Nearly 2 1/2 years after his arrest, a Valencia obstetrician is scheduled to go on trial today on second-degree murder charges stemming from the deaths of eight infants and one fetus in his care.
Milos Klvana, 47, is being prosecuted on allegations that he proceeded with high-risk deliveries--and bungled them--although he knew that he did not have the skill or the equipment to perform them safely at his "birthing clinics" in Valencia and Temple City, according to the prosecutor, Deputy Dist. Atty. Brian R. Kelberg.
Klvana's sometime assistant, Delores Doyle, 36, of Montclair, is being tried with the doctor on two counts of second-degree murder and one count of involuntary manslaughter. Both Klvana and Doyle also face charges of insurance fraud and grand theft.
Klvana is representing himself with the aid of two court-appointed advisory lawyers, Rita-Jane Baird and Richard A. Leonard.
His defense so far has been an attack on Kelberg, whom the doctor said is "obsessed" with the case and is singling him out for prosecution because of the unorthodoxy of his out-of-hospital birthing practice. Klvana is being held in County Jail in lieu of $750,000 bail.
Doyle's attorney has argued his client played only a secondary role in the births and should not be charged with murder.
The trial is expected to last more than a year. Included among about 400 witnesses are medical experts, friends of Klvana and parents of the dead infants. The court record will include thousands of pages of exhibits. Kelberg has said they occupy 45 boxes in his office. The preliminary hearing for Klvana and Doyle lasted four months in 1987.
The district attorney's staff set up a video camera and six television sets Monday in Los Angeles Superior Court Judge Judith C. Chirlin's courtroom so that court personnel and jurors can get a close view of each document.
At the crux of the case is the prosecution's argument that Klvana knew that deaths or stillbirths could result from his decisions not to recommend hospitalization for the mothers in the nine deaths between 1982 and 1986. The legal theory is one of "implied malice," the same premise that is used in murder prosecutions against drunk drivers who cause deaths after having been convicted previously of drunk driving.
"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.
The complications include an insulin-dependent diabetic mother. Infants in such cases are sometimes born prematurely with underdeveloped lungs, necessitating close monitoring and care in a hospital, Kelberg said. Klvana's decision not to have Debbie Friel deliver in a hospital resulted in the death of her son, Jason, a day after his birth in 1984, he said.
Another high-risk situation alleged by Kelberg is known as RH sensitization, a conflict of blood factors between mother and child that causes the mother's immune system to treat the fetus as a foreign invader. Blood tests before delivery can detect this condition so that it can be treated, but in the cases of two deliveries by a woman in 1982 and 1984, no such tests or treatments were done, resulting in a fetal stillbirth and an infant's death one day after birth, according to court documents.
A third condition expected to be cited at trial is known as "meconium staining." Meconium, or fecal matter, can kill the fetus if ingested. During Kim Ennis' labor in 1984, Klvana and Doyle noticed stains of meconium, indicating trouble, but did nothing to extract the material from baby Tyrone Ennis' lungs and did not send him to a hospital, Kelberg has said in court papers. The boy died seven days later.
"The simple fact is that all of the cases involve common textbook obstetrical complications . . . mandating transfer of each mother prior to delivery to a hospital setting," Kelberg said.
Doyle, who is being held in lieu of $200,000 bail, is being represented by Maxwell S. Keith, who has argued in pretrial motions that Klvana, as the doctor, bears the final responsibility for the care of the mothers and the babies, he said.