Lab Workers Were ‘Devastated’ by Tank Failure That Destroyed Human Embryos

The director of a fertility clinic lab where thousands of frozen eggs and embryos were destroyed in a 2018 cryogenic tank failure testified that the incident “devastated” him and his coworkers.

In this Aug. 14, 2013 file photo, an in vitro fertilization embryologist works on a petri dish at a fertility clinic. (AP Photo/Sang Tan)

SAN FRANCISCO (CN) — On the third day of trial over a mishap that dashed some families’ only hope of having biological children, a fertility clinic lab director told jurors he had no warning that a cryogenic tank would fail and destroy thousands of human eggs and embryos.

“The tank was behaving normally,” Pacific Fertility Center lab director Joseph Conaghan said. “There was no sense of panic that anything was ever going to happen with the tank. There was no expectation that anything would go wrong with the tank.”

Conaghan was the second live witness to testify in a jury trial seeking to hold cryogenic tank maker Chart Inc. liable for a March 2018 disaster that destroyed eggs and embryos belonging to three women and one couple. The trial involves only five plaintiffs, but it could establish Chart’s liability for the loss of reproductive tissue belonging to hundreds of other people. The tank contained 3,500 frozen eggs and embryos.

A mechanical engineer previously testified Monday that the catastrophe resulted from Chart’s use of a weaker weld near a liquid nitrogen inflow pipe, making the tank susceptible to cracking, leaks and failure. Chart denies those claims and says the failure resulted from fertility clinic employees misusing the product.

Conaghan described how he arrived at the lab on March 4, 2018, with no signs of anything unusual. When he tried to manually measure liquid nitrogen in a container called “Tank 4,” he had trouble getting the top off. When he jiggled the lid to pry it loose, the whole container started moving. He found that peculiar because the tank is supposed to be full of “dead weight,” or heavy liquid nitrogen.

“It shouldn’t move,” Conaghan said, adding he immediately sensed something was wrong.

After a colleague managed to pry the lid off, Conaghan dropped a dip stick in the tank and measured an inch or less of liquid nitrogen inside, far lower than the 14 inches recorded the previous day.

“If we have a tank that loses 14 inches of liquid nitrogen from one day to the next, that tank is never going back in service,” Conaghan said. “That tank can’t be trusted.”

Conaghan and his staff immediately moved to retrieve a backup tank and fill it with liquid nitrogen so they could transfer 80 metal boxes containing thousands of eggs and embryos. But it was too late. The human reproductive tissue had already thawed.

“More than anything we were devastated by this failure,” Conaghan said, audibly getting choked up as he recalled the painful memory.

“That’s why I do this job,” Conaghan said. “I want these people to have their families. We do this to help people have children.”

On cross examination, Chart attorney John Duffy asked the lab director why he kept a backup tank four stories beneath the lab on the ground floor of the building .

Conaghan said “there was room” for a backup tank in the fifth-floor lab, but “it would have been inconvenient” to keep it there.

Duffy also grilled the director on why he didn’t transfer human reproductive tissue from the container 17 days earlier when he discovered a problem with Tank 4’s computerized controller on Feb. 15, 2018.

Conaghan replied that the controller’s sudden inability to accurately read liquid nitrogen levels had no bearing on the tank’s structural soundness and ability to hold ultra cold liquid.

“Since I didn’t have any concerns about the integrity of Tank 4 at the time, the risk of moving that tissue was too great,” Conaghan said.

He added that frozen eggs and embryos are extremely delicate and should only be moved for emergencies or when they need to be thawed to help patients get pregnant.

Chart’s lawyer further questioned why Conaghan didn’t try harder to get the tank’s computerized controller replaced after he found it was malfunctioning 17 days before the tank failure.

The lab director sent an email about getting the controller serviced on Feb. 28, nearly two weeks after the tank’s controller failed. Duffy emphasized how that email is the only evidence of Conaghan’s efforts to fix the controller. Conaghan said he may also have made phone calls about getting the device repaired or replaced.

During opening arguments Monday, Duffy told jurors that lab staff muted 128 alerts about the tank’s liquid nitrogen levels, suggesting the staff was incompetent, failed to follow proper procedures and misused the tank’s technology.

On Wednesday, Conaghan said those alerts were muted because the controller was malfunctioning and sending out false alarms about low levels of liquid nitrogen. The controller had to be plugged in to start the process of automatically drawing cold liquid into the tank, but the alarms were bogus, he said.

“At all times prior to March 4, we always had a lot of liquid nitrogen in that tank so I had no concerns about the temperature of the tank,” Conaghan said.

Chart’s cross examination of Conaghan is expected to continue Thursday.

The fertility clinic and its owners were also sued for the loss of eggs and embryos, but those claims were sent to private arbitration. Prelude Fertility acquired Pacific Fertility in September 2017, and Prelude’s subsidiary Pacific MSO started managing the San Francisco clinic prior to the March 2018 tank failure.

Chart recalled its cryogenic storage tanks on April 23, 2018, saying it needed to investigate a “vacuum leak and/or failure which may be due to inadequate adhesion of the composite neck to the aluminum unit.”

The plaintiffs’ claims include product liability and failure to recall the tank’s allegedly defective controller device that measures liquid nitrogen levels and sends off alerts about tank problems.

According to the lawsuit, one cycle of egg retrieval, freezing and annual storage costs $8,345, and a second cycle costs $6,995. Some women, including a plaintiff known only as S.M. in the originally filed complaint, paid as much as $10,000 out of pocket to retrieve, freeze and store eggs.

The trial overseen by U.S. Magistrate Judge Jacqueline Scott Corley is expected to continue through June 10.

%d bloggers like this: