A law enforcement task force is investigating claims that a respiratory therapist who proclaimed himself an "angel of death" killed as many as 50 seriously ill patients over nine years at Glendale Adventist Medical Center by depriving them of oxygen or administering lethal injections.
But police said Friday that they were powerless to charge the man, Efren Saldivar of Tujunga, after his alleged March 11 confession because they had no corroborating evidence that a crime has been committed.
Saldivar's brother told a reporter he has left the area and will not be back for a month. The brother, who would not give his name, would not say where the therapist had gone.
As of Friday, officials said, the 450-bed hospital had suspended its entire 44-member respiratory care services department with pay to allow police to more effectively conduct their investigation and to calm public fears. Outside therapists have been brought in to take their place temporarily.
"The whole basis of our investigation is to prove what [Efren Saldivar] stated to us is in fact truth," said Glendale Police Sgt. Rick Young. "Legally, we did everything we could do to hold him. Regrettably, we had to release him."
Young called the case "a rumor we are trying to substantiate" but said, "No one has said, 'Here is a body' and how the person died. We don't have that yet."
But Young acknowledged the possibility that patients' bodies might have to be exhumed and said "all deaths" at the hospital would be probed. Police said they have set up a task force of six investigators working full time at the hospital, poring through medical records of patients.
Saldivar, who was detained for 48 hours but not arrested, told police that he caused "between 40 and 50 deaths" by lethal injections of the muscle relaxant drugs Pavulon or succinylcholine chloride, or by decreasing the oxygen supply of patients who were on a ventilator, according to documents released by state licensing authorities Friday.
The documents recapping Saldivar's interview with police were prepared by attorneys for state licensing authorities, who suspended Saldivar's license March 13. They will attempt to revoke his license at a hearing Tuesday.
"It's absolutely chilling to me, he [allegedly] used drugs and on other occasions did it by blocking the oxygen," Respiratory Care Board Executive Officer Cathleen McCoy said. "Unfortunately, those would be slow and agonizing deaths."
Saldivar told police he killed patients who were unconscious, had do-not-resuscitate orders and "looked like they were ready to die," according to the documents. Asked if he considered himself "an angel of death," he replied, "Yes," the documents say.
Saldivar said "he prided himself in having a very ethical criteria as to how to pick victims," the documents said.
"We don't know that anything wrong happened," said Mark Newmyer, vice president of marketing at Adventist Health-Southern California, at a news conference hastily called by the hospital Friday night. He suggested that anyone who made such a confession "could be crazy."
"There has not been any suspicion of wrongdoing" in the past, he said.
The hospital fired Saldivar March 6.
The suspension of the hospital's respiratory staff "is to assure existing patients that they can be 100% confident that there is no possibility that patients are in jeopardy now and in the future," Newmyer said.
Three unidentified employees from the respiratory care department were suspended two weeks ago on the advice of the Glendale Police Department because "some red flags came up," Young said. He did not elaborate except to say: "If we strongly thought they were a suspect, they would probably be fired right now."
In his confession, Saldivar said he "felt encouraged" by other therapists at the hospital who would sometimes give him room numbers of patients who needed lethal injections.
Saldivar is known to have worked at at least three other hospitals--Glendale Memorial, Pacifica and the former Thompson Memorial Hospital, now called Vencor Hospital of Burbank. Spokespeople at each institution denied knowing anything about him.
Young said the investigation is focusing on Glendale Adventist, but will expand if necessary.
Young said the investigation will take two months or longer to complete. He said it is difficult to prove patients who were about to die have been murdered.
"You can understand our frustration," Young said. "We are looking at people who were on the brink of dying and had a no-resuscitate order on their chart." Respiratory care practitioners help patients with breathing problems, including maintaining equipment to administer oxygen and administering medications as ordered by physicians.
Saldivar told police that the killing began in 1989, six months after he started working at the hospital, the state licensing documents state. He said he "basically suffocated" an already dying patient by putting tubes together that blocked the flow of air. It took the patient 15 minutes to die, the documents indicate.
He admitted to investigators that he had "failed to act" to provide appropriate medical care in certain instances, which also caused patient deaths, according to the documents.
Saldivar told police that he did not start the lethal injections until about three years after he joined the hospital. He said he thought he got the idea from a "20/20" news segment or a "60 Minutes" news report regarding a therapist in Chicago who was killing patients.
In discussing one allegedly lethal injection administered to an Armenian patient, he spoke of his "anger at seeing patients kept alive." However, his precise motives are not clear from the documents.
He said he stopped killing patients in August 1997 after he heard one of his co-workers had seen morphine he was storing in his personal locker at work.
According to the state licensing documents, at least two other employees were involved in bringing information to light about Saldivar. One, respiratory therapist Bob Baker, told authorities that another employee, Elmer Diwa, informed him 1 1/2 years ago that Saldivar had a "magic syringe" after a Saldivar patient died unexpectedly.
Baker said that about four months ago he had found morphine and a paralyzing drug in Saldivar's locker.
At Saldivar's home in Tujunga, a one-story, white wooden house on Valaho Drive which he shares with his brother and mother, his brother said Friday that Saldivar was out of town with a friend and would be gone for a month.
"He suspected all this would happen, so he wanted to stay out of the area," said Saldivar's brother, who declined to give his name because "I want to stay out of it."
The hospital received a tip Feb. 16 from an unidentified "outside source" saying a practitioner may have assisted in the deaths of patients, said the Adventist executive, Newmyer. He said the hospital did its own investigation and found an employee who had tipped off the outside source. On March 2, hospital officials took what they knew to police and suspended Saldivar. He was fired four days later.
Newmyer said there were earlier hints of trouble, but they were not substantiated. The hospital initiated an investigation in April 1997 after it received a tip from an employee about a possible mercy killing by Saldivar.
But officials uncovered no evidence of wrongdoing during their two-month investigation and found nothing to indicate a higher number of deaths when Saldivar was on duty, Newmyer said. Instead, three employees of the department were assigned to monitor Saldivar. Police were not called.
Authorities with the Los Angeles County district attorney's office said they received information on the case about two weeks ago from the Glendale police.
"Extensive further investigation is required before this information can be evaluated," said Sandi Gibbons, a spokeswoman for the office.
Complicating the investigation, a source close to the probe said, is the fact that the alleged killings occurred over a substantial period of time. "Even if you exhume bodies, are these drugs still present?" the source asked. "That's one question."
And if the presence of drugs is established, actually proving a homicide occurred--with so many potential cases involved--will be as time consuming as it will be sordid.
"This is going to be a long criminal investigation," the source said, estimating that it could easily take a year.
"This guy says he has killed 40 or 50 people. Number one, you need the names. Number two, you need the bodies. Number three, you need to examine the bodies and prove there was a homicide."
Authorities noted that the law requires prosecutors to produce evidence of a crime, beyond a defendant's confession.
Kermit Netteburg, spokesman for the Seventh-day Adventist Church in North America, said he spoke with hospital officials about the allegation Friday afternoon.
"They talked about their sadness and shock about having an employee who felt this was appropriate," Netteburg said.
Netteburg added that he was concerned about possible misperceptions that the Seventh-day Adventist Church, which owns nearly 70 hospitals nationwide, may have supported the alleged euthanasia.
"We are a relatively unknown group and it's easy to impugn the worst of motives to groups you don't know well," he said. "The Seventh-day Adventist Church believes in caring for people who are ill, not in trying to end their life."
The hospital has set up a hotline at (818) 409-6672.
Wargo and Huffaker are staff writers for the Glendale News-Press, which is published by Times Community News, a subsidiary of the Times Mirror Co., which publishes the Los Angeles Times. Marquis is a Times staff writer. Also contributing to this story were Times staff writers Scott Glover, Greg Krikorian and T. Christian Miller and researcher Nona Yates.