Officials Defend Board’s Inaction on Obstetrician

State officials on Tuesday defended the California Board of Medical Quality Assurance in the wake of the nine second-degree murder convictions of Dr. Milos Klvana, a Valencia obstetrician whom the board investigated but did not discipline in the deaths of some of the babies that figured in the case.

“I see nothing to apologize for in terms of our efforts,” said Kenneth J. Wagstaff, the board’s executive director.

Wagstaff released a statement Tuesday that called his agency’s investigations of Klvana “unusually difficult” and said that “no governmental agency, no matter how large or powerful, can ever guarantee that bad medical practice will not occur.”

But others, including the prosecutor in the Klvana case, remained skeptical of the board’s performance.

“The system allowed him to get away with it,” said Brian R. Kelberg, chief of the medical-legal section of the Los Angeles County district attorney’s office.

On Monday, a Los Angeles Superior Court jury convicted Klvana, 49, of nine counts of second-degree murder in the deaths of eight infants and a fetus between 1982 and 1986. The prosecution charged that the deaths resulted because Klvana, who operated out-of-hospital birth clinics in Valencia and Temple City, was incompetent and ill-equipped to handle high-risk deliveries, but proceeded anyway.

The investigation that led to Klvana’s 1986 arrest and Monday’s convictions was triggered by the 1984 death of baby Jason Friel. But state medical board officials acknowledged that they knew of Klvana’s involvement in four earlier infant deaths, investigated the cases but took no action against his license.

Kelberg said the case exposed flaws in the board’s system of monitoring the competence of doctors.

Wagstaff responded Tuesday by defending the board’s system of using panels of physicians and medical consultants to investigate complaints of incompetence against doctors.

“I have confidence in the system,” Wagstaff said. “I think the average person should have confidence in the system. The fact is unfortunately that every system can be sidestepped, ducked and in some cases manipulated.”

The board was hampered in its probe of Klvana by a variety of factors, including the doctor’s skill at misleading investigators and falsifying medical records, a reluctance by some parents to cooperate with medical authorities and a dearth of solid information about the deaths at the time they occurred, said California Deputy Atty. Gen. Linda J. Vogel. She represented the board in the Klvana case.

The first death of a baby in Klvana’s care that came to the board’s attention was that of Amy Johnson on Christmas Day, 1982. The board interviewed the parents but were not told of several important details of Klvana’s substandard care until more than two years later, after the district attorney’s investigation of him was well under way, Vogel said.

In another case, the 1983 death of Amanda Herrera, the mother said Klvana administered a labor-inducing drug outside of a hospital setting; Klvana denied using the drug.

Without evidence to corroborate the mother’s story, an investigative panel of two doctors looking into the case said they believed “we would not be able to bring medical evidence to dispute what Klvana was saying,” Wagstaff said.

But Kelberg said this case demonstrated that the board’s investigations are tainted by a collegiality that “calls for this automatic acceptance of what the doctor says and a belief that the patient must be mistaken.”

Klvana’s own attorney, Richard A. Leonard, said the board failed to realize that Klvana had “a motive to lie and fabricate. He (wanted) to protect that (medical) license.”

The 1984 death of Aaron Diederick also was reported to the medical board. Wagstaff’s statement said the board’s probe merged into the investigation begun by the Los Angeles County district attorney later that year after the death of Jason Friel.

Klvana’s license currently is under a court injunction the board obtained earlier this year, after Klvana was found to have been practicing medicine while out on bail. The injunction effectively bars him from practicing medicine, Vogel said.