Obstetrician’s Past Unravels : Inquiry Reveals Stains on Career of Doctor Charged in Infant Deaths as His Defenders Remain Unmoved

Two mothers sat with their babies in a booth at a recent “natural health” fair in Pasadena, soliciting signatures for an unlikely cause--support for a medical doctor accused of second-degree murder in the deaths of four newborn babies and a full-term fetus.

The women said that Dr. Milos Klvana is a “wonderful man” who delivered several of their children the way they chose to have them--in the comfort of their own homes or at his birthing clinics in Valencia or Temple City. They do not believe that Klvana is to blame for the five deaths.

But the Los Angeles County district attorney has accused Klvana of sending the babies to their deaths by failing to take appropriate steps when confronted with serious complications during their births. The case is scheduled for preliminary hearing Wednesday in Los Angeles Municipal Court. Second-degree murder charges will be added then in four more deaths, the district attorney said last week, bringing the total to nine.

30 Other Felonies

Besides the five counts of second-degree murder already filed, the district attorney has charged Klvana with 30 other felonies, including insurance fraud.

Klvana’s assistant, Delores Doyle, who faces a preliminary hearing with him, is charged with two counts of second-degree murder and 24 other felonies, including practicing medicine without a license. She will be charged with one more second-degree murder count, the district attorney said.

In announcing Thursday its intention to file the added murder charges, the district attorney’s office said Klvana will be charged with four more related felonies and Doyle with three.

By choosing not to make the difficult deliveries in hospitals, Klvana made a “high-risk roll of the dice,” said Brian R. Kelberg, deputy district attorney in charge of the medico-legal section of the district attorney’s office and prosecutor of the case.

Klvana, 47, and Doyle, 35, were arrested Oct. 31, 1986, after a two-year investigation by the Sheriff’s Department, the district attorney, the state attorney general and the state Board of Medical Quality Assurance, which licenses and monitors physicians.

The nine deaths occurred between December, 1982, and September, 1986. It was the death of a Saugus boy a day after his birth in August, 1984, that triggered the investigation.

Within weeks of the death of Jason Friel, the Sheriff’s Department, acting on a tip, launched an investigation that led to the district attorney’s lengthy case against the doctor and Doyle.

“As we dug and dug and dug,” more deaths were discovered and the investigation broadened, Kelberg said.

Medical equipment and records of all patients who were being treated for diabetes or pregnancy by Klvana were seized from his offices Nov. 16, 1984, by the district attorney’s office.

After the documents filed with the search warrant became part of the public record and reporters began to do stories on the investigation, more couples who had lost children called the district attorney, county sheriff and state medical board with reports of other deaths.

No Comment From Lawyer

Klvana’s court-appointed attorney, H. Elizabeth Harris, said she will not comment on the case until the preliminary hearing gets under way.

Klvana, whose practice evaporated in the wake of the investigation and a $1-million civil judgment against him, declared bankruptcy last year. He and Doyle have been imprisoned since their arrests; neither has been able to make bail, originally set at $1 million each and reduced this spring to $750,000 each.

Upon advice of his attorney, Klvana declined to be interviewed about the case. But there are others who are eager to defend him.

Klvana’s arraignment and bail-reduction hearings consistently drew vocal crowds of supporters, many of them women who had successfully borne children under his care. Klvana, they maintained, has had a success rate in deliveries better than the national average.

Decline to Blame

Indeed, two of the couples whose babies died under Klvana’s care have said they do not blame him, and one mother went back to him for a second delivery after the first of her children delivered by him died.

Klvana and Doyle also have the support of the American Society for Childbirth at Home, a 10,000-member group representing practitioners of alternative birthing, and the California Assn. of Midwives.

Other support comes from those who know him personally. One of Klvana’s two school-age daughters, in a letter to the editor of the Newhall Signal, called her father “a wonderful doctor, not to mention a wonderful Dad, too.”

Many of his patients apparently share his daughter’s view. Tammy Birrer, one of the women in the booth at the Pasadena health convention, said Klvana delivered two of her three children. “He was a very caring doctor and a friend to us,” Birrer said. “He respected our rights as patients. You don’t get that choice in the hospital.” Birrer said she is pregnant again and plans to have her next child at home.

Another woman who had a successful, and uncomplicated, birth with Klvana three years ago described his Valencia clinic as “the next best thing to home.” There was a comfortable bed, a radio, a refrigerator, and it was cheap--$900, said the woman, who asked that her name not be used.

Klvana’s supporters call the case “a witch hunt” and an attack on out-of-hospital birthing.

But prosecutor Kelberg denied that alternative methods of giving birth constitute the issue. “The issue here is good medicine vs. bad medicine,” he said.

‘Absolute Red Herring’

The home-birth debate is an “absolute red herring,” said Linda J. Vogel, the deputy attorney general who is directing investigations of Klvana for the Board of Medical Quality Assurance. Once the criminal case is finished, Klvana will face a voluminous administrative case compiled by the board. Also listed in the board’s case are several alleged instances of “gross negligence,” including two purportedly life-threatening abortions.

Kelberg and defense lawyers say the preliminary hearing, before Judge James F. Nelson, could take up to four months. At the end of the preliminary hearing, the judge will decide whether there is sufficient evidence to hold either of the accused for trial.

Kelberg said he plans to justify the charges of second-degree murder, which are rarely applied to cases involving medical care, by showing that Klvana and Doyle knew that they were reckless and proceeded with the high-risk deliveries nonetheless.

A key goal of the prosecution is to establish that Klvana acted with “implied malice” in causing the deaths of the babies, Kelberg said. That is the same concept by which some drunk drivers who have caused fatalities have been successfully prosecuted on second-degree murder charges, he said. The legal reasoning is that, if a driver is aware that he is not capable of operating a vehicle safely, yet takes to the road and causes a death, he has committed murder.

“The charge is not that he has an intent to kill any one of these babies or to harm intentionally the mother or baby, but that he acts with a subjective awareness of the complications associated with these high-risk cases,” Kelberg said.

Maxwell S. Keith, court-appointed attorney for Doyle, said he is not impressed with the district attorney’s argument that this is a murder case. Kelberg’s strategy of trying to show implied malice is not well established, he said. “Certainly, he’ll have to show that their conduct was wanton and reckless, with a total disregard for human life. . . . There was certainly no malice in the hearts of these defendants toward little babies,” Keith said.

Kelberg predicted that it will be a hard case to win. “There is always going to be difficulty overcoming the . . . concept all of us have that doctors are the next highest thing to God,” Kelberg said.

Kelberg said Klvana “had a good bedside manner and a medical degree. Somehow, he has been able to slip and slide his way along, covering past disasters.”

As for Doyle, Kelberg said, “She knew she had no training other than to be trained by other unlicensed people” (other unlicensed midwives) but went ahead and delivered one of the ill-fated babies on her own and another with Klvana arriving only after delivery was almost complete.

The unusually extensive court file on the case, which includes a 1,500-page affidavit in support of the arrest warrant, provides a look at some of the evidence collected in the lengthy investigation. Kelberg’s office is a nearly impassible maze of teetering stacks of cartons, each contributing to the more than 80,000 pages of material on the case.

Troubled Career

The affidavit, made part of the public record when it was entered as an exhibit during a December bail hearing, is a detailed portrait of a physician’s troubled career and the evolution of the county’s case against him. It is a 16-year chronicle, told in documents dating back to the physician’s gaining approval in 1971 to practice medicine in the United States.

From an uncompleted residency at Kings County Hospital in Brooklyn, N.Y., in 1975 to the last time a hospital terminated its relationship with Klvana in 1985, Klvana’s performance was consistently rated as unsatisfactory, according to documents in the file.

“All through his career . . . every warning sign was being lit up, and horns were blaring, ‘Doctor, beware,’ ” Kelberg said in an interview. “And he drove right on through.”

The court file provides an in-depth look at Klvana’s medical career and the warning signs alluded to by Kelberg.

Klvana was born and received his medical training in Czechoslovakia, where he first practiced. He fled in 1969 to Switzerland in the wake of the Soviet occupation. From there he made his way to Toronto and then the United States. He became a U.S. citizen.

His medical career here started promisingly but soon ran into trouble.

After getting his 1971 permit to practice and finishing a one-year internship at DePaul Hospital in Norfolk, Va., Klvana was accepted into the obstetrics-gynecology residency program at Kings County Hospital. His performance there was rated poor. A 1974 appraisal by Dr. John Boyce, director of obstetrics and gynecology at Kings County, included a letter from a chief resident who trained Klvana.

In an opinion that would crop up often in later appraisals of Klvana’s medical judgment, the letter said, “I have found his basic attitude to be that things will be OK.”

In a formal evaluation of Klvana, his marks, according to records included in the court file, were as follows: Observation of rules--E (Poor); Conscientiousness--F; Faithfulness--E; Overall rating--E.

In 1975, Dr. James H. Nelson, who first invited Klvana to join the program, asked him to leave without prospect of becoming a chief resident--a step that is required before an obstetrician can become “board-certified,” a commonly recognized seal of approval. “This residency program is a very busy one with large numbers of seriously ill patients,” Nelson wrote in a letter to Klvana. “Not all residents can cope with this kind of residency responsibility.”

Klvana resigned on July 1 of that year.

Nelson never flagged in his skepticism about Klvana’s abilities. When Klvana started applying to Los Angeles-area hospitals in 1976 and administrators sought comments from Kings County, Nelson wrote that Klvana did not satisfactorily complete his residency.

In a letter to Parkview Community Hospital in Riverside, included in the court file, Nelson wrote that Klvana was “released from service” because of his “apparent inability to improve despite repeated counseling.”

Passing Marks

After leaving Kings County, Klvana took the national board examinations required of all physicians as they pass the residency stage of education. His marks in clinical obstetrics and clinical gynecology placed him in the 11th and 15th percentiles, respectively. He was licensed to practice medicine in California in October, 1975.

Klvana was admitted to a residency in anesthesiology that December at Loma Linda University but lasted only a year before he was asked to resign. In a staff review filed as an exhibit at the December bail-reduction hearing, Dr. Bernard Brandstater, Loma Linda’s chief of anesthesiology, wrote, “This applicant withdrew from the program on my advice. Though a pleasant and intelligent young man, his aptitudes are not in acute high-risk medicine.”

In a subsequent interview with investigators, included in the court file, Brandstater said that Klvana “did not appear to recognize the seriousness of a situation and take the appropriate action.”

In 1976, according to Board of Medical Quality Assurance documents, Klvana went into private practice for the first time. He purchased a practice in Granada Hills from an obstetrician who was leaving the state but soon found that it was a failing practice, with few regular patients to provide a steady source of income.

He fell into a habit of acceding to patient requests for diet pills and sleeping pills, according to documents from the medical board’s later investigation of the prescriptions. After an undercover investigation by law-enforcement agents, Klvana in 1978 was convicted of 26 counts of illegally prescribing controlled substances, including Quaaludes.

Klvana nearly lost his license to practice medicine, but after a hearing, the medical board decided to place him instead on five years’ probation, which began in 1980.

In September, 1982, Klvana petitioned the state medical board to have his probation lifted. In a letter, he said, “I would like to ask you to help me to get my probation terminated because making a living in my situation is getting harder. . . . “

He said he had relocated to the Santa Clarita Valley, to a clinic on Peachland Avenue in Newhall, “to get a fresh start,” but was practicing only “with great difficulties.” He explained that he had been denied staff privileges at many hospitals because he was unable, under the terms of probation, to prescribe certain drugs.

Documents in the court file support his account. A letter from Henry Mayo Newhall Memorial Hospital to Klvana in December, 1980, rejected his appeal to remain on staff, listing among other things the “unreasonable burden” created by his probation, which required hospitals to closely monitor his cases.

‘Learned His Lesson’

In March, 1983, two years early, the medical board voted to terminate Klvana’s probation, writing in a decision that “the evidence is convincing that petitioner has learned his lesson.”

Two of the three perjury charges in the criminal case against him relate to allegedly false statements he made in his successful bid to get his probation lifted.

The chronology of Klvana’s career, as laid out in the court file, shows how a physician--despite consistently poor appraisals--can move from one residency program to another, then one hospital to another.

According to hospital documents, Klvana had at one time or another obtained and then lost staff privileges at Newhall Memorial, Northridge Hospital Medical Center, East Los Angeles Doctors Hospital, Valley Vista Hospital in San Gabriel and other facilities. By the end of 1983 and early 1984, Klvana was working primarily out of two clinics--one in Valencia at 24456 1/2 Lyons Ave., the other, the Diet-Right Medical Weight Control Clinic, in Temple City. He occasionally worked at area hospitals.

In the five births that led to second-degree murder charges, most of the problems contributing to the deaths were not rare, according to reports--included in the court file--of several obstetrician-gynecologists who assessed the evidence for the district attorney.

They were “bread and butter” obstetric problems that should automatically have signaled any obstetrician that hospitalization was appropriate, one of the physicians concluded: diabetes in a mother, which is widely considered an automatic high-risk factor; premature delivery of a baby whose lungs were not fully developed; prolonged rupture of membranes with no delivery; asphyxiation of a newborn infant who had inhaled meconium, particles of the fetus’s fecal material that sometimes accumulate in the womb.

Klvana repeatedly failed to heed warning signs that babies were in trouble, Kelberg said, and the “result was a large number of dead babies who never had a chance.”

In February, 1986, one of the couples who lost a child, Julie James and Rudolfo Herrera, won a civil suit against Klvana. But they never collected the judgment of just over $1 million awarded in a non-jury trial by San Fernando Superior Court Judge Bruce J. Sottile, said their attorney, Robert L. Burge. Subsequent suits have not been pursued because Klvana is broke and is therefore, in practical terms, immune from further civil actions, Burge said.

No Insurance

Besides, Klvana practiced medicine “bare,” that is, with no malpractice insurance, according to his applications for staff positions at several Los Angeles hospitals, included in the court file. Practicing medicine without insurance is rare, medical authorities say, especially in such a high-risk field as obstetrics.

Friends of Milos Klvana, a support group based in Granada Hills, is planning to send a large number of home-birth advocates to the preliminary hearing, said Rachael Flug, a founder of the group and mother of a child delivered at home by Klvana.

Flug said that prosecutor Kelberg is obsessed with the case. In a letter to Dist. Atty. Ira Reiner last year, she said Klvana is a “political prisoner” and just the latest in a long line of doctors who have been persecuted for supporting the option of out-of-hospital births.

“I have witnesses here who believe in out-of-hospital birthing but who told Klvana he’s not following the right protocols,” Kelberg said. “I look forward to the defense bringing in any expert they can find.”

It is expected that Klvana’s attorneys will try to prove in at least some cases that the babies were not hospitalized because the parents did not want that to happen, Kelberg said.

But, he said, if Klvana had really wanted to hospitalize any of the infants, it would be expected that he would have noted in his medical records his reluctance to send the infants home. Such a notation might have helped protect him from later lawsuits.

“Nowhere in his medical records do you see the words ‘against my best judgment,’ ” Kelberg said.