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This is an I Heart Podcast. Guaranteed Human this is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or OSA in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snored loudly, or if you spend your days fighting off excessive tiredness, irritability and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lilly, a medicine company. So let me get this straight. Your company has data here, there and everywhere, but your AI can't use the data because it's here, there and everywhere? Seems like something's missing. Every business has unique data. IBM helps your AI access your data wherever it lives to change how you do business. Let's create smarter Business IBM. This is Matt Rogers from Los Culturistas with Matt Rogers and Bowen Yang. This is Bowen Yang from Las Culturistas with Matt Rogers and Bowen Yang. Hey Bowen, it's gift season. Ugh, stressing me out. Why are the people I love so hard to shop for? Probably because they only make boring gift guides that are totally uninsp. Except for the guide we made in partnership with Marshalls, where premium gifts meet incredible value. It's giving gifts with categories like Best Gifts for the mom whose idea of a sensible walking shoe is a stiletto, or Best Gifts for me that were so thoughtful I really shouldn't have. Check out the guide on marshalls.com and gift the good stuff at Marshalls. What do you do when things get tough? You don't give up. You stand your ground. If you've been diagnosed with metastatic prostate cancer and have tried hormone therapy, ask your doctor About Pluto Lutetium Leu177 Bifatide Tetrexitan Pluvicto is not chemotherapy. It's a different treatment that targets PSMA positive cells. Pluvicto can be used before chemotherapy for some people. Pluvicto is a prescription treatment used to treat adults with prostate specific membrane antigen positive metastatic castration resistant prostate cancer or PSMA positive MCRPC who have already been treated with hormone therapy and are considered appropriate to delay chemotherapy. Bluvicto involves contact with radioactivity which may increase the risk for cancer and cause fetal harm. Drink plenty of fluids, urinate often, use contraception and talk to your doctor about ways to reduce the risk of exposing others to radiation. During and after treatment, BlueVicto can cause low levels of blood cell counts, kidney problems, and infertility. Tell your doctor if you have weakness, pale skin, shortness of breath, bleeding or bruising more easily, an infection, or changes in urination. Side effects include decreased blood cell counts, tiredness, dry mouth, nausea, appetite loss, joint or back pain, and constipation. Ask your doctor about Pluvicto, because every day without cancer progression is a victory. Visit pluvicto.com to learn more. Shh. You won't believe what my new friend just told me about dinosaurs. Is your child having conversations you never imagined? Are they learning without realizing it? It's not a tablet. It's not a toy. It's Meco Mini plus, the AI powered companion that turns curiosity into endless learning. Hear the future playtime. Meet the extraordinary Mikko Mini Plus. Only at Costco, we have, like, girls night. Once. Once a month, we get together and we get food, and one time we've did all of our nails. So it's like we get to make fun of people that are pregnant sometimes or make fun of people who don't understand IVF a little bit. So it's kind of like we use dark humor. We also just laugh because that is the way you survive it. But it's been life savings. It's been absolutely life saving. I mean, my husband's wonderful and he can listen to me all day long, but at the end of the day, he cannot comprehend. Whereas I can call you guys and you will spiral with me all the way down and then bring me right back up, and that's what I need. That's so we. We literally laugh and cry together. We just understand. We don't have to explain anything. Like, if we say this is how we're feeling, we understand it completely. In August 2024, about four months after the center for Reproductive Health, I flew to Nashville to meet with some of the former patients of the clinic, like Sarah Davis and Penny Koh. Sarah and Penny didn't know each other before all this happened, but they became fast friends. They were in similar situations. Both had been undergoing IUIs at CRH, not in vitro fertilization. So, unlike many former patients, neither had embryos in storage there, sparing them the agony of wondering whether their genetic material was safe. But that didn't make the experience any easier. Both women still felt deeply violated by what had happened at the clinic and were trying to figure out how to move forward. I purposely planned my trip to coincide with a hearing in the State's consumer protection case against Dr. Jaime Vazquez and the center for Reproductive Health. I didn't know if he'd show up, but I was hopeful I might be able to meet him to get his side of the story. I met up with Penny and Sarah before heading to the courthouse. Oh, do you like my earrings? Do you like my earrings? Do you know what they are? Yes, I know. I'm like slightly rebellion. In honor of the court hearing, Penny was wearing special earrings shaped like vulvas, handmade in shades of pink and cream with a pearl suspended in the middle. They were a quiet act of protest, a statement that women's bodies and health care should not be hidden away or shamed, but seen and respected. Being in a red state, I just don't think women's health care is where it should be. I think we're in the top five for some of the worst women's health care. You're most likely to die in the state of Texas. We are if you're pregnant, which is terrifying. And I usually fall on the more conservative side, but after all this, like, no, I'm falling more moderate, but I'm. I'm advocating more on the other side, which I don't like sides, but I would pick, you know, women's health care. It's opened my eyes politically. Later that morning, we drove downtown for the hearing and squeezed into the elevator together. Oh, my God. This is a very little elevator ever. Oh, dear. Did everybody wear deodorant? I can't promise I'm not. Slave. Something else. Oh, I'm sweaty. I would be nervous to see Vasquez. I've never seen him before. You really? I've never met him. I've seen his name. Penny's offhand remark about having never met Vasquez revealed to me in that moment how truly strange it was. The person at the center of all this turmoil who loomed so large in their lives, was essentially a stranger. The irony was the moment we exited the elevator, we spotted Dr. Vasquez. Though we didn't realize it right away. He looks just like that doctor. Same height. Same height, but he looks very similar. No, she said, that's him. Where? Right there. It was indeed, Dr. Vasquez. That's him on the left. He was in a blue shirt and striped tie with. With wire rimmed glasses perched low on his nose. And he looked weary as he entered the courtroom, surrounded by his lawyers. We followed him in and took a seat at the back where all the former patients sat. I watched him during the proceedings, hoping for some sign of what he was thinking or how he felt. But there was none. So when the judge called a recess, I took my shot. I approached him in the hallway and introduced myself, asking for an interview. Can I interrupt you for one second? I'm so sorry. I just wanted to introduce myself. I'm Melissa Jeltson. I'm a reporter and I'm working on a story about this case. He didn't respond. His attorney spoke for him instead. I just wanted to see if you wanted to talk any of your. No, not. Not right now. Not right now. Do you have a card? Yes. Yeah, and I'm working on a project that will take is months in the making. We'll obviously want to represent your position. Yeah, if you can get me a card, we'll respond. Thank you so much. I did eventually hear back from his lawyer, but Dr. Vasquez, the man so many patients want answers from, who I want answers from, declined to talk to me directly. To try to understand why his clinic shut down, I'd have to do more digging. Foreign. I'm Melissa Jeltson from School of Humans and iHeart podcasts. This is what happened in Nashville. Episode five, the Unraveling. @ its core, this podcast is about the patients left reeling when the center for Reproductive Health suddenly closed its doors. The fallout touched every part of their lives. Their hopes for children, their savings, their marriages, their families. But behind their stories lies a mystery. What went so wrong inside crh? How does a fertility clinic with decades of experience collapse overnight? And if warning signs existed, why did no one act, especially the man running it? Although Dr. Vasquez declined to speak to me directly, one of his lawyers, Dixie Cooper, agreed to talk and we spoke on the phone for over an hour, though she didn't want me to use her audio. Still, I was able to piece together Vasquez's account of the circumstances surrounding the closure from my conversation with Cooper and from court filings. What you'll hear next is parts of a declaration he wrote explaining his version of events and other court documents read by a voice actor. The center for Reproductive Health was a family business from its inception, with my wife Nancy stepping in to serve as a practice administrator. Within a year of the clinic opening, Mrs. Vasquez continued working at CRH for over 20 years. Vasquez describes himself as a committed, hard working doctor who ran a small business with his wife Nancy, without any significant issues for decades. And. And there's some evidence to suggest that's mostly true. During the course of reporting this story, I talked to over a dozen patients, all of whom had good reasons for picking crh. Some were referred by their doctors, others did their due diligence reading as many online reviews as they could. And some patients met with doctors at different fertility clinics in Nashville and just felt that CRH was the best fit. As Vasquez tells it, everything changed after 2019 when his wife Nancy stepped down due to health problems and was later diagnosed with Alzheimer's disease. Without her running the business side, Vasquez says the clinic's finances began to decline to keep the doors open, he claims he had to use his own money to keep it afloat. Dixie Cooper told me that Vasquez is a very smart man, but not a good business person. He was focused on patience, not on the money side of things, and when financial problems did occur, he tried to solve them himself. When CRH experienced financial challenges My wife and I put a significant amount of time, energy, effort and our own money into the practice over the years, always trying to ensure the best quality of treatment, continuity of care for patients and that employees will be paid fairly. We incur personal debt into the form of a home equity loan and multiple other personal loans in order to help CRH and the other affiliated businesses remain financially stable. Dr. Vazquez said he stopped getting any form of compensation from the clinic around mid August 2023. I chose to forego a salary for the entire time from August 2023 until the clinic was placed into a court ordered receivership on April 26, 2024. I did this in an effort to preserve the continuity of care for patients and to ensure that employees will be paid, he said. He didn't realize the clinic was so close to running out of money until his daughter Elena started looking closely at the books in April 2024. Despite being employed as a medical director and working every business day to make money to pay CRH's obligations to employees, employees and on site vendors. Foregoing a salary was not enough to financially stabilize crh. Vazquez denied that any financial malfeasance on his behalf had occurred. Instead, he blamed other more junior employees for mismanaging funds. Former employees of CRH who I trust to be honest and ethical in performing their jobs and in the management of the money coming into the practice were engaging in an appropriate behavior that I learned about when the practice had to cease business due to lack of funds in April of 2024. Those actions include not submitting bills for payments by insurance companies and self pay, giving unauthorized raises to various individuals in the practice and taking unauthorized trips using the CRH credit card, all of which contribute to CRH being unable to make payroll, resulting in CRH having to close the practice. His lawyer, Dixie Cooper, repeated this in her interview with me, claiming that several employees were intent on sabotaging the clinic and taking Vasquez down. She told me that after the clinic shut down, Vasquez's top priority was keeping the embryo safe. She said he went into the clinic every day personally checking the tanks and disputed the state inspector's claim that he'd handled them improperly. More broadly, Cooper criticized the state's lawsuit against Vasquez, claiming it included false and exaggerated allegations against her client, inciting unnecessary panic. She also said that in the days after the closure, Vasquez had been working to find a local clinic to buy CRH and take over. But the deal was scuttled because the state froze Vasquez's assets and installed a receiver. Despite my knowledge and experience, not only was I never consulted for guidance to expedite the process, I was completely shut out of this practice with no access to my office space, the medical records, or any other information located at crh. Cooper explained that after the receivership began, Vazquez and his legal team lost access to the clinic's records, leaving them unable to verify details, challenge the state's claims, or properly defend themselves. She also added that Dr. Vasquez is deeply sorry for what happened and wishes it had never occurred. She said he even offered the state what little money he had left to reimburse patients who paid for services they didn't receive, but the state never responded. He has since declared bankruptcy. In Cooper's telling, the whole situation is a tragedy, one that's harmed both Dr. Vazquez and his patients. She argues that he's a well meaning, well intentioned professional who just got in over his head due to the actions of wayward employees. I wasn't sure what to make of this. It felt a bit to me like passing the buck. As the owner and medical director, Vasquez was the one in charge. I wanted to see what his former employees had to say, and I reached out to more than a dozen of them, hoping to understand their perspective and to learn more about how the clinic operated in its final years. But most didn't respond. Letters and emails went unanswered. Eventually, though, one woman agreed to talk, a former Lab employee whom Dr. Vasquez has accused of trying to destroy his practice. And she tells a very different story. So you're telling me that the AI that's meant to make everyone's job easier to manage just adds more to manage on top of the thousands of apps the IT department already manages. Funny how that works. Any business can add AI. IBM helps you scale and manage AI to change how you do business. Let's create Smile to Business IBM. This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or OSA in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snored loudly, or if you spend your days fighting off excessive tiredness, irritability and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lily, a medicine company. This is Jacob Goldstein from what's yous Problem? Business software is expensive and when you buy software from lots of different companies, it's not only expensive, it gets confusing. Slow to use, hard to integrate. Odoo solves that because all Odoo software is connected on a single affordable platform. Save money without missing out on the features you need. Odoo has no hidden costs and no limit on features or data. Odoo has over 60 apps available for any needs your business might have, all at no additional charge. Everything from websites to sales to inventory to accounting. All linked and talking to each other. Check out odoo@o d o o dot com. That's o-o.com Shh. You won't believe what my new friend just told me about dinosaurs. Is your child having conversations you never imagined? Are they learning without realizing it? It's not a tablet. It's not a toy. It's Meco Mini plus, the AI powered companion that turns curiosity into endless learning. Hear the future of playtime. Meet the extraordinary Meco Mini plus only at Costco. Season two of Unrivaled basketball is here and the talent is unreal. Paige Beckers, Nafiza Collier, Kelsey Plumb, Briana Stewart and more are back to redefine the game. Unrivaled basketball season two, sponsored by Samsung Galaxy Tips off January 5th on TNT, TruTV and HBO Max. I have actually gone through treatments myself to get my baby and so I know like how emotionally invested like you can get. Marie began her job at the center for reproductive health in 2022. Because she still works in the industry, she asked us to use a pseudonym. We've also modified her voice to protect her identity. Society tells Women that your job and your goal as a woman is to be a mother. And I was one of those people that had that ingrained. And so it was really frustrating to be like, well, my body doesn't work the way that it's supposed to. Marie was hired to work in the lab. It was her first real job after getting her bachelor's degree in biochemistry. And she was excited to learn the ropes. I worked in both parts of the lab, so andrology and embryology. And then I also did like all the ordering for the lab stuff. I also kept up with any tracking that we needed to for inspections. So for both cap, FDA inspections, like any documentation or records. And then when we did things like the genetic testing and the PGT reports came back, I was typically the person who called the patients with like their fertilization reports and stuff like that. At first, Marie loved the job. Being able to help people like, like use science in such a cool and niche way that enables them to reach their goals and dreams. In that way it was great. The work was intense and the hours were long, but Marie bonded with the other employees over the high stakes. They were, after all, helping to create life. When we were in cycle, it was really stressful because we had a lot of patience and a lot of work to do. We spent a lot of late nights there, like six, seven o' clock at night was not uncommon. To leave when we had gotten there at like 8 o' clock in the morning. I remember one cycle ended up being so big that we took shifts and people came in in like four hour blocks. And then when we were out of cycle, we did a lot of paperwork and it was a lot more chill. The staff were genuinely close, lending a warmth to the whole operation. We were a big family. We all had lunch in the lunchroom together. There were several employees who hung out after work together in different groups. There were a couple medical assistants who ended up getting married, who had other employees as bridesmaids in their wedding and things like that. Marie told me she'd enjoyed the sense of community she found at the clinic, but professionally it wasn't what she'd hoped for. She'd expected hands on mentoring and real training, but the place felt rudderless. By the time she arrived, Vasquez's wife Nancy had already left. And Marie said no one seemed to really be in charge. Staff were left to manage the day to day on their own with little oversight or direction. Dr. Vazquez didn't seem especially interested in teaching, she said, and there was no full time senior Embryologist on staff. When per diem embryologists came in a few days each month for egg retrievals or embryo transfers, Marie would pepper them with questions, trying to absorb as much as she could before they left again. Most of the time, it felt like she was learning on her own. It was a lot of reading protocols and following written instructions. I signed up for additional training and took some online courses. The plan was to eventually be certified in both andrology and embryology. And so those courses were, like, part of that path towards it. After about a year and a half at the clinic, Marie realized she could no longer work there. She felt there was no room to grow professionally. And she says she'd started to notice things that made her feel uneasy. Patients being told inaccurate information about their embryos, staff stretched too thin, and protocols that seemed to shift depending on the day. The hours started getting later and later. Like, you shouldn't be working more than eight hours because your eyes are going to get tired. You need, you know, those breaks so that you can rest and recover. Make sure that you're staying at your best so that you can give the patients the best and most accurate care possible. We started dropping witnessing, which was concerning. Murray said the clinic had stopped consistently doing what's called human witnessing, which is where a second person observes lab procedures as quality control, verifying that you are moving the right eggs into the right dish for the right patient, and then when they become embryos, that you're using the right sperm that they've signed for. As she saw it, employees were overworked. Some were doing jobs they weren't trained for. To her, it reflected a culture of cutting corners, a looseness with the rules that made mistakes feel not just possible, but inevitable. I asked her what it was like to be inside the clinic at that point, believing it was starting to come apart and knowing how much patients were counting on them. You, as someone who went through fertility treatment, would you have been comfortable at that stage, choosing center for Reproductive Health as your clinic? No, but I had insider knowledge, and a lot of that information wasn't available to, like, patients on the outside. In early 2024, Marie put in her notice, and she wasn't the only one. A lot of other employees, also frustrated by the working conditions, were leaving. Towards the end, more and more people were starting to put in their notices as well, and those physicians weren't being filled or replaced. The smaller clinic, you have a person doing multiple positions, and so when one person leaves, it's essentially like five positions that you're trying to fill. But with one person, and then that's not being replaced. And then there are multiple of those scenarios in different aspects of the clinic. Like on the laboratory side, on the clinical side, on the financial side, all different sides, this was happening. It was like, okay, there's not going to be anybody left to hold this clinic up. Like, it's going to fall. We could see it coming. And so if we could see it coming, then there's no reason Dr. Vasquez didn't see it coming. In court documents, Dr. Vasquez claimed that Marie was one of the disgruntled employees responsible for the clinic's financial ruin. She denied the allegations and said that she had no responsibilities involving billing, insurance, or other financial matters. Dr. Vasquez also accused her of organizing the staff against him by encouraging them to quit their jobs. Marie told me that she did advise some employees to resign before they got themselves into ethically or legally dubious professional situations. There were a couple of people who I worked with who, when I found out that they weren't going to interview or hire for my position, I was like, I would recommend that y' all also leave so that you are not like, stuck or trapped in doing a lot of these things that you're not qualified or trained for. You could potentially, like, have negative repercussions for your career later down the road. Another employee who put in their notice around the same time as Marie was Dr. Ferrer Dyer, who was hired in 2020. You may remember Dyer from episode three. He's the one who did his medical training in the UK and was practicing at CRH as a fellow. Though some patients I interviewed were under the impression he was their licensed doctor, he agreed to speak with me on the record. With his attorney present, I asked him about the patients I'd spoken to who felt like they hadn't been treated with honesty. Here's what he said. The journey for fertility medicine is an emotional one, and it's long and it's arduous and it's tough. I just hope that patients don't get discouraged because they feel as though something went wrong with their treatment and my involvement in it, when I know that there was nothing wrong with my treatment and involvement with their process. Truth be told, looking backwards, I think that we helped a lot of people. Dyer told me that the entire reason he started working at crh was because Dr. Vazquez had promised to help him get his license. Except, according to Dyer, Vasquez kept pushing the goalposts, saying he needed to work as a fellow for two years. Then four Then five before Vasquez would sponsor him. I go in with Vasquez March 1st of 2020, and by the time I get to March of 2024, he says that I need to have another year. So his threat to me was, I don't believe that you have completed all the curriculum that would show that you're proficient enough to be your own reproductive endocrinologist. I want you to give me another year. I'm going to pay you fellowship money, which is not a lot of money, and then you still will work for me, and then we'll go next year to the state. As we explored in Episode three, it's unclear how this arrangement would have led to Dyer attaining licensure. Still, he says that was his belief. Emotionally, it's sort of tough where you put in four years, somebody gives you a promise, and then you know that they're gonna renege on the promise. Not to say that you give up, but you sort of lose the passion that you had for said clinic. I asked Dr. Vasquez's attorney for more information about any assistance he provided to Dyer in gaining licensed and to respond to Dyer's claims, but didn't hear back. Dyer says that beyond his waning confidence in Vasquez's promises, he was also dealing with complications from type 1 diabetes. These factors combined told him it was time to leave. It had started with renal failure that had gone blind in an eye due to diabetic retinopathy, which I actually got corrected. So I wrote a letter of resignation in January. And then I told him, hey, I'll stay until my four years are up in March. And then at that point, he sort of stopped talking to me. I stopped seeing his patients in late February, and then I had to write up all of my charts and whatnot, and I was out by March 29th. Both Marie and Dyer quit before the final stretch of the clinic's operation, when things really went downhill. I wasn't able to speak to any employee about those last days of practice, but I know that Vasquez hired a new junior embryologist, Jasmine Bills, less than a month before the clinic shut down. She described her experience at CRH in an affidavit, which was filed in the state's consumer protection case against the clinic. Here, a voice actor reads parts of her statement. My dream job was to work in embryology. Jasmine said her training consisted of three to four days at crh, learning from an embryologist who worked on a per diem basis at the clinic. My first official day at the center was March 25, 2024. It seemed like the staff didn't know how to direct me for this position to due to it being outside their scope of practice. I started looking at training manuals from the World Health Organization because I didn't know what the best practices were. Although I was the junior embryologist, the center didn't have a full time senior embryologist on staff. I was never given a comprehensive overview of lab safety procedures. I just picked things up from the employees who were training me. It was Jasmine's job to analyze sperm samples and prepare them for intrauterine insemination procedures. She was also responsible for maintaining the cryogenic tanks. The alarms on the storage tanks go off if the tank's liquid nitrogen levels fall below a certain threshold. And if there isn't enough nitrogen, the embryos in the genetic material could start to thaw and become non viable. An alarm company had a list of people to call if the alarms went off, but I was told the staff weren't sure who was on the alarm call list because of all the staff turnover. And to my knowledge, I was not on the storage tank alarm call list. Jasmine had only been officially working at the clinic for less than two weeks when she, like the rest of the staff, got an email from Dr. Vazquez's daughter Elena, saying that the staff would not be paid due to lack of funds. She came into work the following day. Regardless, I asked Dr. Vasquez what was going to happen with the center and being paid, but he didn't respond. He just looked at me. I decided to gather my things and leave. Still, Jasmine says she decided to come back to the shuttered clinic the following week to prepare some specimens for transfer, including, it seems, Sydney's embryos. Before it became evident I was not going to be paid, I'd accepted embryo and sperm transfers and I felt morally obligated to complete those transfer requests. And even though it was unlikely for me to get paid for that work while at the closed clinic, she checked the liquid nitrogen levels in the tanks. They were low, she wrote, though they hadn't yet reached dangerous levels. She filled them up before she left, but didn't mark it in the records. As she was no longer technically an employee. This was the last time she set foot in the center for Reproductive Health. I never received any communication from Dr. Vasquez or any other CRH administrators about when I would be paid. I could not apply for unemployment because I never got a paycheck from CRH. My first paycheck was supposed to be on April 5th. I'm back working at the pharmacy I was at previously, but in a lower position. According to Jasmine's affidavit, Dr. Vasquez appeared to be confused about the clinic's deteriorating situation. Her account was echoed by several patients who who recalled being told that operations were merely on hold or experiencing low volume, as if normalcy would soon return. One patient, Jacqueline Locke, told me about a zoom meeting she had with Dr. Vasquez on April 3, 2024, the day before staff were notified there were no remaining funds to cover their pay. The call with him was to kind of go over what our next steps would be. I hopped on the call with him after he was like, at least two hours late, and he had like, no idea what the purpose of the call was. I was thinking that we were getting, like, some really helpful information that was going to help us move forward and get to our goal. The call went on for an hour and a half. Jacqueline told me she struggled to follow Dr. Vasquez's train of thought. She'd already done two egg retrievals with him and was debating whether to try again. It wasn't a simple choice. She lives in Canada, so another round meant more flights for her, her husband, and their small children, more time away from work, more strain on her body, and more money they didn't really have to spend. And through it all, Vasquez never said a word about the clinic's financial trouble or that it might not even be open much longer. That makes me feel sick to my stomach. I really don't understand what went on in his head. So let me get this straight. Your company has data here, there, and everywhere, but your AI can't use the data because it's here, there, and everywhere? Seems like something's missing. Every business has unique data. IBM helps your AI access your data wherever it lives. To change how you do business, let's create Smile to Business. IBM, This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or osa, in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snore loudly, or if you spend your days fighting off excessive tiredness, irritability, and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lilly, A medicine company. This is Jacob Goldstein from what's yous Problem when you buy business software from lots of vendors, the costs add up and it gets complicated and confusing. Odoo solves this. It's a single company that sells a suite of enterprise apps that handles everything from accounting to inventory to sales. Odoo is all connected on a single platform in a simple and affordable way. You can save money without missing out on the features you need. Check out odoo@odoo.com that's o d o o.com Shh. You won't believe what my new friend just told me about dinosaurs. Is your child having conversations you never imagined? Are they learning without realizing it? It's not a tablet. It's not a toy. It's Meco Mini plus, the AI powered companion that turns curiosity into endless learning. Hear the future of playtime. Meet the extraordinary Miko Mini plus only at Costco. Season two of Unrivaled basketball is here, and the talent is unreal. The best women's players on the planet are running it back with even bigger moments and bigger stakes. Don't miss as Paige Beckers, Nafiza Collier, Kelsey Plumb, Brianna Stewart and more take the court and redefine the game. This isn't your regular season. This is unrivaled, where the pace is faster, the energy is higher and every athlete shines. Unrivaled basketball season two, sponsored by Samsung Galaxy, tips off January 5th on TNT, TruTV and HBO Max Dr. Vasquez tells the story as an abrupt fall, a good clinic suddenly running into financial trouble. In his version, everything changed when his wife left in 2019 and the business began to slip. But based on my reporting, that's not entirely true. I dug into the public records related to the clinic to get a glimpse at what was happening behind the scenes. This ended up being fairly complicated, as there's no one government agency that regulates fertility clinics. I was able to get some reports from the Tennessee Department of Health, which inspected the clinic every other year, as well as reports from the fda, which inspects clinics that handle donated reproductive tissue, eggs, sperm, that kind of thing. According to the Tennessee Department of Health, the clinic had been cited for deficiencies at least twice in the years before Dr. Vazquez's wife left. In 2007, state inspectors discovered that one of the clinic's nurses did not have documented training for two tests that she'd been routinely performing. They also noted a couple of instances where the clinic was not adhering to recommended quality control testing practices. In 2010, state inspectors found that the clinic had been using an expired solution to test semen samples for about a month and a half. This meant there was no reliable way to confirm the test was working or that any of the patient results from that period were accurate. The federal inspection records reveal more troubling observations. In 2017, FDA inspectors found that the clinic wasn't properly screening or evaluating donors for infectious diseases. For example, they learned that the clinic did not test all egg donors for Zika as required. They also documented one case where an egg donor had been treated for chlamydia but was not tested to see if she had recovered prior to her donating. The FDA noted that the clinic didn't have appropriate procedures in place for how donor screening and eligibility decisions should be done. This matters because donor screening is what protects patients from using sperm or eggs that carry infectious diseases or serious genetic conditions. In 2019 and 2022, FDA inspectors went back to the clinic and found similar issues donors not screened properly before allowing them to donate and inadequate paperwork documenting required testing. The FDA classified all three inspections from 2017 to 2022 as VAI, meaning voluntary action indicated, a category used when violations are objectionable, but the agency believes the clinic can correct them without formal enforcement action. About a month before the clinic shut down in April 2024, the FDA inspected once more. This time they discovered that some donor files still contained patients real names, a breach of privacy rules meant to protect both donors and recipients. Over the years, the deficiencies the state and FDA documented did not trigger serious action. They were considered minor, fixable, not enough to cause urgent concern. But these shortcomings did at times trickle down to the patient experience, as Peter Ricci and his wife learned in their time at crh. The worst irony when it comes to our experience with Centers for Reproductive Health is that our initial experiences were actually very good. Peter is a 36 year old writer and editor. He and his wife first went to the center for reproductive health in 2022. My wife is an ovarian cancer survivor, so we knew from when we started dating that we would have to find alternate means to be parents, which is something we both very much want to do at the time. They were living in Nashville and were drawn to Dr. Vasquez's egg and embryo donation program called American Embryo Adoption Agency, or aeaa. We're really impressed with center for Reproductive Health and the number of egg donors they had, and our early interactions with them were actually very encouraging. Their plan was to purchase donor eggs and use Peter's sperm to create embryos for a surrogate. They had an extensive database. We Were able to look through and see who we could potentially be matched with. My wife is African American, so we liked that there were black donors who we were able to consider because we thought, ideally, we'll have a biracial child then that will match what a biological child of ours might have looked like. In the summer of 2022, they obtained eight eggs. Seven were successfully fertilized with Peter sperm, but only one developed into a healthy embryo. They were disappointed, but not deterred. As a backup, they began considering the purchase of additional donor embryos Just in case they needed them. It was when my wife was looking back on the CRH database To see about purchasing embryos that she saw the profile for the person whose eggs we had used for our own creation. And she recognized the photo. She could tell that it was the same person. But this time around, there was a disclaimer on the profile that they were a silent carrier for a spinal disorder. And this was not something that was on the profile when we considered it, and it was not something that they had reached out to us to say. The egg donor Peter and his wife had used to create an embryo was a silent carrier of alpha thalassemia, A blood disorder, and spinal muscular atrophy, A genetic neuromuscular disease. Peter's wife sent an email to CRH asking for more information, like why they were not told about the donor's status when they purchased the eggs. The CRH employee who responded said that the donor was not tested at the time. It wasn't until, quote, much later that this information became available. The disorders the donor carried were recessive. They would only pose a risk if Peter was also a carrier and he wasn't. So they decided they would still move forward with their one embryo. By this point, the couple had moved to Chicago. They began the process of trying to move the embryo from CRH to their fertility clinic in Illinois. We're working with the new clinic, and they begin going through a rigorous process to evaluate that embryo. And it was through that process that we learned a number of things involved in the creation of an embryo and then the different things that were not done that CRH should have done. For starters, there was no record of CRH compiling what's called a summary of records. Now, what that basically means is it's a summary of my healthcare information relevant to embryo creation. So an easy list of things for a clinic to look over and to say, okay, everything is good. They were unable to produce a summary of records. They just weren't able to provide it. After extensive review The Chicago clinic said it would not accept the embryo for two reasons. One, because it was missing the summary of records, which meant they could not confirm that CRH followed FDA protocols. And two, because the egg donor was a silent carrier of a spinal condition. In an email, the clinic noted that this second reason in particular is their standard policy, one that it said many IVF centers follow. It's quite devastating to get that far down the line and then to realize, oh, we're unable to use the embryo. You feel like a fool when you're in these circumstances. You think, why was I not asking these questions? Why did I take their word for it? Why was I not thinking ahead of what complications could arise? It's very difficult to resist those thoughts and feelings when things go so horribly wrong. Peter and his wife decided to sue, arguing that CRH had broken its contract online. The clinic had advertised that it followed guidelines from the American Society for Reproductive Medicine, the group that sets best practices for fertility clinics nationwide. Those guidelines specifically call for genetic screening of egg donors for conditions like cystic fibrosis, spinal muscular atrophy, and thalassemia. But the donor they used turned out to be a silent carrier for two of those very disorders. In an email to Peter's wife, a staff member at CRH admitted that they do not routinely run genetic tests on egg donors, instead relying on family histories for known genetic conditions. That seemed pretty clear cut. Okay, breach of contract. They claim to be members of these different associations. They did not follow these things. They made certain promises to us when we agreed to work with them and signed contracts for it. So we're going to file a lawsuit then to have everything that we put in compensated. But it wasn't so clear cut. The clinic argued the case could only be brought under Tennessee's healthcare liability law, meaning that if the clinic won, the financial consequences for the riccis would be severe. They were responding in such a way that if we decided to take things to trial and they triumphed, so we were not awarded damages, and so on, Tennessee law allows them to then compel us to pay their legal fees and expenses. Ultimately, that was not a risk they were willing to take. They needed to save their money to pursue fertility treatments. We had to accept that the satisfaction of getting our money back from what we had put in and them admitting the wrong they had done, that it was not going to happen. So we made the tough call to voluntarily dismiss the case with prejudice. A month or two later, their lawyer reached out again with some surprising news. Johnny calls me up and says, you are not going to believe this. CRH's offices were just raided. Their finances have been frozen. They are in absolute turmoil. And that was when we saw then the floodgates open. Looking back, Peter said he noticed a lot of red flags at crh. He described forgotten appointments, a lack of organization, and what seemed to him like a casual attitude towards the rules. There was a slowly creeping suspicion of dysfunction in the space. And anyone is free to ask, well, why did you keep going with them? And the simple answer is, you get deeper and deeper into this process, it becomes harder and harder to walk away and you're not really in the position to then stop and go somewhere else. They're not giving you a refund if things do not work out. Peter and his wife are still feeling the fallout of their time at crh. It's a struggle that since the clinic's closure, they now share with other former patients. It's been the wildest of experiences of feeling isolated and used and disregarded and then learning that we're not the only ones, that others have also experienced this and they have their own horror stories. You're not going into fertility treatment from any position of strength. And it's a uniquely vulnerable kind of health care, meaning fertility and creating new life. When I last spoke with Peter, more than three, three years after he and his wife first walked in the door of the center for Reproductive Health, their fertility journey remained ongoing. We're still not parents, by the way. Next time on the final episode of what Happened in Nashville, the patients grapple with unanswerable questions and the long term consequences of CRH's collapse. I immediately just started questioning everything. I honestly thought, like, would my outcome have been different had I gone somewhere else? I was so focused at a certain point on the betrayal and the mistrust, and obviously that's never going to go away. That's always going to be there. And the shortcomings of one clinic serve as a cautionary tale for the industry at large. It has shaken my trust in healthcare and medical professionals. I don't trust that the industry is not out for the profit. They see desperation and they see dollar signs. Patients are left in the dark to steel themselves against the consequences of medicine when it goes awry. The question is, how much regulation of the clinics do we want? What Happened in Nashville is a production of School of Humans and I Heart podcasts, written, reported and hosted by me, Melissa Jeltson. Our producer is Edelise Perez. Our senior producer is Amelia Brock, with additional production by Emily Siner and Carl Cadle. Theme song by Jessie Nye Swonger Sound design, scoring and mixing by Jeremy Thal and Jesse Niswonger Fact checking by Savannah Hughley and Austin Thompson. Our production manager is Daisy Church. Voice acting by Tony Guerrero and Taylor Church. Executive producers are Jason English, Virginia Prescott, Brandon Barr and Elsie Crowley. If you're enjoying the show, tell everyone you know. And don't forget to leave a rating in your favorite podcast app. This is Sophie Cunningham from Show Me Something. 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