Molly Myers and her husband, Rick Hatfield, had been trying for a couple of years to have their first child.

“We tried to go through the natural process and it wasn’t happening,” Hatfield said. “We realized we needed to see someone for help.”

A Brattleboro, Vt., gynecologist recommended Misty Blanchette Porter, a fertility specialist at Dartmouth Hitchcock Medical Center in Lebanon.

A graduate of Hanover High School and Dartmouth’s medical school, Blanchette Porter joined DHMC’s division of reproductive endocrinology and infertility, or REI, in 1996.

“I can’t imagine what what we would have done without her,” Myers told me. “It didn’t matter what kind of weird question I had, she was always there with an answer.”

In 2009, five years into their marriage and Blanchette Porter as their doctor, Myers and Hatfield opted for in vitro fertilization, or IVF.

DHMC’s first IVF baby was born in August 1987 — less than six years after the first successful IVF birth at a U.S. hospital in Norfolk, Va. (The first “test tube” baby worldwide was born at a British hospital in 1978.)

Myers was 35 when she underwent her initial IVF procedure. About half of women under 35 give birth after one IVF cycle, according to the U.S. Centers for Disease Control and Prevention. The chances of having a baby using IVF decrease as a woman gets older.

For Myers and Hatfield, the first three cycles — then $10,000 a pop, which wasn’t covered by insurance  — didn’t pan out. But they had the financial means to try for a fourth time.

“It’s a lot of money and stress,” said Hatfield, who works in management at a large beverage company. “Here I am, a beer distributor, giving my wife hormone injections at home. That in itself is hard.”

Myers, who works at a yoga studio, added: “It can be very hard mentally when things don’t work, but Dr. Porter and her staff were very supportive. I never really thought that I wasn’t going to eventually have a baby.”

On March 11, 2011, Josie Hatfield, 6 pounds, 8 ounces, was born at DHMC. Her parents jokingly referred to her as their “$40,000 baby.”

Abrupt closure

On an afternoon in early May 2017, Blanchette Porter and DHMC’s other fertility specialists — Albert Hsu and David Seifer — were called into a closed-door meeting. Edward Merrens, DHMC’s chief clinical officer, and Leslie DeMars, chair of the obstetrics and gynecology department, were waiting for them in a conference room.

Minutes later, the three fertility specialists learned DHMC was shutting down its entire REI division, including the IVF clinic, which had been operating for more than 30 years, at the end of the month.

In announcing the decision to the public shortly thereafter, Merrens said that difficulty finding nurses to staff the REI division precipitated its closure. But as I wrote about last week, Merrens’ claim of “staffing and resource issues” was a smoke screen.

Regardless of the reasons, the effects were the same. More than 120 patients with a wide range of reproductive hormonal and infertility issues were left in the lurch.

The IVF clinic, which the REI program built its reputation on, brought hundreds of babies into the world.

“At the time of the REI closure, our medical teams worked with patients to help transition them to other IVF providers,” Audra Burns, a spokeswoman for Dartmouth Health, DHMC’s parent organization, told me in a recent email.

“We do not have current plans to reopen the program at DHMC,” Burns added.

Since the clinic’s abrupt closure in 2017, countless women hoping to conceive when all else fails have had to travel outside the Upper Valley for their reproductive care.

The nearest IVF clinics are at the University  of Vermont Medical Center in Burlington and Boston IVF, a large for-profit company with a clinic in Bedford, N.H.

From many parts of the Upper Valley, the drive to either center is 1½ hours or longer. In the early stages of IVF, patients often have multiple medical appointments a week.

Josie, now 13, has a younger brother, Samson, who was conceived unexpectedly the old-fashioned way two years later. Myers and Hatfield divorced in 2022. They remain close friends, and their children split time between her house in Hanover and his home in West Lebanon. They also continue to take vacations as a family.

“I can’t imagine what we would have done without (DHMC),” Hatfield said. “Would Josie be here, if we’d had to drive to Burlington?

“I don’t know.”

‘Whistleblowing complaint’

The patients the DHMC clinic served extended beyond women trying to immediately get pregnant. It also cared for young female and male cancer patients who wanted eggs or sperm frozen for later use in case their treatment regimens led to infertility.

“Clearly, the community has suffered and continues to suffer by Dartmouth Health’s odd decision to cease providing REI services, locally,” Norwich attorney Geoffrey Vitt said. “They had an established REI clinic with a true leader in the field in Dr. Porter. The abrupt decision to kill it all was irrational and can only be explained by the retaliatory and discriminatory motives that are the basis of the lawsuit.”

Vitt’s law firm is representing Blanchette Porter in the federal wrongful termination suit that she filed against DHMC in October 2017.

Vitt said his client is seeking “substantial recovery, including punitive damages,” but he declined to specify a dollar amount.

DHMC’s lawyers at Foley & Lardner in Boston have fought to keep information about the case out of public view.

Last April, U.S. District Court Judge Geoffrey Crawford ruled that documents relating to Hsu and Seifer’s job performance should remain sealed. They are not parties to the lawsuit.

While denying Vitt’s motion to have the documents unsealed, Crawford acknowledged the “public interest in the closure of the (REI) division may be difficult to gauge, but the court accepts that it is substantial. DHMC is one of a handful of hospitals in our region large enough to support the mission of serving patients suffering from infertility.”

The case is scheduled for a jury trial, which could take up to three weeks, at the federal courthouse in Burlington, starting March 24.

“The primary issue in the case is whether Dr. Porter’s employment was terminated for business reasons or, as she alleges, in retaliation for whistleblowing complaints she made against younger physicians in the (REI) division,” wrote Crawford, who has overseen much of the case but due to health issues won’t preside over the trial.

Blanchette Porter alleges that rather than addressing the complaints she lodged about “improper, incompetent and harmful conduct by physicians” in the REI division, DHMC leaders shuttered the program.

If DHMC hoped that pushing Blanchette Porter out after 21 years at the hospital would silence her, it failed.

In her sworn testimony, Blanchette Porter alleged that her REI colleagues, Drs. Hsu and Seifer, “were ordering and performing unnecessary testing and … they were billing for that unnecessary testing.”

When I asked about the allegations, Burns, the Dartmouth Health spokeswoman, replied via email that the organization doesn’t comment on ongoing litigation.

I sent emails and left phone messages at the current offices for Hsu and Seifer, who both no longer practice medicine in New Hampshire or Vermont. I didn’t hear back.

Hsu came to DHMC in 2014. For several years before Hsu’s arrival, Blanchette Porter served as acting director of the REI division, where the number of fertility specialists fluctuated between one and five during its 30-year history.

In June 2016, with Blanchette Porter dealing with a health issue of her own, DeMars brought in Seifer, who had been working in Oregon, to serve as director.

It wasn’t long after that Blanchette Porter sent Seifer a report she had written about Hsu’s job performance. From working with Hsu and observing him in the operating room, Blanchette Porter said she questioned his capabilities.

In addition, she “regularly” told DeMars that Hsu “did not have the capacity to be a competent REI physician.”

But Hsu wasn’t the division’s only problem, Blanchette Porter argued. In her deposition, which the appeals court referenced, hospital staff “expressed serious reservations about (Seifer’s) alleged substandard technical ability… and other concerns impacting patient safety.”

A longtime REI nurse, Sharon Parent, testified in her deposition that after assisting Seifer and Hsu in egg retrievals, she had concerns about their surgical techniques. Parent, who retired before the clinic’s closure, testified she voiced her concerns to DeMars, who allegedly responded that Blanchette Porter “set a high bar and (Parent) had to accept that other doctors did things differently.”

In her deposition, DeMars testified that “Misty is an amazingly gifted and dedicated reproductive endocrinologist and infertility specialist who I think through technical skill and creativity was able to achieve lots of desired pregnancies for women, and that’s her ‘Misty magic.’ ”

Barry Smith, the head of obstetrics and gynecology at DHMC for nearly 30 years before retiring in 2004, has known Blanchette Porter since her medical school days.

Smith, who lives in Norwich, told me that Blanchette Porter is a “very good physician,” who is nationally recognized for her work in REI medicine, particularly when it comes to ultrasounds.

“She’s also very demanding,” Smith said. “She doesn’t put up with people who aren’t interested in doing (REI) well.”

Appeals court resurrects lawsuit

In her lawsuit, Blanchette Porter also maintains that she was discriminated against because of a disability. In late 2015, she developed a cerebral spinal fluid leak that caused serious neurological problems, including headaches, blurred vision and fatigue.

She was granted two leaves of absence, but continued to work part time in stretches. In September 2016, she underwent the first of two surgeries at the Mayo Clinic in Rochester, Minn.

She was still recovering from her first surgery — and working 20 hours a week — when she learned in May 2017 that her job was being eliminated.

Five months later, she filed her lawsuit.

In November 2020, after reviewing pleadings, depositions and other information presented during discovery, Crawford, the federal judge overseeing the case, granted summary judgment in favor of DHMC for “lack of proof of causation.” In essence, the judge ruled that Blanchette Porter’s case wasn’t strong enough to merit a trial.

But last February — more than six years after Blanchette Porter filed her lawsuit — the case came back to life. The U.S. Court of Appeals for the Second Circuit in New York ruled in a 100-page decision that Crawford had erred.

Much of what Blanchette Porter claimed in her lawsuit deserved to be heard by a jury, the three-judge panel ruled.

Crawford “erred in concluding that no rational juror could infer that (Blanchette Porter) was terminated, and not retained, based on her disability or whistleblowing-type activity,” the judges wrote.

The appeals court agreed with Crawford, in part, dismissing Blanchette Porter’s “claims that she was otherwise discriminated against by denial of a reasonable accommodation of her disability prior to her termination or was retaliated against for exercising her rights to such accommodation.”

A 100-page federal appeals court decision isn’t “unheard of, but is extraordinary,” said Jared Carter, a professor at Vermont Law and Graduate School in South Royalton who teaches appellate advocacy.

The lengthy decision speaks to the complexity of the case and its “lots of moving pieces,” said Carter, who reviewed the appeals court decision for me last week.

Blame to go around

Even if the trial doesn’t come off (chances of a last-minute out-of-court settlement are remote, but still a possibility), the case has shed light on DHMC’s inner workings.

Internal emails entered into the court record show that DHMC administrators didn’t hesitate to play the blame game. DeMars, who is no longer at DHMC, and Merrens, the chief clinical officer, were two of the game’s top players.

On April 25, 2017, DeMars emailed Daniel Herrick, who oversaw budgets and finances for the REI division. (In his deposition, Herrick testified the program was “marginally profitable.”)

“While David (Seifer) is not a good leader, his failure is also the result of a masterful takedown by Misty Porter,” DeMars wrote. “If she had wanted to support him, she would have made the division successful.”

Merrens also had not given a “fair characterization” of Hsu, maintaining that he’d been a “problem since day 1,” DeMars added: “Again, Misty has decided that she no longer wants to work with him or teach him, and she is bullying him. He did an amazing job by himself Jan.-Aug. 2016.”

In the same email, DeMars didn’t hold back with her criticism of Seifer: “David is a nudge, who somehow lacks situational awareness, but he came into a dysfunctional division with half the team determined to make him fail.”

It’s “conceivable that (Seifer) could join one of the Boston IVF practices (Lord help them) and compete directly for these patients,” she added.

In his deposition, Merrens testified there were “clearly challenges around Albert (Hsu)’s capability” and there were “the issues with David Seifer.”

According Merrens, management had “gone through all this work to understand that, at every level, there is dysfunction and we’re not sure that we can safely provide care for women in an ongoing fashion.”

Blanchette Porter was a “talented clinician who was highly respected,” Merrens said in his deposition.

In a May 12, 2017 email to Herrick, however, he wrote that all three doctors had a “role in the dysfunction.”

“It was not just Dr. Hsu and Dr. Seifer. Misty played a role, whether she was present or whether she was on leave, in understanding, involving herself, and doing a whole range of things.”

The appeals court took Merrens to task for the comment: “We think it peculiar to refer to a physician’s ‘understanding’ as a factor contributing to dysfunction.”

After the closure was announced, some of DHMC’s medical staff wanted Blanchette Porter to remain employed as an ob/gyn surgeon and noted she was also an “expert in gynecologic imaging,” which the hospital could use. Blanchette Porter also told management that she wanted to continue working at DHMC.

On May 12, 2017, Merrens emailed DeMars.

“I am getting inundated with heartfelt and long emails wondering why Misty can’t stay on to do her ultrasound complex operative and teaching role even if we end REI,” he wrote. “I just need to know how better to answer this question.”

DeMars replied the staff was “remembering Misty as a full-time employee wearing 3 hats, and not the one who has been out for almost 18 months.”

‘Going to see this through’

Blanchette Porter, now 62, told me that shortly after DHMC announced the closing, she received a call from UVM Medical Center, asking if she’d be interested in joining its REI staff. Longtime UVM physicians and administrators were familiar with her work. Before coming to DHMC in 1996, she had done a three-year REI fellowship at UVM.

When UVM reached out to Blanchette Porter about coming to Burlington in 2017, she was still dealing with her cerebral spinal fluid leak. She had yet to have her second surgery at Mayo Clinic.

In 2018, she joined the staff at UVM’s Center for Reproductive Medicine and the medical school faculty.

Blanchette Porter still lives in Norwich, but she and her husband, Tom, have a condo in Burlington, a short drive from the UVM Medical Center.

Nearly eight years after her job at DHMC was terminated, Blanchette Porter is about to get her day — weeks, actually — in court.

“I was always going to see this through,” she told me in an email this week. “The Dartmouth Health system serves a large geographic area, and patients have limited alternative options. Therefore, DH has an even greater responsibility to meet the needs of the population it serves, and to ensure the safety of all patients who seek care within its health system.”

After DHMC shuttered its REI division, the academic medical center’s residents could no longer complete all of their training in Lebanon.

Now, DHMC doctors in their second and third years of residency go to Boston IVF’s clinic in Bedford, and also do a “month-long rotation at UVM specifically to learn about REI,” said Burns, the Dartmouth Health spokeswoman.

Among the UVM doctors training them?

Blanchette Porter.

Jim Kenyon can be reached at jkenyon@vnews.com.