The allegation was made against the veteran Greenwich doctor in a 2005 medical malpractice lawsuit - which was quickly settled, then sealed, the very court documents shredded. The suit was filed by a couple when a DNA test revealed that the husband was not the biological father of their twin girls, born after an insemination procedure performed by Ramaley.
The state Department of Public Health investigated after the lawsuit, but did not order Ramaley to undergo a DNA test - even though state law appears to give the department authority to do so.
Instead, in a 2008 consent agreement negotiated with Ramaley's attorney, they fined the doctor $10,000 for "using the wrong man's sperm" in the procedure and allowed him to keep an unrestricted license.
The lawsuit was settled before Ramaley had to answer questions.
Through a letter from his attorney, Ramaley denied the accusation to the Department of Public Health during its investigation.
Contacted this week outside his Southport clinic, Ramaley said he had no comment.
A DPH spokesman insisted this week that the department did not have jurisdiction to ask Ramaley to submit to the test, which would determine the truth or falsity of the claim that he fathered the twins himself.
Greenwich Time obtained much of the state's investigative file on the matter through a Freedom of Information Act request.
The case began in 2002 when a woman visited Ramaley, 61, at Brookside Greenwich Ob-Gyn Associates to have an intrauterine insemination performed. She brought a sample of her husband's sperm and the hope that the treatment might help the couple get pregnant.
Nine months later, she gave birth to twin girls.
It should have been a joyous occasion, but the mixed-race couple quickly noticed something wasn't right. The twins had a strikingly fair complexion that seemed impossible, considering their father was black.
Their appearance was so uncharacteristic of the couple that people frequently asked if the twins were adopted, according the lawsuit.
After several months of speculation and anxiety, the couple sought a paternity test in March 2004. The husband was not the twins' biological father.
The couple filed a lawsuit several months later. One count alleged that Ramaley, identified in the suit only as "Dr. Roe," had not only used the wrong sperm, but intentionally used his own in an "extreme and outrageous" act.
"Upon information and belief, Dr. Roe intentionally inserted his own sperm into (the patient), causing (the patient) to become pregnant and give birth to children biologically fathered by Dr.
Roe," the lawsuit stated.
"Dr. Roe intentionally concealed that he had inseminated (the patient) with sperm from someone other than (her husband), despite the fact that he knew he had done so."
The couple's lawyer drafted a set of questions, asking Ramaley if he used his own sperm in the procedure.
But before Ramaley had to answer under oath, the lawsuit was withdrawn, the case settled and a confidentiality ruling was imposed prohibiting anyone involved in the case from discussing it.
Greenwich Time is not identifying the couple to protect the family's privacy.
Because of the gag order, principals in the case declined to give Greenwich Time explanations about what led the plaintiffs to make the allegation that Ramaley used his own sperm.
Ramaley "always maintained this was an accident," Ramaleys' attorney, Steven Errante, said. "There was never any proof of the allegations made in the complaint."
In 2006, the Department of Public Health received notification from a national medical-data tracking organization that Ramaley had entered into a settlement in the 2005 lawsuit. The department, responsible for medical discipline in the state, launched an investigation of the suit's claims in January 2007.
In October 2007, an outside consultant from the American Board of Obstetrics and Gynecology was brought in to review Ramaley's case. The consultant, Dr. Robert Gfeller, a Hartford-area gynecologist, reviewed medical records, DNA results from the twins and the 2005 lawsuit complaint. He determined that Ramaley made serious errors.
"The matter speaks for itself as a violation of this Standard of Care when DNA analysis of the products of IUI conception (the twins) do NOT have the genetic DNA material of the intended father and that, therefore, the sperm of another male was used in the insemination," states Gfeller's report.
Gfeller found that Ramaley did not properly label sperm specimens and failed to have a system in place to keep track of his procedures.
"There needs to be a system to verify and maintain identity of the sperm sample through receipt, processing and disposition," wrote Gfeller. "There is no evidence supplied that this process was followed or recorded in the chart. If it is not written and recorded, it did not happen."
Gfeller found Ramaley failed to maintain an accurate chart for the intrauterine insemination.
"Chart recordings are scant in detail, hardly legible there is no indication who performed" the insemination, the report goes on to say.
Gfeller found Ramaley had no record that his patient signed an "informed consent form," which all patients undergoing invasive procedures are required to sign. Gfeller's inquiry did not include any DNA testing of Dr. Ramalay, which would have resolved the allegation that he used his own sperm for the intrauterine insemination.
"No DNA testing is reported that gives credible, positive evidence" that Ramaley substituted his own sperm for that of his patient's husband, wrote Gfeller - but the DPH never asked for such a test.
Gfeller did not return several calls for comment.
In November 2007, a nurse consultant employed by the Department of Public Health summarized the findings of the investigation, faulting Ramaley for the six instances cited by Gfeller where the standard of care had been seriously violated. The DPH drew no conclusions and found no deviation from the standard of care with respect to the central allegation that Ramaley used his own sperm.
Responding to the fact that DNA evidence showed the twins did not have the genetic material of their intended father, the nurse, Pamela Pelletier, wrote that it was a "gross and very serious violation of the standards of care."
A copy of that DNA evidence was withheld by the state from the material requested by Greenwich Time. Applicable public-records law appears to allow for such a record to be redacted to protect patient confidentiality, but released in redacted form. The state declined to release it at all.
Also included in the state's report was a letter from Ramaley's lawyer denying the charges against him. "The allegation that Dr.
Ramaley is the biological father of the twins is denied," wrote attorney Steven Errante.
The case closed there for state health officials.
In 2008, Ramaley signed a consent order agreeing he would not contest the allegation that he used the wrong sperm, while not admitting guilt. The consent order makes no mention of the allegation in the lawsuit that he used his own sperm. The consent order simply stated that Ramaley inseminated a patient with "the wrong man's sperm." He received a $10,000 fine and was allowed to continue practicing. Although the consent order states he is no longer practicing intrauterine insemination, it does not explicitly bar him from doing so.
This week, the Department of Public Health confirmed that Ramaley has an unrestricted license.
In March 2009, New York state entered into a consent order with Ramaley as well in the same case. In a settlement offer, they proposed to fine him $10,000, suspend his license for one year and place him under three years' probation. Instead, Ramaley voluntarily surrendered his New York license, noting he had not practiced in the state for many years and never intended to again.
The New York investigation file is not releasable under state law, a health department spokesman said.
Today, Ramaley, who lives on Lejeune Court in Greenwich, is a practicing physician at Southport Women's Healthcare, at 2600 Post Road in Southport. He is also affiliated with Bridgeport Hospital, a Yale New Haven institution that is under the same umbrella as Greenwich Hospital. Ramaley joined both practices in 2006, just after the lawsuit settled and the same year he left Greenwich.
According to records, Ramaley resigned from his Brookside practice on June 30, 2006. That same day, he requested a leave of absence from Greenwich Hospital.
The investigative file also shows Ramaley was not disciplined by either the practice or Greenwich Hospital after the incident.
For patient advocates, Ramaley's story is a prime example of why increased transparency is needed in the state health-care system.
"Times have changed and transparency needs to be paramount," said Jean Rexford, executive director of the Connecticut Center for Patient Safety, an organization aiming to improve the quality of health care through advocacy and accountability. "Many times the needs of the patient are just forgotten."
In this case, Rexford said the state should have ordered a DNA test and the public should have full disclosure of the allegations.
"It is an obligation of DPH to investigate fully," Rexford said. "I know they talk a lot about thorough investigations. In this case, it sounds as if they stopped short because lawyers got involved. Once again the public is on the other side of the decision-making process.
"I would urge (the state to act) on the side of the patient as opposed to the side of physician. Not that you are guilty until proven through a process. But when public health is at stake, we have to be extraordinarily careful.
"When you go into a physician's office there will be a license on the wall," Rexford said. "That license is a promise that the state has done its due diligence. If there is a back story the public does not know about, I think it does a disservice to the patient."
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Information from: Greenwich Time, http://www.greenwichtime.com
