County Had Cited Glendale Hospital

Glendale Adventist Medical Center, where a worker has allegedly confessed to killing 40 to 50 patients, has been cited several times in the past few years for failing to lock up potentially dangerous medications, according to a review of hospital inspection records.

In all cases, the hospital moved quickly to correct the problems, according to a review of Los Angeles County Department of Health and Human Services records by The Times.

“All of the corrections that were recommended are in place,” said Mark Newmyer, a hospital spokesman. “We definitely implemented and have followed all those recommendations.”

In a May 1995 inspection, health regulators found syringes with morphine sulfate resting unsecured on a counter in the recovery room at the hospital. Respiratory therapist Efren Saldivar has told police that he killed 40 to 50 patients at the hospital--some by lethal drug overdoses--between 1989 and August 1997.

The room didn’t have any patients then and when regulators checked again about a month later, the problem was corrected, according to the report by the Los Angeles County Health Facilities Division.

The incident occurred when a nurse briefly set down a morphine-filled syringe--a technical violation since the filled syringe was never supposed to leave her hand, Newmyer said. “Even though the nurse planned to pick it up, we were cited,” he said.

In that same inspection, regulators instructed the hospital to correct a problem in its nuclear medicine division in which keys to the medication were kept in an unlocked drawer and accessible to anyone, records show.

The regulators also found that a cart stocked with medications and used to provide supplies for the emergency resuscitation of patients was accessible to unlicensed staff in the hospital’s central services department.

Newmyer said that problem occurred because the hospital was using carts that weren’t equipped with locking drawers. All carts in the hospital now have drawers that can be secured.

It could not be determined late Tuesday if Saldivar would have had access to the carts. Some experts in the respiratory care field have expressed confusion at how Saldivar would have had access to the drugs he allegedly used to kill his victims. In his purported confession, released in connection with a hearing to suspend his license, Saldivar said he used the muscle relaxant drugs Pavulon or succinylcholine.

In March 1995, records show, regulators asked the hospital to correct a problem with open-ended medication orders. They said that an order for morphine was too vaguely worded, asking for a dosage range between “two to four milligrams” instead of a precise dose. Newmyer said hospital doctors are now under strict orders to prescribe only exact amounts of morphine.

The hospital also corrected other problems such as undated vials of drugs and keeping drugs more than 30 days, records show.

Some of these mistakes are commonly found in large institutions, county officials said.

“It would be unusual for a hospital not to have violations,” said Jean Olander, the program manager with the county’s facilities division.

Indeed, overall the hospital scored well in the 1995 review, receiving 88 out of 100 points. Later, that score was upgraded to 94 when the hospital rectified some problems, said Janet McIntyre, a spokeswoman for the Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals nationwide.

In a separate inspection in June 1997, inspectors also found that several intravenous solution bags containing antibiotics were left on a nurse’s station counter instead of being locked up. The nurses told regulators that they had no other places in the station to keep them, records show.

Hospital officials said those violations occurred in a unit where Saldivar never worked. They also said the antibiotics had nothing to do with the drugs that Saldivar allegedly used to kill patients.

“There is no connection,” Newmyer said. “We see no connection between the antibiotics and the present situation.”

Meanwhile, Saldivar, a 28-year-old Tujunga resident who allegedly described himself as an “angel of death,” did not show up for a hearing Tuesday on whether to permanently revoke his license.

Administrative Law Judge David B. Rosenman agreed to continue Saldivar’s interim suspension pending a formal hearing on revocation. Despite the judge’s extending the start of the hearing by 30 minutes, neither Saldivar nor any representative appeared.

The head of the state agency that oversees respiratory care practitioners defended the decision to seek revocation of Saldivar’s license.

True or untrue, “in light of his confession, [his action] is a breach of trust,” said Cathleen McCoy, executive director of the state’s Respiratory Care Board.