Murder Trial Opens : D.A. Says Klvana Knew Inadequacies

A Valencia obstetrician accused of second-degree murder in the deaths of eight infants and one fetus had “a cavalier attitude” about his patients’ safety, a prosecutor said Tuesday in opening arguments of the physician’s trial in Los Angeles Superior Court.

Dr. Milos Klvana, 47, was told several times during his medical career that he lacked the skill to handle high-risk deliveries, Deputy Dist. Atty. Brian R. Kelberg said.

“He knew he was not cut out to practice where life-and-death decisions had to be made,” Kelberg argued. “He nevertheless plowed forward, no matter how many babies died, no matter how many mothers were put at risk.”

Klvana is being tried with Delores Doyle, 36, of Montclair, an unlicensed midwife who sometimes served as his assistant. She is charged with three counts of second-degree murder.

Both have pleaded not guilty to the second-degree murder charges and to insurance fraud, grand theft and conspiracy.

The deaths occurred because Klvana failed to recommend hospital deliveries for women who had common complications of pregnancy--including diabetes, a conflict of blood factors between mother and child and ingestion by the baby of its own fecal material before birth, the prosecution has charged.

In addition, Klvana often administered a labor-inducing drug without properly monitoring the fetal heartbeat and without first determining whether the mother’s birth canal was wide enough to deliver without putting lethal stress on the baby’s head and umbilical cord, Kelberg said.

Kelberg’s opening statement is expected to continue for at least two more days in Judge Judith C. Chirlin’s courtroom. Defense attorneys representing Klvana and Doyle are expected to make their opening statements next week.

Klvana’s defense will note the doctor’s role in hundreds of successful births--mostly those without high-risk complications--and the fact that state medical authorities did not take direct action against Klvana’s license until more than a year after his arrest, said Richard A. Leonard, one of two court-appointed attorneys representing Klvana. (The Times incorrectly reported Tuesday that Klvana was representing himself at the trial.)

On Tuesday, Kelberg traced Klvana’s medical career from his education in Czechoslovakia in the 1960s to his practice in the Los Angeles area, where the nine deaths occurred between 1982 and 1986.

In 1975, Klvana left Kings County Hospital in Brooklyn, N.Y., before completing a four-year obstetrics residency because the hospital did not consider him qualified to undergo the final year as chief resident, Kelberg said.

Later that year, he began a residency in anesthesiology at Loma Linda University but was forced to resign after his improper administration of painkillers caused the death of a young patient there, Kelberg said.

Those experiences, along with Klvana’s loss of staff privileges in the early 1980s at several hospitals in the San Fernando and Santa Clarita valleys, show that Klvana knew he was unable to handle high-risk cases, Kelberg said. That knowledge, and the basic understanding that mishandling such cases can result in deaths, form the basis for the murder charges, the prosecutor said.

Both defendants are in custody, with Klvana being held in County Jail in lieu of $750,000 bail and Doyle at Sybil Brand Institute in lieu of $100,000 bail.