Investigators Face Difficult Forensic Task

Authorities seeking to confirm the alleged confession of a respiratory therapist that he killed as many as 50 patients face a formidable forensic task because exhumed bodies, some dead for years, may not yield telling clues, experts said Saturday.

One of the drugs allegedly used by the therapist, Efren Saldivar, breaks down quickly and can be difficult to detect, especially in decayed bodies of elderly patients.

“You may never know” what happened, said Cyril Wecht, a forensic pathologist and attorney who is a county medical examiner in Pennsylvania.

As for bodies of patients who may have been suffocated, “forget it,” Wecht said. “Absolutely nothing will be revealed. Nothing.”

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Speculation and shock were much in evidence Saturday, the day after release of legal papers indicating that Saldivar allegedly confessed to killing between 40 and 50 patients at Glendale Adventist Medical Center since 1989 by cutting off their oxygen or injecting them with the muscle relaxants Pavulon or succinylcholine chloride.

While experts pondered the difficulty of building a case against Saldivar, despite his purported admissions, patients and employees at the hospital expressed horror and disbelief. Meanwhile, the hospital and police switchboards were inundated with more than 200 calls, many from concerned families.

“This is scary. . . . It’s an incredible hospital,” said Reggie Jimason, a driver with a medical transport company who was ferrying dialysis patients to the hospital Saturday. “It’s known to be a very good hospital, one where you’d say, ‘If I get sick, take me to Glendale Adventist.’ ”

Alan G. Perkins, 49, whose father, former Glendale City Manager C.E. “Gene” Perkins, died at Glendale Adventist Medical Center in October 1993, said his family is wondering whether his father was one of the victims.

C.E. Perkins, considered one of the city’s most influential municipal leaders, died after a long battle with Parkinson’s disease.

“It seemed so strange to hear the news,” said Perkins, of Davis, Calif. “It is one of those things that is really at the outer edges of murder. I don’t think that guy can take it upon himself to make those decisions.”

What really happened might be an elusive tale. But there is some precedent in similar cases that suggests at least some of the truth is attainable.

Fred Rieders, a toxicologist who worked on the O.J. Simpson defense, agreed with Wecht that there is “no chemical way” of detecting whether patients died from having their oxygen deliberately cut off. But he said there is a reasonable chance of detecting the paralyzing drugs, provided the bodies are in decent condition. Even the fast-decaying succinylcholine chloride has been detected in bodies exhumed as long as a year after death.

“It’s very difficult to predict,” he said. “Some people buried for years are in very good shape. In other cases . . . there’s nothing left but the skeleton.”

First, the alleged victims must be identified. A task force of six investigators is trying to do that by poring over records at Glendale Adventist.

Wecht said the best bet for investigators is to start with the most recent cases in which patients were least expected to die. Even though Saldivar allegedly “says he killed 40 or 50 . . . you can nail him on one or two,” Wecht said.

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The fast-acting nature of paralyzing drugs, and the fact that they leave behind no obvious signs of foul play, explains why they have been selected by killers in other famous cases, Wecht and Rieders said.

One was used by Dr. Carl Coppolino, convicted of killing his wife in 1967 with an injection of succinylcholine chloride in a love-triangle murder in Florida. The defense argued that the drug was untraceable in her body, but the prosecution’s experts prevailed with the argument that enough of the substance was found in her body to account for her death.

The drug also figured in the case of a Texas nurse who was convicted in the murder of a 15-month-old child in 1982. Prosecutors claimed there was evidence that many children died in the nurse’s care between 1978 and 1982. Traces of the muscle relaxant were found in the 15-month-old’s body more than a year after her death. But Rieders said another child’s body in that case was just bones upon exhumation, yielding no answers.

Experts said Saturday that there would be little or no legitimate reason for a respiratory therapist to be using such muscle relaxant drugs. The drugs are almost exclusively used by anesthesiologists to depress breathing during surgery.

“These are very dangerous,” Rieders said, and are generally used only by specially trained doctors.

One respiratory therapist in Sacramento suggested that the drugs usually would be available to a therapist only if he had a connection with access at the hospital, or if he obtained keys to restricted areas. The drugs are used to put breathing tubes in patients, but administering the drugs for that purpose is not usually a respiratory therapist’s job.

The Sacramento therapist, Bruce Mac Neill, a hospital supervisor and president of the local chapter of the California Society of Respiratory Care, said he was dismayed by the allegations against Saldivar, but not all that surprised that such a case could go on undetected for so long. He said staffing cuts under managed care have left respiratory therapists, along with many other supporting medical personnel, alone with patients much of the time.

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Despite Glendale Adventist’s assurances that it is taking “every reasonable precaution” in light of the investigation, visitors and health workers at the hospital were full of questions. Many expressed shock that this might have occurred at a hospital with Glendale Adventist’s sterling reputation.

Dr. Giovanni Smith, a pulmonary specialist at the hospital, said he found out about the allegations from a patient he was examining early Saturday.

“I didn’t know what to say. . . . It’s not terribly reassuring when a patient has to hear it on the television,” he said.

Jimason said that when he heard the allegation, he thought of the many patients he has transported to the hospital. “I couldn’t believe it,” he said. “You think they are going up there to seek help, that they are going to one of the best places . . . I think everyone is scared.”

Another medical transport driver, Josue Mendoza, expressed outrage. But pointing out that Saldivar worked with the very ill and dying, as he does, Mendoza said: “You have to have a strong heart. You get to know them [the patients] pretty well. After a while you can get kind of cold because if you let yourself get emotional, you are going to get very depressed.”

Reactions from those with loved ones at Glendale Adventist ranged from fear and bafflement to sympathy for the hospital’s staff. “They don’t need this, this guy, they’ve been doing a good job,” said Vinny Angelo of Glendale, whose mother-in-law is a dialysis patient.

Others were more jittery. “Oh my God, I’ve got a friend in here who couldn’t sleep all last night because of this. It’s terrible,” said an Eagle Rock woman as she hurried into the building. The woman said her friend is a pulmonary patient, but added that she saw little reason to fear the hospital because of the allegations. “It’s a very good hospital. You can’t get in a tither about it. You put your life in your hands in any hospital, you don’t know if there is some kook in there.”

Times staff writers Evelyn Larrubia and Megan Garvey contributed to this story.