescending talk about how to treat patients and how to be empathic and responsive. I mean, the whole thing was just like, what is happening here. Are we all being subject to this insulting training because of one person? One theory that none of the staffers I talked to had was that a colleague was stealing drugs. That's usually how IT works with diversion. People don't suspect their co workers.

but increased .

complaints of pain are known sign of drug diversion, and leadership is responsible for seeing the big picture. And if a manager was aware enough of pain to invite someone to speak on IT, they should have investigated all possible reasons for the pain, including the drug supply. Probably the most basic step in preventing diversion is how you handle and store the drugs in the first place.

At long north, these systems were not great. For one, the long north clinic didn't have a pixi, a kind of secure vending machine for drugs that records each transaction. A machine is not a solution for poor oversight. And not every outpatient setting has one of these machines.

But two patients who worked as nurses were shocked that the clinic didn't have a pix, as I can even take something as simple as a thailand all out of the pixel without somebody wanting to know which patient went to when I was given, how much was given. One of them told me. A stafford, the o clinic, told me that when they wondered red to a manager why they didn't have a pixi, they were told yao didn't want to buy one because I was too expensive.

The way drugs are precured supposed to be tightly regulated too because obviously that's a point where they could be pokey at long worth at least some of the clinics drugs came from. While Greens, including fatal like IT, was somebody's job to run out to all Greens and pick up final IT sounds weird. And IT was even to people who worked at the clinic.

Staffers told me that when dona had this job, he had often been insistent and trying to get doctors to sign the prescription SHE needed for the drug store. One staff were remembered sh'd be very, very, very aggressive. Another said that dona was constantly harassing fellows to raise scripts for patients that we're gona be done the following week.

At the time, both of these staffers attributed this to a kind of mania for organization, but both also clock IT as odd IT was okay. She's like, super efficient. One of them said she's trying to get her job done so you can go home to her kids, take your kids to their activities.

In early twenty twenty, the clinic moved out of the long warf office to a newly renovated building in orange. Almost immediately, the pandemic started. One patient remember shaking her doctor's hand, unlike march eighth, and the handshake already feeling a little strange, the clinic shut down for a while. And by the time thing started up again, IT was june twenty twenty, the month that dona says he started stealing final.

At the new building, there were new drugs. Now patients were offered the precedence. Anais ologies came to the clinic for most retrieval, adding powerful sedatives like proper fall into the mix with final medaille.

Some staffers noticed a difference right away. The patients were more deeply asleep. One of them said to me, IT was more like a full on surgery by comparison.

They looked tremendously comfortable. But proper file isn't a pain drug. I just kind of taxi out. And to the fertility doctors, that deep cedant likely mass, the fact that some patients weren't getting fatal.

So in the procedure room, some patients appeared comfortable, but in the recovery room, some of them came to in severe pain. At home, some continued to feel severe pain. And that partner makes sense to several doctors.

I spoke to people not from yale that is short acting. Maybe IT would cover pain for up to a half hour after the procedure ends, but that's probably IT. So how to explain the severe pain patients fill hours later or the next day? People I talked to didn't doubt the patients were in severe pain. They just didn't know where I was coming from, but any patient in severe pain after an agra rival should not have been discharged, doctor said. It's just not supposed to hurt that much, and severe pain is a sign that something might be really wrong.

When danna got to orange, SHE basically took over the drugs in march twenty, twenty two months before he says he started stealing fant. SHE completed an application with the D E, A that allowed her to sign controlled substance orders. SHE was in charge of ordering drugs for the clinic.

The room where the drugs were stored was sometimes unlocked, and dannon was able to enter without swiping her access card. Obviously, things went wrong with this set up, and even more things went wrong with this set up. Then we're reflected in dana's criminal case.

Days after the loose camp was first discovered, the dea investigated the clinic. Their audit found that a lot of drugs went missing. Understand, watch six percent of academy, twenty four percent of the mada slam, thirty five percent of the fan tmo.

This is in addition to vile SHE tempered with these are hundreds of other missing vials that just who knows what happened to that? It's possible that this was just very bad record. Keeping the records from this time are messy handwriting logs.

But was Donna also stealing the meddle lam in the kadeem? IT is speculation to ask, but IT is also were not to ask, given that he was stealing the sentences. No matter what happened with those drugs, these are serious discrepancies.

Yield agreed to pay the D E, A, A three hundred eight thousand dollar fine to settle these and other violations of the controlled substances act. So that's accountability on a regulatory level, on a personal level. Just who weather was not looking at those logs, who was managing dona, a staff I spoke to emphasize the lack of oversight during this time.

The nurse manager was new and IT was somewhere twenty twenty. The pandemic, the clinic was Operating with a skeleton crew, is how the staff were described IT. A lot was happening on telemedicine. In retrospect, CT IT was right for abuse, the staffer said.

The pandemic made IT easier for dona to hide what he was doing. But there is one thing that would have been very hard for her to disguise. How did nobody notice that shit tempered with the vice, especially the caps people I talk to who work with fant ovals, were just kind of blown away by that the caps on these files pop off, and IT would be impossible to receive them the way they came.

Of course, ultimately, an anesthetic logic did not a salute cap. And now the problem wasn't that the final diversion was hidden. The problem was with how that would be addressed.

The loose cap was discovered on a friday, and the following week the news was shared. File was missing. IT was almost immediately clear that danna was under suspicion. Poor dona, when staffer remembers a manager saying the staffer thought poor dona for patients.

lawyers advised .

efforts not to talk about this, even among themselves. IT was all basically about protecting yale. One staff were remembered.

Nobody cared about anything that we went through us providers. No one cares what patients went through. IT was all just sort of minimizing this as much as quickly as possible. The staff, as I talked to, emphasize that what they went through was nothing compared to what the patients went through.

But they had also been betrayed by dona, and now they had to restore, with the repercussions of that, what accuse they might have missed, what IT meant to have caused pain to their patients, or do not have recognize the pain they were in, or the reason for IT. Obviously, they were going to talk about IT with one another. I mean, there was constant talking.

One staffer said that just wasn't realistic. I'm sorry, it's crazy. We can't keep working and not vent and provide support to each other.

Six weeks after the loose camp was discovered, yell sent out that letter that infuriated patients, staffers too. I found that letter so offensive, said one of them. The letter was an official story yield told about these events in the staffer, and some of the patients had the same reaction to the story as IT was told in the letter and would be told later. The story evaded IT blame, shifted its focus attention on to a person and away from the institution.

IT is a language that that that um doesn't take responsibility IT individual tes, the problem. So it's hears this woman who was troubled, who took advantage and otherwise improbably well oiled machine, you know and .

again and not like, what can we do to never have this happen again but more, you know, well, you know, IT was her for she's gone. You know.

I think if IT wasn't dona IT could have been anybody else. They didn't. They didn't create an environment where there were checks and baLances, where there was a proper policy and procedure in place, that there were ways to mitigate risk.

IT was like a here's this problem. We've now eliminated the problem, but there was a whole system of enablers. There was a whole system that helped prop on up, excuse her behavior and then threw her out.

IT is a source of deep frustration for many of us that the party line up and down has been about one bad egg. E, A. Stafford told me, I would have like to see my institution acknowledge mistakes, apologize to patients for a systemic failure on yellow part, take ownership and clearly outline steps to prevent this from ever happening again.

Two former staffers gave me the same reason for leaving the clinic that they felt they could not provide good patient care to be, quote, not proud of the Carrier providing and constantly apologizing. It's just exhAusting. One staff er said to me in the end, the staffer felt that good patient care was not the driving force at yl IT warn me down. I got really tired of feeling like I was expressing the same patient care concerns and other being told that someone was working on IT or that IT wasn't an issue.

While yael declined to answer almost all of my questions, they did offer me a statement. Yield deeply regrets the distress suffered by some of its patients when a former nurse at the yield fertility center diverted pain medication intended for patient procedures after yield discovered the nurses misconduct, IT removed her from the center, alerted law enforcement agencies and notified patients who might have been affected. The center also reviewed its procedures and made changes to further oversight of pain control .

and controlled substances.

That phrase, pain control IT wasn't part of that earlier statements yale gave about these events, at least not the ones i've seen as if he took them awhile to understand the issue here, not just the institutions failure to control drugs, the institutions failure to control pain. How to think about that pain as a patient and as a practitioner that's coming up after the break when episode four of the retrieval .

continues?

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Early on in my reporting, a staff er suggested to me that not all of the patients in the lawsuit had actually been victims of donas crime. Could their pain just be the reality of the retrieval in the moment? I did not know what to make of the suggestion.

What would you mean for me to consider the question that maybe not all of the patients have been victims in situations that involved this belief? Questioning can be consider as doubt. And to be clear, the stanford was sensitive to these nuances, too, emphasizing that no matter what, these patients have been betrayed by.

The clinic later told me that on that original department of justice call, this was, quote, the million dollar question. How do I know if this happened to me? And the answer was, you don't. My answer to this question is that the underlying issues are still the same. Patients reported severe, unexpected pain, and that pain was not properly addressed and maybe haven't been for years before these events.

For example, after hearing this podcast, a patient hood undergone a painful retrieval at the clinic some years ago contacted me soon after her retrieval, SHE complained in writing, asking why, yelled in offer, quote, additional pain control options during agra, rivals similar to those offered at other fertility centers here, and connective, such as proper, after a follow up meeting to address this in other issues, a doctor in a leadership position detailed the patient list of action items will work on making anesthesia available to our patients. He wrote. That was in twenty fourteen.

When this patient heard this podcast, IT was like he was hearing the story of her own retrieval. I was crying out in pain. SHE told me before the retrieval, a nurse had assured this patient that you would hold her hand to help her through IT.

I don't want your hand. The patient remembers thinking, I want the drugs I had for my dental surgery. Even a decade later, her retrieve is a trauma.

SHE does not speak about. Patients say that yield dismissed the pain they reported. Offering inadequate pain control is another way of dismissing pain, another way of saying this doesn't matter.

It's upsetting either way whether patients were in pain because their drugs were stolen or because the drugs the clinic used, we're just not enough for too many patients. When a patient is in pain during a retrieval, what are the people in the room with her fuel? Let's walk you through. Let's walk through the essential unit of the story about the ill clinic, the retrieval. Here's how worked at .

long worth the .

doctor would walk into the room, lights or dim, patient ready there. Once the patient was sedated, the doctor would begin.

If the patient flinched, the doctor would stop, asked the nurse to give more mids, wait for them to kick in, if the meet still didn't work the same thing again, and then if there were no more times to stop, no more final to give, the doctor might say something like, you have this many followers left, would you like me to stop or keep going? And most of the patients would say, keep going, there's competing interest, right? One yellow safer said to me, they're uncomfortable, but they want to have a baby.

This is an impossible position for the patient. Of course, the patient is saying, yes, I want this, but what else could they say by this point in their treatment? There's already so much they've submitted to and so much control they're relinquished.

And there's a time sensitivity a doctor doesn't have all day. There's only a window of a couple hours to get this done. After that, the patient will ovulate and lose all of her eggs.

There's an awareness would come before this money time, maybe previous losses. The lash shop for the insurance runs out. It's not a life saving procedure when yellow staff er said to me.

But also I don't think elective is the right word to use for something that's allowing someone to build a family when they otherwise aren't able to. Doctors know what the patient has put into this and what he wants out of IT. Each time i'm doing a retrieval and getting followers, a doctor from another clinic said to me, I remind myself that this egg could be the baby.

But getting through a painful retrieval does not feel good. It's awful ful. One staffer from yield told me that's not why I went to medicine to cause people pain.

So what are the people in the room with a patient feeling a lot? It's not that they are aware of pain is that they're tuned to multiple varieties of IT, including the pain of longing. The patient puts up with the pain because he longs to have a child. The doctor knows the depth of that longing. Getting the eggs causes one kind of pain, but relieves another.

The literature on pain and fertility procedures is, for the most part, very concrete, which you reuse for pain rather than how should we think about IT. But I did come across one study with a more holistic approach, a paper on, quote, trust, pain and exit points. This paper explored why patients chose to endure the pain of fertility treatment and what experiences of pain made them quit.

IT was an idiosyncratic paper, kind of a mix of the sociological and the personal. And the research had been done twenty years ago in israel in a setting where agreement als were done via an incision through the abb demand. But we still the applicable actually, what felt timeless was the author's conclusion that you endure the pain of fertility treatment because you, in a way, are already a mother.

You are in the future in which you are already a mother and you are suffering on behalf of your children. Put aside the notion that suffering on behalf of your children is in transit to motherhood, or that all fertility patients want to be mothers. Of course, there are patients who would not use this word or find that identity relevant. What's meaningful here is that you put up with the pain in the present because of how badly you want, what you want in the future, whether that is a particular identity or anything else.

So that's why patients stayed in fertility treatment. Why did patients ts leave a higher level of hurt is required than that of pain or humiliation alone? The doctors wrote. Only when the women felt that the treatment endanger their physical or mental existence did the women quit their ivf treatments.

Some of the hill patients did stop utility treatment. Most kept going and most who did had babies. That's what matters, right? The baby is just one outcome. What do the other ones look like for the patients? And for dana, that's next on the final episode of the retrieval.

The retrieval is produced by me and Lawrence r. cheskin. Laura edited the series with editing in producing help from Julie snyder, additional editing by kate mingle and iron glass research, in fact, checking by ben fAiling and kin love music supervision, sound design and mixing by feb wing, original music by color alone and music mixing by toma poli in a tuba is the supervising producer for serial productions at the new york times.

Our standards editor, a Susan westling legal review by dana Green, art direction from public o delkin producing help from jeffrey Miranda Kelly, do ron beri, as a way, avoid an initial money. Sam, Donna is the assistant managing editor. Special thanks to our cl seaters linsey oker cami, make an awesome shanon page rebeca fAiling this, assume Maggie Smith and adam for chesty. The retrieval is a production of serial productions in the new york times.