Fertility Doctor Who Fled U.S. Is Welcomed in Chile : Medicine: Patients flock to Jose Balmaceda, formerly of UC Irvine. But his arrival may add to scrutiny of his field.

SANTIAGO, Chile —  Facing a dozen lawsuits and a criminal probe into his activities at UC Irvine’s Center for Reproductive Health, Dr. Jose P. Balmaceda sold his Corona del Mar home last summer and boarded a plane to his native Chile, calling the trip a visit to his ailing mother.

But the besieged fertility expert--who fled the Chilean military junta two decades ago--has come home. And despite his bruised U.S. reputation, his presence in this city of 4.2 million is playing more like the bittersweet return of the prodigal son.

His lawyer has said Balmaceda will return to the United States “when he is ready,” but investigators are doubtful.

Balmaceda, accused with his partners of egg-swapping without patients’ consent and financial wrongdoing at the UC Irvine clinic, is already booked solid with patients at a prestigious clinic nestled near the Andes Mountains.

His family is settled in a house in an upper-middle-class neighborhood. Balmaceda, 47, has not been formally hired at Clinica Las Condes but is working as a consultant from an office built for him in 1993 by colleagues hoping to lure home the man they hail as the father of Chilean reproductive medicine.

Despite the accolades, his tainted return comes at a delicate time for the country’s nascent field of fertility medicine, now facing the prospect of regulation in the conservative Chilean legislature. Even if Balmaceda is eventually cleared, his colleagues say, he drags the UC Irvine scandal to Chile at the worst of all possible times.

“There are people who believe that it’s better that this whole [scandal] stays buried,” said Dr. Ricardo Pommer, who practices at the competing Clinica Las Nieves. “This might make the Chilean law much too restrictive. We are worried.”

Balmaceda left Orange County this summer while officials from at least seven agencies were investigating him and his partners, Dr. Ricardo Asch and Dr. Sergio Stone. He sold his home and later put his wife and two youngest children on a plane bound for Chile. The couple’s two oldest children have chosen to remain in the United States.

More than two months ago, Balmaceda applied to join the staff of Las Condes clinic, one of only five in Chile that offer assisted fertilization. His application is within days of final acceptance and secretaries at the clinic have penned a long waiting list of patients anticipating his return to practice, said Dr. Fernando Zegers Hochschild, head of the unit for reproductive medicine and one of Balmaceda’s closest friends from medical school.

“We’re not the FBI. We aren’t an investigative body, we don’t have anything to do with internal tax issues in the United States,” the clinic’s medical director, Dr. Jaime Manalich Muxi, said last week. “All we know is we have an application from a man who is famous, who is an expert in fertility all over the world. We have to evaluate what the overall effect will be of having him join the clinic.”

Political Tumult

Balmaceda, known as Pepe to friends, grew up with six sisters, the son of a timber mill owner. In 1967, he entered the Catholic University Medical School along with Zegers, and the pair later won residencies at the University of Chile’s clinical hospital.

At 23, Balmaceda married Veronica Pascal, but family ties and the political tumult of his country were about to deal him a blow that would send him into exile.

Gen. Augusto Pinochet led a brutal coup in 1973 that overthrew the socialist Popular Unity government of Salvador Allende, resulting in Allende’s apparent suicide and the deaths of thousands of his supporters.

To the left of Allende’s party was the guerrilla Leftist Revolutionary Movement. Among its leaders: Andres Pascal Allende, a nephew of Salvador Allende and the cousin of Balmaceda’s wife. It was Balmaceda’s decision to harbor his wife’s militant relative at his home that brought the country’s military police looking for him in 1975.

According to friends and an account that Balmaceda gave to a Chilean magazine last summer, intelligence agents came to the hospital looking for him and Balmaceda made a dash for the service stairs. For two months, he and his wife hid at the homes of friends, eventually seeking refuge in the Venezuelan Embassy and landing at the University of Texas a year later.

There, Balmaceda met Asch, and in 1984 the duo pioneered the fertilization technique called GIFT--or “gamete intra-Fallopian transfer”--a procedure in which eggs and sperm are implanted into the Fallopian tubes, where conception occurs naturally.

UC Irvine and Stone lured the well-known pair west two years later and they set up a clinic with Stone in Garden Grove. By 1990, the trio launched the Center for Reproductive Health.

But the team collapsed this past May when the university severed ties with the three doctors and filed suit, accusing them of transplanting eggs without patients’ consent, conducting human research without permission, obstructing university investigations and prescribing a non-approved fertility drug. They also are being investigated for possible tax and insurance fraud.

Patrick Moore, Balmaceda’s attorney, said that after 1989, his client mainly practiced at Saddleback Memorial Medical Center in Laguna Hills--a satellite of the UC Irvine fertility center--and has never wittingly removed or implanted eggs without consent. His closest friends insist he had no involvement in ethical infractions.

But university officials have said they believe that Balmaceda and Asch--who directed the UC Irvine clinic--were involved in the misuse of eggs. Asch is now living in Mexico City.

News of the investigations, lawsuits and staggering allegations of ethical missteps has been largely absent in the Chilean media. But the scandal has not escaped Manalich, the Las Condes clinic’s medical director.

Zegers said the staff of 180 doctors, all of whom own shares in the clinic, were notified of Balmaceda’s application and given 10 days to object. According to Zegers, none did, and all that remains is a final decision by the clinic’s board of directors.

“He will be in the top of the top, where he belongs,” Zegers said. “If, for any reason, things don’t turn out that way, then we will both be somewhere else in this city.”

‘He Is a Pioneer’

But Balmaceda’s sudden presence in Chilean medicine could send a bolt of fear through a staunchly conservative and fiercely Catholic country already troubled by assisted reproductive medicine.

Divorce remains illegal in Chile, and so conservative is the legislature that it only recently passed a law allowing organ donations--after a five-year debate. Forty percent of legislators voted against it.

Three months ago, Chile’s chamber of deputies introduced the country’s first law to regulate reproductive medicine.

The law would ban any donations of eggs or sperm, a common practice in Chile and worldwide for nearly four decades.

It would also set prison sentences for the freezing, sale or destruction of embryos and require all clinics working in the field to undergo intense scrutiny of any procedure they plan to use or develop.

Clinica Las Condes has opted not to freeze eggs or donate them to other women, eliminating the potentially charged issue of consent, Manalich said. Other clinics in Santiago do freeze eggs, but most only donate them free, with signed consent, and anonymously.

Manalich said Balmaceda has signed a document at the request of his colleagues promising to abide by Chile’s moral guidelines in his work at the clinic.

Most agree that Balmaceda has left an indelible mark on the development of reproductive medicine in Chile.

“He is a pioneer,” said Dr. Simon Dujovne, director of the Clinica Las Nieves and president of the Chilean Society of Assisted Fertilization. “We have copied what he has done well.”

Not only did Balmaceda get Santiago doctors started with the GIFT technique in 1985, just last May he helped them fine-tune micro-injection, a technique where sperm is injected into a harvested egg, which is then implanted. Most critically, he helped create Chile’s core of infertility specialists, inviting them to Orange County to work with him as fellows, Dujovne said.

“He hasn’t just helped people here,” said Dr. Patricio Gonzalez Suau, a specialist in reproductive medicine at the competing Clinica Alemana, who came to Orange County in 1993 in order to work with Balmaceda. “He has enabled many doctors here to enter into this field of medicine. Pepe was always a wonderful role model for us and he was always willing to help us.”

Even as Balmaceda pulled in an estimated $27,000 a week in his partnership with Asch and Stone, he did not forget his birthplace, friends said. He treated more than 30 Chilean couples who traveled to see him, seeking techniques not yet developed in Chile. And he began regular trips home as soon as the country’s political climate allowed him to do so.

“I think he always wanted to come back when he retired,” said Gonzalez. “We always said, ‘When are you coming back, Pepe? We need you here!’ What he can give to the Chilean doctors will always be more important if we are close to him.”

Behind the scenes, Balmaceda was engaged in talks with the Clinica Las Condes’ unit of reproductive medicine as early as 1991 to plan his return, and in 1993, Zegers had an office built for his friend as a lure and as an honor.

It was against this backdrop, with a firm lifeline connecting him to his native Chile, that the floor dropped out from under Balmaceda, leaving an illustrious career as one of the preeminent experts in fertility medicine in tatters.

A Warm Welcome

By most accounts, Balmaceda has been openly accepted in the medical community since his recent return: Earlier this month, he received a warm welcome when he spoke at a conference for Latin American fertility experts at the beach resort of Vina del Mar. He still travels widely and just last week addressed the Academy of Sciences in Barcelona, Spain.

But some say the doctor has been conspicuously absent from the medical social circle, and has chosen instead to seclude himself with family and close friends. Four of his sisters live in Santiago, as do his parents and more than 20 nephews and nieces.

Friends have paid visits to Balmaceda in Zegers’ elegant Las Condes home, devoid of clutter and off limits--by Zegers’ personal orders--to newspapers, television and other distractions of daily life.

“I think he’s progressively feeling [more at] home,” Zegers said. “Home is where you have friends, where you have family, where you have roots and share the language.”

Meanwhile, attorneys pressing civil lawsuits against Balmaceda--as well as Asch--say the doctors’ absence will complicate cases. Lawyers have already given up on the notion of getting their hands on any of Balmaceda’s assets if they manage to secure judgments against him. But they are eager to talk to him.

“I think his deposition would be fascinating,” said lawyer Melanie Blum, who represents several patients. “I think he knows an awful lot, and if he were to give it up, it would be tremendous. It would break open all the secrecies in this case.”

If criminal charges are brought against Balmaceda, he could face extradition under an aging and rarely used treaty that covers crimes of theft, a Department of Justice spokesman said. As for Balmaceda, Zegers will say only this:

“I think he will do what has to be done, as he has done always.”