State Takes New Look at Probe of Klvana : Medicine: A consultant concluded in 1984 that the now-convicted doctor’s care was no different than that offered ‘in the Third World.’

A medical consultant’s conclusion in 1984 that Dr. Milos Klvana, convicted earlier this week in the deaths of eight infants and a fetus, was not criminally liable for one of the deaths because his care “was no different from many situations in the Third World” has prompted a new inquiry into the state medical board’s probe of Klvana.

The consultant’s conclusion was contained in documents concerning the investigation by the Board of Medical Quality Assurance into Klvana that were reviewed Thursday by The Times.

Klvana was convicted Monday in Los Angeles Superior Court of second-degree murder in the deaths of eight infants and a fetus he delivered at his clinics in Valencia and Temple City. In the nine cases, which occurred between 1982 and 1986, the prosecution blamed the deaths on Klvana’s incompetence and his bungling of common but high-risk complications of pregnancy and childbirth.

The Board of Medical Quality Assurance has acknowledged knowing about Klvana’s involvement in at least four infant deaths before the start of the Los Angeles County district attorney’s investigation that led to Klvana’s conviction.

In the aftermath of Klvana’s conviction, the district attorney who prosecuted the case has been critical of the board’s earlier probe.

On Tuesday, medical board director Kenneth J. Wagstaff had defended the board’s handling of the Klvana investigation.

Wagstaff had said the board did not act against Klvana’s medical license in at least two of the four deaths it investigated largely because of a lack of solid information or evidence to contradict Klvana’s denials that he used a labor-inducing drug outside of hospitals.

But in one of the documents reviewed by The Times, a board consultant concluded that Klvana was not criminally liable in one of the deaths being investigated by the board because his care was “no different from many situations in the Third World.”

Told of this document, Wagstaff said Thursday he was launching “a significant internal review” of how the agency handled its investigation of Klvana.

The document was an evaluation by Dr. D. Gene Parks, a consultant the board hired for an opinion on the 1983 death of Amanda Herrera. Parks’ Feb. 25, 1984, report said that Klvana had committed gross negligence in his handling of Amanda’s delivery, but added in part: “Despite the grave errors of both omission and commission, I am reluctant to state that the subject physician committed manslaughter. . . . I would assume that his practice in this case is no different from many situations in the Third World where only marginal medical care is available.”

The Herrera infant’s death was among those for which Klvana was convicted of second-degree murder.

Wagstaff said Thursday he had not read the Parks evaluation. But he said it will prompt him to notify the board’s consultants that “there is a community standard of care in California, and it is not a Third World standard.”

“I would therefore be most interested in having our medical consultants explain to me how Dr. Parks’ assessment fits that policy,” Wagstaff said.

Also, another of the documents reviewed by The Times raises questions about how aggressively the board investigated Klvana’s use of a labor-inducing drug that now is blamed for the Herrera infant’s death.

The baby’s mother, Julie James, told authorities that Klvana used Pitocin, a labor-inducing drug, to speed Amanda’s delivery. The infant died after her head was forced through the mother’s birth canal.

Klvana told the board he did not use Pitocin. On Tuesday, Wagstaff had said a panel of two doctors closed the case because they had no medical evidence to corroborate James’ story over Klvana’s.

On Thursday, Wagstaff said he had not read a Sept. 21, 1984, memorandum from Dr. Adrian Mayer, a medical board employee and a member of the physician panel that shelved the board’s Herrera investigation.

In the memo, Mayer states that he and Parks were “under the impression” that Pitocin was used to speed Herrera’s delivery. But after hearing Klvana deny it and after seeing that the doctor’s records did not show he used it, Mayer wrote in the memo that he concluded that “this information knocks out Dr. Parks’ charges of gross negligence based on inappropriate use of Pitocin.”

Mayer’s memo briefly mentions the existence of a coroner’s autopsy in the case but does not discuss it in detail nor indicate whether it was reviewed. The autopsy, according to Los Angeles County Deputy Dist. Atty. Brian R. Kelberg, who prosecuted Klvana, showed injuries indicating that Amanda’s head was forced through the birth canal. Kelberg said that, had the medical board examined the autopsy closely, investigators would have realized that Amanda’s head injuries were consistent with the use of Pitocin.

Attempts to reach Parks and Mayer for comment Thursday were unsuccessful.

Kelberg, who prosecuted the Klvana case, said the Parks and Mayer documents demonstrate one of several “institutional problems” with the medical board’s system of using physician panels to investigate accusations of misconduct and incompetence against doctors.

“One sees the collegial relationship between the medical consultant from the board and his medical colleague, who is the suspect,” Kelberg said. “. . . You see an unwillingness or an inability to recognize that no doctor would admit to giving Pitocin in an office setting without fetal monitoring or an infusion pump.”

Wagstaff said part of his review of the Klvana case will include the 1980-83 period during which the doctor’s medical license was on probation.

The board knew of at least four cases of alleged incompetence by Klvana during that period but terminated the probation anyway in March, 1983, records show.

The cases, according to court and medical board documents, involved the 1982 deaths of two babies--one of which resulted in a second-degree murder conviction against Klvana--along with allegations that Klvana botched a breech birth and a tubal ligation.

One board investigator, Dr. Lillian Rachlin, wrote in a 1983 memo: “Since we are getting a series of cases, from different sources, I believe a full-scale investigation should be done prior to possibly submitting this material” to the state attorney general’s office, which acts as prosecutor for the board. She suggested subpoenaing hospital records in the cases.

But the board issued no subpoenas and conducted no follow-up investigations in those cases, Kelberg said.