← What Happened in Nashville
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- [00:00]
A
This is an I Heart Podcast.
- [00:02]
B
Guaranteed human I'm Carolyn.
- [00:05]
C
I have metastatic breast cancer.
- [00:07]
B
I was concerned after my diagnosis.
- [00:09]
C
Qasqali gives me more life for living. Since I've been prescribed, I've seen a daughter get married. I now have a grandchild and another one on the way.
- [00:16]
D
Cascali ribociclib 200 milligram tablets with hormone therapy is for adults with HR positive HER2 negative metastatic breast cancer do not take with tamoxifen. In the clinical study at 80 months, women taking Cascali plus letrozole lived over a year longer versus letrozole alone. Individual results may vary. Kiskali may cause serious skin reactions, liver problems and low white blood cell counts that may result in serious infections. Life threatening lung problems and abnormal heartbeats can occur. Your doctor should test your heart and blood before and during treatment. Tell your doctor if you have new or worsening cough, chest pain or dizziness before taking Cascali. Tell your doctor all your medical conditions, medicines you take and if you're breastfeeding, pregnant or planning to be sick and harm an unborn baby. Common side effects include nausea, headache and tiredness. Real patient compensated for her time the of risk. Learn more cascali.com.
- [01:08]
E
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.
- [01:35]
F
10 athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.
- [01:45]
You are the fittest of the fit. Only one of you will leave here with an IFIT contract worth $250,000.
- [01:54]
G
This is where mindset comes in.
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F
Someone will be eliminated.
- [01:58]
C
Pressure is coming down.
- [02:00]
F
This is Trainer Games.
- [02:02]
A
Watch it on Prime Video starting January eight.
- [02:05]
D
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.
- [02:45]
G
Shh.
- [02:46]
F
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 cur curiosity into endless learning. Hear the future of playtime. Meet the extraordinary Miko Mini Plus, Only at Costco.
- [03:14]
C
This episode contains discussion of childhood sexual abuse. Please take care while listening.
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You can't ovulate harder if you think about it better and you pay more attention to it. You can't do anything like that. So all we have is what people sell us. And unfortunately we will buy whatever you are selling when you're in this.
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When Sarah Davis begins trying to get pregnant in her mid-30s, she discovers a world of products for sale promising to increase her fertility and give her a child.
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I read every article, I followed every supplement company on Instagram. I fell down the rabbit hole of the wellness industry that is just utilizing Instagram to sell you crap you don't need.
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Sarah now works as a creative director for a clothing company, but she spent her 20s as a fashion designer in Nashville sewing bedazzled tour costumes for icon Dolly Parton. When I first talked to Sarah on the phone, she came across as street smart and impervious to bullshit. But the quest to get pregnant can unmoor even the most grounded among us.
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I racked up so much debt trying to do all this. At one point I was on like $400 a month worth of supplements. Everything's $90 and lasts for 30 days. And it's just, it's so much online.
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It'S easy to find other people's advice on exactly what you need to do to get pregnant, which may or may not be scientifically rigorous. Drink lots of pomegranate juice, take CoQ10, keep your feet warm to warm your uterus. And there's even some funny IVF superstitions like eating McDonald's french fries on the way home from your embryo transfer.
- [05:03]
A
There is literally a blog that lists the 90 some odd things she did to get pregnant. All the cleaning supplies have to be changed, all the soaps, all your shampoo, all of your toothpaste. You can't put chapstick on your lips because it's gotta be organic and free range or whatever the heck it's gonna be. Sounds crazy, but that's how I felt. That's how I felt like that's what I need because that's what's gonna get.
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Me Pregnant Sarah went all in. She tried expensive teas that claimed to have a higher success rate than ivf. A special bracelet that tracked her fertility. Seed cycling, which is when you eat specific seeds during certain phases of your menstrual cycle.
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You're supposed to take these two seeds in your smoothie for the first two weeks of your cycle, then these two seeds in the second two weeks of your cycle, and then. And it's supposed to balance out your hormones.
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And she even resorted to magical thinking.
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I had gone to a crystal shop and gotten a special crystal that was supposed to. I don't even. It was supposed to waste money. That's what it was supposed to do. That's exactly what it did. It was supposed to sell me on something I didn't need.
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Fun fact, I bought a crystal, too.
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You can buy a spell on ebay and someone from, like, Transylvania will say a spell over you and your uterus.
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C
Or from afar, paying a stranger real dollars to cast a spell to help you get pregnant. Just take a moment to let that sink in. To an outsider, it may seem ridiculous, but I understand it. Just like I relate to those fairy tales about infertility from the past, these stories all revolve around the same idea. When you want to get pregnant this badly, you will do anything, no matter how uncomfortable, bizarre, inconvenient, or expensive, to get a baby in your arms.
- [06:57]
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Let's freaking do it. I will drink disgusting tea. I will take all these supplements. I will do all the things I need to do. If that will get me to my end goal, let's do it. We're tired, we're broke, we're emotional. We just want it to be over. Unfortunately, people have figured out that this group of people are easy to take advantage of because we're desperate.
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I'm Melissa Jeltson from School of Humans and I Heart Podcast. This is what happened in Nashville, Episode three. Do you think that's your ovary?
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Human fertility as a subject matter and as an important role in societies dates back literally thousands of years. If you go back and look at some of the Egyptian papyri that were then able to be interpreted after the discovery of the Rosetta Stone, there are actually fertility therapies that are described in great detail in hieroglyphics.
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This is Dr. Alan Penzias, a board certified reproductive endocrinologist and associate professor at Harvard Medical School. He's talking me through the history of fertility medicine.
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So the fact is that fertility and infertility were recognized not only as problems thousands and thousands of years ago, but also recognized that there were potential treatments that could then alleviate the suffering of those who weren't becoming pregnant. Now, to us in the 21st century, looking back at some of the methods they used, some of them were really remarkably insightful. Others were quite way off the mark.
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C
In ancient Greece, for example, women were told to fill a cloth pouch with ground lead and iron, dip it in breast milk and insert it into their vaginas. In medieval Italy, one suggestion was to bury an egg near a cathedral for eight days, then dig it up and eat it.
- [09:07]
H
But as we move through human history and throughout the renaissance and then into the 18th and 19th century, when we started discovering things, being able to look at cells under the microscope and see motile sperm, and ultimately in the 1960s, 1970s, we started to see medicines that allow women to ovulate more regularly.
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The 70s saw one of the biggest advancements in fertility treatment.
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The watershed event that broke the dam and allowed millions of women to be able to become pregnant was In July of 1978, Louise Brown was born, the first human baby born as a result of in vitro fertilization.
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We can now hand it to our.
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Catholic baby cried at 20 seconds.
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Top doctors reported that the baby was doing fine and eating well. And the parents, they reported, were doing fine, too.
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After the birth of the first so called test tube baby in England in July 1978, the race was on for the United States to follow. Fertility clinics began springing up across the country, including one at Vanderbilt University in Nashville, Tennessee. It quickly became a magnet for ambitious reproductive endocrinologists eager to stake out their claim in the new and fast expanding field of IVF. One of those physicians was Dr. George Hill, who spent his early career at Vanderbilt before breaking off in the early 1990s to open his own practice, the Nashville Fertility Center, A clinic that still exists today.
- [10:49]
H
What I was told when I arrived at Vanderbilt was that Vanderbilt was the.
- [10:53]
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Fourth IVF program in the country, and that Vanderbilt had the fourth IVF baby in the country. So it was one of the early IVF programs. We had patients coming from all over the country.
- [11:06]
H
We had a pretty big drawing area.
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Here, so I'd been very busy at Vanderbilt.
- [11:11]
H
It was a smooth transition going into private practice.
- [11:15]
C
Dr. Hill wasn't the only IVF doctor to branch out on his own after his time at Vanderbilt. Dr. Jaime Vazquez also followed a similar path. After graduating from medical school in Chile, Vasquez moved to the US where he got his medical license. According to his bio, he held faculty positions at Thomas Jefferson University and the University of Wisconsin, Madison before joining Vanderbilt's faculty in 1991, where he served as director of the division of Reproductive Endocrinology and infertility. In 1995 he left to open his own clinic, the center for Reproductive Health, or crh.
- [11:57]
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Let us help you make your dreams.
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Become a reality by calling us at.
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The center for Reproductive Health.
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Newspaper ads from the time show Dr. Vazquez recruiting staff, a receptionist who could juggle many activities simultaneously, lab techs willing to work weekends. He filed paperwork with the state outlining a high volume infertility practice with its own operating rooms and lab. Vasquez was envisioning what the future of IVF was going to look like and planning accordingly. Dr. Vasquez declined to sit for an interview with me, but I was able to find promotional videos of him talking about the science of fertility, his clinic's approach to treatment, and his own reasons for choosing this work, which offers some insight.
- [12:44]
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The patient is my boss. Clinical science can allow me to make a prediction about what treatments are more likely to be successful. I give them all the options and I say I think that this is more likely to be successful. But I don't have a crystal ball. And if the patient decides a different treatment, we try it. I will not argue with the patient and try to force her to go into a different direction. It is her decision to make.
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C
Even as he worked to build a modern IVF clinic, Vasquez described his mission in personal terms rooted in love, children and legacy.
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E
When I see my kids, I'm amazed. That was a gift straight from God and my wife, and I'm so fortunate to have that. Not having that would make me feel very empty. So probably I should fight to help couples with infertility to have their family.
- [13:53]
C
I was able to glean some information about the clinic's early years from Federal Records. Since 1992, federal law has required fertility clinics to report their outcomes to the CDC, and CRH first appeared in a 1996 report. By then, the clinic had already joined the Society for Assisted Reproductive Technology, also known as Sartre, a kind of trade group that works to establish and maintain standards that members must follow. A few years later, Dr. Vasquez's laboratory earned accreditation from the College of American Pathologists, a private organization recognized by the federal government to ensure compliance with national laboratory standards. By all appearances, Dr. Vazquez was making sure his new clinic was would be at the cutting edge of medicine, technology and care. It took some time to build up the clinic's clientele, but eventually it found its rhythm as a smaller, more intimate operation, providing around an average of 100 IVF cycles for patients a year. While it was the smallest clinic in Nashville, this was framed as a selling point.
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E
Our philosophy of care is to be a family.
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And to help your family to grow. And we want to use clinical science to do that, but we want to do it in a personal way.
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The center for Reproductive Health's website also boasted that the clinic was responsible for the birth of more than 2,000 babies since its opening in the 90s. Patient testimonials reinforced the message that new patients were in the right place.
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G
I've always joked that Dr. Vasquez knows sperm and eggs like no one else. I know that sounds terrible, but it's so true. He has always been so warm and friendly.
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A
Dr. Vasquez was somebody who he sits down with. You took time, answered questions, just approached it differently. He'll do a lot of testing up front, but that testing helps him figure out exactly what's right for you. When the babies were born and came.
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C
To see our children and us in the NICU several times, I mean, I.
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A
Don'T think we would have gotten that from one of the larger multi physician centers.
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C
This personal approach continued behind the scenes too. Dr. Vasquez's wife, Nancy, managed the facility for two decades. The staff was described as tight knit and many worked there for years. One woman, a lab tech, stayed for well over a decade. Others, though, like in any small business, cycled through quickly. Over the years, Dr. Vazquez had employed other doctors, nurse practitioners and physician's assistants. But there were also stretches where he was the only doctor on site managing patient care. The One constant at CRH was Dr. Vazquez himself. The clinic was his baby and he was involved in all aspects of its operations. But as Dr. Penzias explained to me, running an IVF clinic is a big job.
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It's a very complicated circumstance. There are so many components to a well run IVF program that it is complex, it's doable, but it takes a good sized team with a lot of experience to be able to pull it off well.
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C
In 2019, Vasquez's wife retired due to health concerns and and their daughter Elena came on to assist with this. The clinic was going through some big changes and Dr. Vasquez needed some extra help on the patient side. So in 2020, he hired someone new. Dr. Hill, who ran a competing IVF clinic less than a mile from CRH, heard talk of this new hire. He had someone there that he called his fellow.
- [17:47]
E
I don't know much about the person.
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That he was calling his fellow.
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I mean, obviously we knew nothing about.
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H
What was going on over there.
- [18:01]
F
10 athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.
- [18:11]
You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.
- [18:20]
G
This is where mindset comes in.
- [18:22]
F
Someone will be eliminated.
- [18:24]
C
Pressure is coming down.
- [18:26]
F
This is Trainer Games.
- [18:29]
A
Watch it on prime video starting January 8th.
- [18:32]
G
Shh.
- [18:33]
F
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, the AI powered companion that turns curiosity into endless learning. Hear the future of playtime. Meet the extraordinary MECO Mini Plus Only at Costco Come for the Black Friday seasonal savings. Stay for the award winning reporting for a limited time. Access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime, but don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheart this is Sophie Cunningham.
- [19:33]
D
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't sleep on OSA.com this information is provided by Lilly, a medicine company.
- [20:14]
E
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.
- [20:43]
A
There are two things in this world that I have absolutely no doubt that I can do. Sew and take care of children. Those are the two things that I'm like, got it. I do remember in kindergarten, I was like, all right, I gotta have a boyfriend. Because you gotta have a boyfriend to have a husband, and you gotta have a husband to have a baby. It was like putting it together at five and was like, okay, I gotta start now. I gotta start with a boyfriend. Now I remember that thought process because the end goal was always a baby.
- [21:13]
C
In pursuit of her lifelong dream, Sarah poured money into supplements, herbs, and teas that promised miraculous results, but never delivered so much as a positive pregnancy test. By early 2023, after two years of trying, she's feeling burned out and disillusioned by the trendy fertility hacks advertised on social media. So when a coworker suggests she try the center for Reproductive Health, she's eager to begin a relationship with a trained medical professional she could trust. No more woo woo solutions, just science data and someone qualified to guide her.
- [21:52]
A
He was very nice. He was very friendly. He was sarcastic. He cussed with me. I grew up with a dad that is a sailor, and I am the same way. And it was like, okay, this guy, he is. It felt like a friend. It felt like I was sitting down to talk to a friend.
- [22:14]
C
Sarah isn't talking about Dr. Vasquez. In fact, during her entire time as a patient at CRH, she says she never even met Dr. Vasquez. Instead, she sees another provider, Dr. Ferrer Dyer, the man Dr. Vasquez hired in 2020. Significantly younger than Dr. Vasquez, Dr. Dyer had an easygoing, jocular demeanor where Vasquez's bedside manner could be academic and long winded. Dyer was funny and personable.
- [22:44]
A
He was super friendly. He was super positive.
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C
In their initial consultation, Sarah tells Dyer about her years of trying to conceive and her uncertainty about whether or not she's ovulating. And he seems receptive to her concerns.
- [23:03]
A
And I was like, oh, my God, this is amazing. Someone is finally listening to me. It felt like such relief. And he spent a lot of time going over the basics of how the body works, going over just stuff that you're like, no one else took the time to go over this.
- [23:23]
C
Before turning to IVF, Sarah says Dr. Dyer recommends she try intrauterine insemination, or IUI. This is a procedure where sperm is inserted inside the uterus right around ovulation. So the timing has to be exact. I've done four IUIs. You strip half naked and lie on a bed with your legs in stirrups. Then the medical provider inserts a thin catheter into your uterus and deposits the sperm giving it essentially a head start on its journey to the egg. It's not usually painful, but it's uncomfortable or at least awkward. For me personally, it was emotional and stressful, and success rates are low. It could feel like, I'm going through all of this and is it even going to work? Still, IUIs are often the first step in fertility treatment because they are a lot faster and cheaper than IVF. While Dr. Vazquez handled the more complicated IVF cycles at the clinic, Dyer did most of the IUIs. And in September of 2023, Dyer performed Sara's first IUI at the center for Reproductive Health. The experience goes smoothly, but she does not get pregnant.
- [24:39]
A
I mean, it's soul crushing. You just think, okay, great, now. Now what do we do? You spend 12 hours being mad, and then you're kind of like, all right, they told me the first one wouldn't work. You Google the crap out of it and you find out that it doesn't work for a lot of people and that a lot of times people get pregnant on the second one or the third one, and you're like, okay, we'll figure it out financially. Now I know what to expect. This is in September.
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C
I.
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A
We'll do another one in October. We'll do another one in November. We were taking my husband's family to Texas, to Fort Worth for Christmas. We were renting a house, and we were going to go down there. I had these grandiose plans. If either of those worked, I was going to have pajamas mailed to the house, wrapped, and one of them was going to be baby pajamas. And, like, I had this whole plan planned out.
- [25:26]
C
But the rest of 2023 does not go as planned. On Sarah's next cycle visit in October, she has a large cyst, and she's prescribed birth control to shrink it before continuing in November. She's hopeful about moving forward, but when she goes in for her appointment, the normal ultrasound tech is not there. And the woman who's supposed to perform her exam seems confused.
- [25:53]
A
She's like, okay, I don't really know what I'm doing, and I don't really know how to do ultrasounds. I'm just a nurse, but they've got me back here. Then while the wand is inside of me, she goes, I. Do you think that's your ovary? I'm sorry, I don't. Are you. You can't be talking to me. There's got to be somebody else in the room, because I don't. I don't know. Do. Am I supposed to know what's happening on the screen. And I was just like, this is literally determining whether or not we move forward with the next cycle, whether I have a sister or not. So I need you to know what my ovary looks like.
- [26:28]
C
Sarah complains to the front desk staff, and another employee does a repeat ultrasound. But it's not entirely clear what's going on inside Sarah's body. She decides to cancel the cycle. It's around this time that Sarah starts to question if the clinic is functioning properly.
- [26:48]
A
I was like, okay, this is not good. And since we had been there, a bunch of the people at the front desk had gone. The girls at the front desk would kind of be like, I don't know what's going on.
- [26:59]
C
Sarah and her husband are losing confidence, and they decide the next IUI will be their last at crh. If it doesn't work, they'll move on to another clinic.
- [27:09]
A
We entertain the idea of not going back at all, but that would have delayed everything because you have to do testing, and you have to wait for the appointment, and you have to. So it's like, we might as well do one more, and then in the interim, be. Be looking for someone else, and that way, at least we're not wasting a ton of time.
- [27:27]
C
Sarah says she also begins to have concerns about Dyer himself.
- [27:32]
A
When I first met with Dyer, my thyroid was high. TSH was high. And he prescribed me thyroid medicine. When I went to pick that thyroid medicine up, it had Dr. Vasquez's name on it. And I was like, this is weird. Asked the front desk. They said, oh, Vasquez just signs all the prescriptions. It's his account that assigns all the prescriptions. So we just do it all under him because he's the owner of the planet. All right, fine, whatever. Then all of the fertility drugs were in Vasquez's name. When I picked those up, and I asked again, and at that point, it was kind of like, okay, all right, it's fine. It is what it is. But it's. I definitely noticed it and thought it was weird.
- [28:13]
C
Sarah decides next time she's in the clinic, she should just check Dyer's credentials.
- [28:18]
A
I had told myself before that appointment with him, make sure you look at the wall to make sure there's a medical degree, because his name wasn't on any of the meds. And I was like, I need to make sure. I just need to check that.
- [28:30]
C
So at her next appointment, she looks around the exam room, and there it is on the wall, a framed medical Degree with Dyer's name on it. It gives her the confidence she needs to move Forward with her second IUI with him in February 2024. It doesn't work. And so, as planned, she and her husband seek care elsewhere. The following week, Sarah is sitting in an office of a new fertility clinic when she's asked about her previous provider.
- [29:01]
A
She asked me who I was seeing, and I told her Dr. Dyer. She goes, you know he's not a reproductive endocrinologist, right?
- [29:10]
It's a pretty small field, and I know most of the people in a, Like, a pretty big vicinity. I know at least of their names. And I was like, okay, you know, you leave that appointment, you're just focused on the next step. You're focused on you.
- [29:23]
C
But the comments linger. And so she decides to do some research. If Dyer isn't a reproductive endocrinologist, maybe he's just a general practitioner. She looks Dyer up on Google, but finds nothing. Nothing on social media either. She tracks down the website that lists licensed doctors in Tennessee, runs his name through, and nothing comes up. She can't even find his name on the center for Reproductive Health's website.
- [29:50]
A
I was like, you know what? This can't be this hard to find, right? Like, am I just dumb? Every other website in Nashville has all the doctors listed. They're on the door.
- [29:58]
G
So.
- [29:58]
A
So it's like, okay, this is weird. There's no mention of him with the board. There's no mention of him with a license in the state of Tennessee. There's nothing.
- [30:08]
C
Sarah wants answers. Over the next few weeks, she keeps trying to get a hold of Dr. Vasquez so he can explain what's going on.
- [30:16]
A
I called the office and I said, listen, something's going on. I left a message. There's some questions about Dyer's qualifications.
- [30:27]
C
No one calls her back. On Tuesday, April 9, Sarah tries calling the clinic once more.
- [30:34]
A
It rang and rang and rang. The front desk didn't pick up. And then it went to the emergency service, and she was like, I can't help you. I'm just here in case of emergency. Call back later. She didn't know what was going on.
- [30:50]
C
A few days later, she comes across Sydney's news article and learns that the center for Reproductive Health had suddenly closed. Unsure of what all this means, Sarah Contacts News Channel 5, the same news outlet that broke the initial story about CRH's closure.
- [31:07]
A
I knew that if one person had given up on this journey because of anything that these idiots had said, that they needed to know what was going.
- [31:13]
C
On they run another segment about the clinic, this time focusing on the questions swirling around Dyer's qualifications.
- [31:22]
F
Stunning new allegations tonight against the Nashville.
- [31:25]
A
Fertility Clinic, now being sued by the Tennessee attorney general.
- [31:29]
E
Tonight, another bombshell.
- [31:30]
F
Why did the man who treated so.
- [31:32]
A
Many of these women hold himself out.
- [31:34]
C
To be a doctor?
- [31:40]
F
10 athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.
- [31:51]
You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.
- [31:59]
G
This is where mindset comes in.
- [32:01]
F
Someone will be eliminated.
- [32:03]
C
Pressure is coming down.
- [32:05]
F
This is Trainer Games.
- [32:07]
A
Watch it on prime video starting January 8th.
- [32:11]
G
Shh.
- [32:12]
F
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 Come for the Black Friday seasonal savings. Stay for the award winning reporting for a limited time access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime, but don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheart.com this is Sophie Cunningham.
- [33:12]
D
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.
- [33:53]
E
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.
- [34:21]
C
Patients are already reeling from the center for Reproductive Health sudden closure. They've suffered canceled IVF cycles, lost money in time, and nearly 1,200 embryos are still trapped behind locked doors. Now a new and devastating fear emerges. Had they been treated by someone who wasn't a licensed doctor? After Sarah goes to the press, she has lingering questions about if what happened at CRH might be considered a crime. So she files a complaint with the Metro Nashville police. And the Special Victims Unit sets up a dedicated email address for former patients to recount their experiences at the clinic. In the wake of the news segment, as many as 65 families contact police, according to reporting by News Channel 5. For some, like Penny Ko, a 35 year old scientist who had been a patient at the clinic for a year, the fear isn't just about the quality of the medical care she received. It's also about feeling violated. She had been treated by a person who she worried might not have had the training or legal authority to do so. This man saw and performed procedures on her half naked body.
- [35:40]
G
I still feel kind of gross. I still feel cringy, even though I know it's not my fault or anything I've done, but it happened to me. So I'm like, yeah, I don't want anybody in my space. Anytime someone puts their hand on my shoulder, I'm just like, eh, like inching away. I'm just like, I just don't. After something like that happens, you're like, if they can be deceiving, how do you know somebody else isn't deceiving? Like it starts to play mind games. Unfortunately.
- [36:03]
There'S so many emotions that go on with that because I was sexually assaulted as a child. So it kind of starts pulling back. Trauma from younger ages.
- [36:12]
C
Penny is sitting in her OB GYN's office reading an article on her phone when she learns that Dyer had no medical license.
- [36:21]
G
I felt like I was going to pass out from anxiety because I was like, there's no way this is real. Like I started really spiraling. I could feel my face like get bright red. I can tell it was like a panic attack.
- [36:32]
C
During her time as a patient at CRH, she had undergone several IUIs with Dyer. She had put her trust in him and his training, and as part of the procedures, he touched her private areas and used medical equipment inside her body. So when she learns he isn't a licensed physician, she feels an overwhelming sense of betrayal. For Penny, it's a pain that's horribly familiar.
- [36:59]
G
If you've ever been Sexually assaulted. It puts you back into that category again, where you're just like, I don't want anybody touching me. I don't want my own husband touching me. Like, you just feel disgusting, you feel violated, you feel manipulated. Like, all of the emotions, you know, at that point, you're deceived.
- [37:16]
C
Penny told me that because she was sexually abused as a child, seeking fertility care as an adult had been challenging. She found the iuis in which she had to take off her clothes and lay still as Dyer inserted sperm inside her. Mortifying.
- [37:32]
G
I mean, I honestly had to. The whole time I had the procedure done, I laid back, closed my eyes because I just didn't want to see. Your legs are up, you're completely naked from the waist down. You feel the doctor like, kind of touching you. Even with my own husband in the room, I was like, I'm embarrassed. Like, I don't want him seeing me that way either. It's just a different level of embarrassment.
- [37:58]
C
Penny, Sarah, and other women who saw Dr. Dyer in the clinic feel that he wasn't honest about his credentials and presented himself as something he was not. This is an accusation that Dyer denies in full.
- [38:13]
B
If there is one sound bite that you use as a part of this, it is everything that Dr. Dyer did was appropriate under all applicable laws and regulations.
- [38:25]
C
That's Chanel Acheson. When I first reached out to Dyer for comment, he wouldn't speak with me. But Acheson, his lawyer, did. I eventually caught up with Dyer a few months after this, and we'll hear from him later in the show. But his attorney talked me through his position and presented the case that he did nothing wrong.
- [38:45]
B
First, I want to say that the fertility journey is an extremely emotional, traumatic, difficult journey anyway, in the best of circumstances. And I can absolutely understand and empathize with the trauma that these women are feeling. I cannot imagine the heartache. And I want to be clear that nothing I am saying negates that, takes away from that all of those feelings are real and valid. That said, nothing that Dr. Dyer did was inappropriate. He practiced the way that every single doctor that has ever pursued a medical license in the United States has practiced, which is under the purview of the license of another doctor while he was pursuing his own.
- [39:41]
C
Acheson told me that Dr. Dyer was working under the medical license of Dr. Vasquez while he was seeking his own license. She explained that Dyer, although an American himself, attended and graduated from a medical school in England called St Christopher's in 2007. Back in the States, he began taking the Medical licensing exams required to practice medicine in the US and passed some, but not all of them, Dr. Dyer.
- [40:09]
B
Passed his first two licensing board exams and then his mother fell ill and so he stopped everything to take care of his mother for a number of years. Everything for him took a backseat and unfortunately she ended up passing away. And then he started pursuing, you know, his own career again.
- [40:29]
C
Acheson said that in 2020, 13 years after Dyer graduated from medical school, he started working at the center for Reproductive Health as a fellow, believing it would help him advance in his dreams of becoming a licensed doctor. Although foreign medical school graduates like Dyer must complete a formal three year residency to obtain a medical license in tenness, something Dyer had not done, Acheson says that Dyer was told his work at CRH would set him up for an alternative route to licensure.
- [41:02]
B
He was told if he would work for two years at the center for Reproductive Health, then Dr. Vasquez would sponsor him towards this licensure issue. And that kept getting bumped out. And the final thing that he was told was, you know, four years. So he was just short of his four years.
- [41:16]
C
Acheson didn't provide any additional details about this fellowship, and it's unclear if Vasquez was even authorized to offer such an option.
- [41:26]
But beyond the fact that Dyer didn't pass all the required tests or complete a residency, there are also questions about the medical school he attended, St Christopher's in Luton, England. Today, the school no longer exists, and in 2005, during the time Dyer was a student, it was the subject of critical reporting by the BBC questioning its legitimacy. The UK's licensing body ultimately chose not to recognize St Christopher's in Luton as an authorized medical school because it couldn't provide proof it was offering education up to the UK's standards. As a result, graduates from that school cannot get licensed to practice medicine in the uk. In the us, some states have barred graduates of St. Christopher's and Luton from obtaining a medical license. Texas, for example, has the school on its most recent list of fraudulent or substandard institutions it won't recognize. New York, where I live, also hasn't accepted it in the past. Now, what about Tennessee? The state has specific rules surrounding international medical schools, and it's not entirely clear whether this school would be accepted or not. I reached out to a state spokesperson to clarify, but they declined to comment. Still, Dyer's lawyer points out to me that American authorities permitted Dyer to take the US medical licensing exams and claims a number of his classmates from St Christopher's have successfully gotten their Medical licenses in the states and are currently practicing.
- [43:04]
Acheson emphasized that Dyer was only working as a fellow under Dr. Vazquez's supervision. She says he didn't assess patients, prescribe medication, make diagnoses, or design treatment plans. He only carried out plans created by Vasquez. She says that Dyer was upfront with patients about his role and that it was entirely appropriate for Dyer to use the title doctor as he had earned a medical degree.
- [43:33]
B
Anytime that Dr. Dyer would come into the room and introduce himself to somebody, he would say, you know, My name is Dr. Dyer. I am Dr. Vasquez's extern or his fellow. I practice under the supervision of Dr. Vasquez. Dr. Dyer's white lab coat said fellow on it. You know, it was always made very clear that Dr. Vasquez was the one making the decision. I understand that there is perhaps a propensity to see a white coat and say, that's the person making the decisions, but that's not, in fact, the case.
- [44:05]
C
In Acheson's telling, Dr. Dyer is not a villain in this story. He's another person failed by Dr. Vasquez. She said that the fellowship arrangement benefited Vasquez because he didn't have to pay Dyer a doctor's salary.
- [44:20]
B
Dr. Dyer was paid peanuts for his time there was. The benefit to Dr. Vasquez was cheap labor. Essentially, Dr. Vasquez sort of left a trail of victims. You know, I absolutely understand that. And primary among that is the women who were left kind of high and dry. And that, you know, this is trauma on top of trauma. Like, I get that Dr. Dyer is another victim.
- [44:47]
C
I asked Dr. Vazquez's attorney about these allegations, but haven't received a response. Acheson told me that Dyer's life has been ruined by the news coverage around this case.
- [44:59]
B
His life has been taken away from him because of these news stories. The torches and pitchforks are very much out.
- [45:06]
C
He's now suing News Channel 5 for publishing and broadcasting allegedly false and defamatory statements about him, namely claiming he is not a doctor when he holds an MD and implying he was acting illegally or improperly. News Channel 5 is standing by its reporting. In a court filing, their lawyers wrote that the news segment, quote, did not portray plaintiff in a false light, let alone one that would be highly offensive to a reasonable person. I can't confirm if Dyer did accurately represent himself as a fellow to every patient he met with as he claims. I was able to identify two patients that said they knew he was a fellow at the time, but Penny doesn't recall Dyer identifying himself as anything other than doctor. She believed he was a licensed doctor in the state of Tennessee. More so, she believed he was her doctor. I read through some of her portal messages from the clinic, and Penny pointed out to me what she thought was a telling back and forth. During one of her IUI cycles, a staff member reached out to her to tell her that her estrogen was higher than expected and then wrote, I have Dr. Dyer reviewing your chart and will get back to you with his thoughts on moving forward or not. Later they added, okay, he says, let's go, but he only wants you to take one Clomid tablet a day instead of two. I read through portal messages of other patients, too, and saw Dyer refer to in the same way as if he was a doctor giving medical guidance. Perhaps Dyer was consulting with Dr. Vazquez on patient care, as Acheson says, But this wasn't clear to Penny or some others I spoke with. Like Sarah, I never once heard the.
- [46:57]
A
Word fellow ever being mentioned. I never once heard anything other than, I'm Dr. Dyer and I'm going to get you pregnant. That's it.
- [47:05]
C
Penny and Sarah both told me they hoped that Dr. Dyer and Dr. Vazquez would face some sort of profound professional or criminal repercussions. Like a number of other patients, they had both filed police reports about Dyer's actions and complaints with the Tennessee Department of Health. Five months after they reached out to authorities, they finally got some news. Here's Penny.
- [47:29]
G
We got that whole, we're sorry to.
- [47:31]
C
Inform you, and you know, honestly, I've.
- [47:33]
G
Gotten more sympathy from losing on a bottle cap, you know, opening one of those bottle caps. Sorry, you're a loser. Like you didn't win. That's kind of what it felt like.
- [47:41]
C
Penny received a letter from the District Attorney's office explaining that while Dyer may have violated ethical standards, it did not appear he had broken the law. The DA had considered a rarely used sexual assault charge called rape by fraud, but found the evidence didn't meet the law's criteria. I had never heard of this and looked it up. The charge is defined as unlawful sexual penetration of a victim accomplished by fraud. When I spoke with the assistant da, she explained that the act would have to be done for sexual gratification, something they said there was no evidence of here. A second letter from the Department of Health arrived shortly after stating that its investigation into Dyer had been closed with no further action. The letter states, there was, quote, not sufficient evidence to conclude that Ferrer Dyer practiced medicine in Tennessee without a license. Under Tennessee law, licensed doctors like Dr. Vasquez are free to delegate what they consider to be routine technical tasks to non licensed employees like Dyer. As far as the state of Tennessee saw it, that's what Dr. Vazquez had done. So just leave you with a bunch of questions.
- [48:59]
G
In the end.
- [49:04]
C
Penny, like a number of patients I spoke with, was confused about why a person without a medical license would be allowed to perform an iui, a procedure that is precise, time sensitive, and takes place inside the uterus. In Many other states, IUIs must be performed by a licensed clinician, typically a physician, but sometimes a physician's assistant or nurse practitioner. But when one former CRH patient reached out to the district attorney's office to ask about this, she says they told her it would be legal in Tennessee for a janitor to perform an IUI if a doctor delegated it. I'm not sure this is quite correct. From my read of the Tennessee Board of Medical Examiners delegation policy, it seems like handing off IUIs to an untrained janitor would indeed be a violation of the rule of either way, Penny is troubled by the DA's response.
- [50:03]
G
So, like, what kind of example is that setting moving forward for other doctors? What's stopping other doctors from doing that in the future?
- [50:10]
C
The whole response by the state left the patients feeling dismissed and gaslit.
- [50:16]
A
A group of extremely educated women and their spouses did not misunderstand, understand anything. We are being treated like we're a bunch of dumb girls who don't know how to read. And that's unfair and it's wrong. We know exactly what was going on. It was presented to us exactly as we've said. He was our doctor. He was the only person that was giving us treatment. And it feels terrible to be told that we're a bunch of dumb girls that don't know better. We're not stupid.
- [50:51]
C
Next time on what Happened in Nashville. After months of little news and growing panic, the state finally starts to inventory what's inside the tanks, and the results are deeply troubling.
- [51:05]
A
They're talking about women receiving the wrong embryos.
- [51:08]
C
And then I get this letter that.
- [51:09]
F
Says we have 10 and we're only.
- [51:10]
A
Supposed to have eight. At that point I like I didn't.
- [51:14]
F
Know how to else I was going.
- [51:16]
A
To hit more rock bottom. I don't trust the state of Tennessee to handle my health care. We would just never accept this in other areas of medicine.
- [51:28]
C
What happened in Nashville is a production of School of Humans and iHeart 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 Jesse Nye Swonger Sound design, scoring and mixing by Jeremy Thal and Jessie Nye Swonger Fact checking by Savannah Hughley and Austin Thompson. Our production manager is Daisy 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.
- [52:18]
F
10 athletes will face the toughest job interview in fitness that will push past physical and mental breaking points.
- [52:28]
You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.
- [52:36]
G
This is where mindset comes in.
- [52:38]
F
Someone will be eliminated.
- [52:41]
C
Pressure is coming down.
- [52:43]
F
This is Trainer Games.
- [52:45]
A
Watch it on prime video starting January 8th.
- [52:49]
G
Shh.
- [52:50]
F
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' 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. Come for the Black Friday seasonal savings Stay for the award winning Reporting for a limited time, access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime, but don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheart the world's best ski.
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C
And snowboard athletes are chasing medals. Now.
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A
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