Hospital Probe Is Reverse Whodunit

A week after the investigation went public, the police were in crisis mode, holed up in a house adjacent to the now besieged hospital, trying to piece together the puzzle of the “angel of death.”

Six detectives in the Glendale Police Department have been assigned to the strange case of Efren Saldivar, 28, a respiratory therapist who allegedly confessed to killing 40 to 50 people at Glendale Adventist Medical Center over the last nine years.

Such a scenario would challenge the resources of even the biggest police department, never mind Glendale’s 229-member force, which handled just eight new homicides last year.

But the particulars make this case yet more difficult, with the police themselves calling it a “whodunit reversed,” meaning they have a suspect and are searching for victims.

By the weekend, police had identified 35 potential victims. Many of the names were winnowed out of hundreds of calls from people with a loved one who died at the hospital since 1989, when Saldivar began working there as a reportedly cheerful 19-year-old fresh out of a one-year training program.

Saldivar has not been formally charged by police. But if he is responsible for the string of killings that police say he disclosed in a jaw-dropping “confession” only three weeks ago, it would represent an unprecedented killing spree, albeit a quiet one supposedly conducted in the name of mercy. The only mention that law enforcement documents make of Saldivar’s possible motive is that he was “angry” that terminally ill patients were being “kept alive.”

Much of the fascination with the alleged killings, which made headlines worldwide, may grow out of the country’s newfound concern with end-of-life issues.

Witness Oregon’s recent vote to legalize doctor-assisted death and the dozens of Midwesterners who have turned in desperation to Michigan physician Jack Kevorkian.

Although Americans dread the thought of spending their last days in a hospital bed, lonely and mute and connected to soulless machines, that does not excuse what Saldivar allegedly admitted to, medical ethics experts said.

According to court papers filed to suspend his respiratory care license, the state says he made “his own determinations, using his own criteria, about who, when and how patients should die. . . . He holds himself out as, and prides himself in being, the arbiter of death.”

To many, the Saldivar story has such chilling resonance precisely because respiratory therapists, whose work has been little publicized until now, are expected to play an ever-larger role in health care in coming years, as the bulk of the population ages and people grow more dependent on breathing machines to keep them alive.

In fact, the state Respiratory Care Board may use the angel-of-death case, no matter how it turns out, to press for tighter regulations on the profession. “Respiratory patients are very vulnerable,” said Cathleen McCoy, the board’s executive director. “If you can’t breathe for yourself, you can’t defend yourself.”

At the hospital-owned house serving as their makeshift command post, the Glendale investigators have been poring over medical records, reading scholarly papers on false confessions, and interviewing scores of hospital workers.

By the weekend, the police were still evaluating whether they had the resources to handle an investigation that appears daunting in scope and complexity, said spokesman Sgt. Rick Young. “If we have to bring in state or federal agencies, that will happen,” he said. “We have to figure out how big this thing is.”

Inquiry Sparked by Anonymous Tip

It was on March 3 that the Glendale police met with hospital administrators, after a tipster’s call to the hospital that Saldivar had “helped someone die fast,” perhaps in mid-February, according to a police affidavit. Officers went on to interview a respiratory therapy colleague of Saldivar’s, Bob Baker, who recalled once seeing in Saldivar’s hospital locker vials of two different drugs, morphine and succinylcholine chloride, the affidavit says.

Respiratory therapists are prohibited from possessing or administering the drugs, which can kill a person by paralyzing muscles used to breathe if administered in high doses.

On March 11, Saldivar appeared at the Glendale police station, where he underwent a lie detector test and, the police say, provided a “confession” after waiving his Miranda rights, which entitle him to have a lawyer present during questioning.

He began reluctantly, admitting that he killed a patient in 1989, six months after being hired by the medical center, police said. That person, who was breathing with assistance from a ventilator, suffocated some 15 minutes after Saldivar choked off the oxygen supply, according to the affidavit.

Then, as the audiotaped interrogation wore on, he admitted to other killings, the affidavit says. “He told me that he had caused between 40 and 50 deaths” since 1989, Glendale Police Officer William Currie stated. Saldivar killed some ventilator patients by depriving them of oxygen, other patients with a lethal injection, and perhaps others by simply failing to provide medical care when needed, the document indicates.

He told the lie detector technician that he considered himself an “angel of death,” the affidavit says.

Court papers differ on when the most recent alleged killing took place. There are references to a final lethal injection last August, but also to a patient dying “fast” in February.

The night of the interrogation, Glendale police detained Saldivar on suspicion of homicide.

Still, without corroborating evidence of the crimes, police could not hold him long. They alerted the state attorney general’s office, which teamed up with the Respiratory Care Board to prepare court papers to have Saldivar’s therapy license suspended because he “endangers the public health.”

A judge immediately granted that request and Saldivar’s license was temporarily suspended. Saldivar has been in hiding, and neither he nor a legal representative appeared last week at a judicial hearing to revoke the license permanently.

On Friday, March 13, after Saldivar spent 48 hours in jail, police let him go for lack of evidence to arrest him. He was fired the same day.

Another two weeks passed before the alleged killings surfaced in the news media, rocking the hospital and swamping the police. The disclosures drove the mysterious Saldivar underground and transformed the incident into a full-blown, tabloid-style scandal, complete with a bumptious media mob and a family member trying to broker access to the sought-after suspect.

Brother Serves as Spokesman

The only person thus far to claim to speak publicly on Saldivar’s behalf is his younger brother, Eddie, a dental assistant. They live with their mother in the small, white Tujunga house in which they were raised.

Eddie Saldivar says that although his brother is hiding--from the news media, not police--he is considering making a public statement. Eddie’s comments about the allegations against his brother are somewhat ambiguous: He has flatly denied that his brother confessed to police. But he also suggested to a Times reporter that although it is not accurate to refer to his brother as an “angel of death,” it might be “OK” to use the phrase “angel of mercy.”

Friends of Saldivar interviewed by The Times say they have trouble imagining him as a serial murderer, even one who prided himself on the humane ethical criteria he used to select his victims.

“I don’t personally believe that it happened, but if it did happen, I’m sure it’s not anything like they are making it out to be,” said Hannah Clark, 26, a friend of the family.

“He is not a murderer,” she said. “I can’t see him intentionally hurting anybody.” She said he is generous, enjoys treating friends and family to restaurant meals, and has a passion for video games.

A profile attached to what is listed on the Internet as his e-mail account says Saldivar enjoys movies, biking, Net surfing and computer games. His notable quote: “When you reach the end of your rope, just tie a knot and hang on!”

He attended Verdugo Hills High School and volunteered in a school club that sang Christmas carols at convalescent homes and helped organize blood drives.

At graduation in 1987, Saldivar skipped the ceremony, telling friends he had to take a vocational test to be a butcher. But Verdugo High officials say he never graduated because he missed one course requirement.

“He was always a soft-spoken, quiet guy, but he seemed to go out of his way to do weird things,” said Mark Conrad, a 28-year-old accountant who described himself as one of Saldivar’s few friends in junior high and high school.

In May 1988, 18-year-old Saldivar enrolled in the Valley College of Medical and Dental Careers in North Hollywood, now known as the Concorde Career Institute. People interested in respiratory care can train for one year and be qualified as a technician, or for two years and become a therapist, which carries greater responsibility. Saldivar took the shorter route, getting his certificate in 1989.

In his first six months at Glendale Adventist Medical Center, he worked under the supervision of a licensed respiratory care therapist until he got his license to practice. It was around that time, according to the police affidavit, that Saldivar said he took his first life, by choking off the patient’s air supply.

Saldivar worked at the hospital as a full-time and part-time employee until his firing, according to a work history provided by the hospital. Meanwhile, he worked at no fewer than four other hospitals during that time period, according to Glendale police: Glendale Memorial Hospital, Methodist Hospital in Arcadia, Pacifica Hospital in Sun Valley, and the now-defunct Thompson Memorial Medical Center in Burbank.

Saldivar also worked at a dozen or so nursing homes that contracted with Thompson Memorial for convalescent care, according to friends and former supervisors. However, it could not be determined which nursing homes he visited.

Lori Welker, who briefly supervised Saldivar in 1996 while he was working at Thompson, said he was a solid, conscientious employee. She said he appeared to enjoy caring for patients.

Hints of Trouble Surfaced Earlier

The anonymous tip to Glendale Adventist officials last month that set the Saldivar investigation in motion was not the first word of possible foul play the hospital received.

Nearly a year earlier, in April 1997, a hospital employee anonymously told superiors that a respiratory therapist had hastened patient deaths. The hospital’s two-month internal investigation eventually focused on Saldivar, though the hospital declines to say why.

Among other things, it statistically compared deaths on Saldivar’s shift over 15 months with deaths on other respiratory care practitioner’s shifts.

The hospital says it found no evidence of wrongdoing. Still, administrators assigned three staff members to monitor Saldivar closely.

Hospital officials at the time did not notify the police of their investigation. Glendale police say that the department would not necessarily expect to be informed of a vague accusation. Nonetheless, police say they will investigate the hospital’s conduct, though it is not a priority.

Perhaps more troubling, the state Respiratory Care Board says the hospital did not inform it of its investigation. There is no law that would have required the hospital to report the incident earlier, said the board’s McCoy. But if the board had been notified, she added, there is no question that it would have pursued the matter.

Police Predict Progress on Case

Glendale police have acknowledged that similarly elaborate confessions in other cases have turned out to be false. But they say that within the next two months, they plan to produce physical evidence to charge and prosecute Saldivar. There are indications that others may be investigated as well: As of Friday, five members of the hospital’s 38-person respiratory care unit, including Saldivar, had been fired.

The investigation will involve exhuming at least one of the alleged victims and searching for traces of a lethal injected drug.

As forensic scientists have pointed out, such drugs do not remain in a corpse indefinitely, and it may be virtually impossible to detect signs of suffocation.

If exhumed bodies yield no direct evidence of a crime, prosecutors might also successfully press their case using accumulated circumstantial evidence, said Charles Weisselberg, law professor at the University of Southern California.

But building that sort of case may also be difficult, given that the hospital has said it has found no correlation between Saldivar’s work schedule and the incidence of patient deaths at Glendale Adventist.

Over at the investigators’ makeshift headquarters near the hospital, Currie, the primary investigator and a 16-year veteran of the force, has been warned that he may spend the rest of his career trying to build a case against Saldivar.

“He has already been told this is a career case for him,” Young said.

Times staff writers Scott Glover and Greg Krikorian contributed to this story.