Saldivar Admitted to Possible Role in ‘100 to 200’ Deaths

Respiratory therapist Efren Saldivar said in 1998 that he may have contributed to “anywhere from 100 to 200” deaths at Glendale Adventist Medical Center, according to a transcript of his confession to a polygraph examiner and police investigator.

Saldivar said he sometimes simply neglected to provide the help a patient needed--by giving “not the greatest CPR,” for example--but eventually started killing elderly patients by injecting paralyzing drugs into their intravenous lines, according to documents unsealed by a judge Friday.

Asked to estimate the number he killed that way, Saldivar said, “It has to be 40-something. I can’t believe it’s more than 50.”

That estimate, of 40 to 50 deaths, is the one that was included in the only public summary of Saldivar’s confession until now, in a police affidavit released shortly after the March 11, 1998, interrogation. Saldivar was arrested and held for two days then, but was released and quickly recanted the confession. He was rearrested Tuesday and charged with murdering six patients in 1996 and 1997.

The transcript, unsealed with hundreds of pages of other documents Friday, provides the first substantial look at what Saldivar told police during the wrenching several-hour taped interrogation.

His remarks include a diatribe against Armenian patients, whom he viewed as exploiting government programs to collect excessive benefits.

“I don’t want to sound racist, but this is a large Armenian community and there’s a lot of--of falsifying Medicare stuff,” the transcript quotes him as saying.

Though Saldivar described himself as an “angel of death” who could not stand to see terminally ill patients suffer, other unsealed documents indicate that one patient he may have targeted was revived--and is still alive today.

Another respiratory therapist said she once saw Saldivar inject a drug into a patient’s intravenous tube, according to a police affidavit, “but could not remember which patient it was.” That co-worker also said she saw Saldivar remove a potent muscle relaxant from a tray in the emergency room. She “took the drug away from Saldivar and gave it back to a nurse,” the affidavit states.

The co-worker, who often was paired with Saldivar on overnight shifts, told investigators she was having an affair with Saldivar, “including having sex with him during work,” and agreed to speak at length only under a grant of immunity, according to the document.

The voluminous records were ordered unsealed Friday by Pasadena Superior Court Judge Joseph F. De Vanon now that Saldivar, 31, is in custody. The documents were submitted by Glendale police in 1999 as the basis for getting court orders to exhume the bodies of 20 former Glendale Adventist patients.

Along with laboratory tests showing the presence of the paralyzing drug Pavulon in patients’ bodies, the material--especially the confession--is likely to be key ammunition for Los Angeles County prosecutors, who Wednesday filed six murder counts against the pudgy Tujunga resident. The charges allege the special circumstances of poisoning and “multiple murder,” which could carry the death penalty.

Saldivar was released soon after his confession because prosecutors said they needed independent evidence to corroborate his statements. A 34-month task force investigation followed. He is now being held without bail in the Los Angeles Men’s Central Jail.

His 1998 visit to the police station was voluntary, to answer questions raised by a short investigation based on a tip to Glendale Adventist that a therapist had “helped a patient die fast.”

In the nearly three years since, both Saldivar and his attorney have downplayed the significance of his statements, which were summarized in a police affidavit used to revoke Saldivar’s state license.

Woodland Hills attorney Terry M. Goldberg, who represents Saldivar in a series of civil suits, called it a “coerced ‘false confession.’ ” If Saldivar said things that were incriminating, it was because of “mental illness,” the lawyer said.

Saldivar himself told TV interviewers that authorities duped him by claiming they had conclusive evidence against him. He had been suffering from depression and had been “wanting to die for years,” he said, so decided to use police to carry out his wish--by making up a story that would get him the death penalty.

Saldivar recently told The Times that the investigation was still alive only because Glendale detectives were “fooled” into believing the lies of co-workers who disliked him.

The 134-page interrogation transcript shows that Saldivar’s questioners--polygraph examiner Ervin Youngblood and Glendale Police Det. Will Currie--did not have to do much prodding for him to speak about hospital deaths. They clearly tried to keep him talking, and he did.

Though the conversation before the formal interview is not part of the transcript, the document indicates it is Saldivar who, when asked what drugs he used, mentions Pavulon. His questioners seem unaware of that drug. He has to spell out the name of the drug for them, according to the document.

Speaking first to the polygraph examiner, Saldivar said he came to answer questions “to clear me up.” But he then declined to take the test, saying he was worried how it would come out when asked if he had done anything like killing patients.

“There’s been a lot of times where I’ve not actually done it, but kind of assisted in either directly or indirectly,” he explained.

Waived His Miranda Rights

By the time the interrogation was over, Saldivar had elaborated at length. “I’ve already said enough,” he commented near the conclusion. “I think that’s enough to lock me away.”

Saldivar gave many of the most damaging statements after the detective entered the room to take over for the polygraph examiner and read him his Miranda rights to remain silent and have an attorney.

Saldivar waived those rights, then provided details such as the criteria he used for picking out patients to kill: He looked for ones with “do not resuscitate” orders on their charts, he said.

Saldivar told Youngblood that he killed his first patient within a year of arriving at the hospital in 1989, when he was just 19. An elderly cancer patient on life support kept lingering, he said, even after the family “already said goodbye” and the doctor signed a death certificate.

Saldivar said he adjusted the tubes on a breathing machine so “the patient basically suffocated.”

A couple of years later, he said, he began injecting fatal doses of muscle relaxants into patients’ IV lines, inspired by a TV report about a hospital worker in the Midwest who had done the same thing.

Saldivar said he felt “nagging guilt,” but that emotion was “nothing compared to the anger--rage, of seeing somebody kept alive in this position.”

But he adopted another tone in discussing Armenian patients, whose families he suspected of lying about their age and using false identities to collect benefits.

“Patients come in . . . according to Medicare or Social Security, they’re 100 years old--97 years old,” he said. “You look at them, they’re 67.”

Glendale has one of the most concentrated Armenian communities in the United States, accounting for more than 60,000 of the city’s 203,000 residents, by some estimates.

Only one of the six victims identified this week is Armenian. But other documents show that authorities exhumed the bodies of several other Armenians, perhaps to test whether Saldivar acted on his dislike by killing them.

Saldivar never provided specific names of patients he said he killed. Periodically, the two questioners tried to pin him down on the number of deaths.

After Saldivar spoke of contributing to many patient deaths, in ways including failure to act--such as by giving inadequate CPR or “not the best compressions”--Youngblood asked, “could that be more than 100 patients?”

“I believe so,” Saldivar replied.

“OK . . . between what figure and what figure? Be realistic in your mind.”

“Anywhere from 100 to 200,” Saldivar replied.

“OK. Definitely under 500?”

“Oh, yeah. Definitely,” Saldivar said.

Later, when the conversation turned to lethal injections, Saldivar offered the smaller 40-to-50 estimate.

When he recanted the confession in two TV interviews, Saldivar called it a fabrication--and an attempt at suicide to end a depression that had plagued him for years. “I figured, you know, one death isn’t going to be enough for the death penalty.”

Near the end of the confession transcript, Saldivar worries about a different impact of his incriminating words--on his family.

“This is so scary,” he said. “My family depends on me so much. Not only am I not going to be there, but I’m going to shame them.”

Saldivar’s story changed over the course of the session, as the interrogation intensified.

At first, he said he only used Pavulon, and on only two patients--and never used another muscle relaxer, succinylcholine chloride, though vials of it reportedly once were discovered in his locker by co-workers. Later, he said he used combinations of the two drugs on patients.

Saldivar told Currie that he finally stopped killing after five years--about August 1997--when other respiratory therapists stumbled on the drugs in his locker while playing a prank.

That “freaked me out,” he said, “I have been clean since.”

Two of the victims identified this week died that August.

Pavulon or succinylcholine chloride are used in respiratory procedures--such as to suppress normal breathing muscles so doctors can insert a breathing tube--but a respiratory therapist would never be authorized to inject them.

Saldivar said he picked up his first supply when a bottle was improperly discarded.

Saldivar said he also picked up drugs at another hospital where he moonlighted, but never killed patients there. “The only place I ever did that was here at Glendale Adventist,” he said.

Though his co-workers did not actively assist him, he said, some were aware of what he was doing and even “encouraged me . . . We didn’t pick anybody healthy . . . who had a future,” he said.

“It became a joke and that was my way of handling the guilt. . . . ‘Hey Efren, did you go and visit this patient?’ ”

The talk became so loose, he said, that he sometimes got credit for killing patients who died naturally.

He said he did not feel like the “angels of death” he sometimes saw on TV. “I think of myself as a normal feeling person,” he said.

When he would see suffering patients whose condition “turns into multi-system failure, it becomes such a pathetic thing that your heart just bleeds,” he said.

Saldivar at one point emphasized that he had learned his lesson and “this won’t happen again.”

But he sensed that his words would probably send him to prison.

“I’m not a very spiritual person, but I have spiritual roots,” he said. “And I believe that I’m not going to be judged good.”

Co-Workers’ Suspicions Noted

More details of the case against Saldivar--beyond his own words--are provided in an affidavit filed to get a Pasadena judge to approve the exhumation of bodies on April 28, 1999. The affidavit, written by the head of the Glendale police task force, Sgt. John R. McKillop, and four investigators, outlines a range of circumstantial evidence against the nine-year hospital worker, much of it provided by fellow respiratory therapists.

The document describes a nagging suspicion among co-workers that Saldivar was killing patients, some of it expressed in black humor, like a comment that he had a “magic syringe.”

But the co-workers seem to have provided few details. Saldivar’s colleagues often could not remember the names of patients and sometimes were reluctant witnesses, the document says, especially Ursula Anderson, the respiratory therapist who said she was having an affair with Saldivar.

Nevertheless, the co-workers’ statements do link Saldivar to supplies of at least one of the drugs he said he used to kill patients.

In addition, a nurse placed Saldivar in the room of a dying patient, who has since been classified as one of the murder victims.

The affidavit also confirmed the episode that at least indirectly set off the “magic syringe” talk and an internal hospital investigation of Saldivar--the Dec. 30, 1996 death of Salbi Asatryan, 75. In the charges against Saldivar, that is the earliest of the six alleged murders.

Glendale Adventist says it was not alerted to the “magic syringe” rumor until April 1997--after three more of the alleged murders.

It then conducted its own “examination of medical records and respiratory staff activity, but found no substantive facts or evidence to support the rumor.”

Saldivar worked almost another year at the hospital before the phone tip prompted a second internal investigation, then a call to police.

Among other evidence cited in the affidavit supporting the exhumation of bodies:

* The same respiratory therapist who reported the “magic syringe” comment to his supervisor did not alert hospital higher-ups months later in 1997, when he opened Saldivar’s locker as part of a practical joke and saw vials of morphine and succinylcholine chloride. The therapist, Bob Baker, was worried he would get in trouble for breaking into the locker, intending to swap Saldivar’s gear with the contents of a co-worker’s locker.

* Another respiratory therapist, Elmer Diwa, told detectives that he twice noticed a “frowning face” next to the names of patients--ones who had died--on a grease board in the respiratory care department. Diwa said he confronted Saldivar, who told him he “took care of the patient,” using an unspecified drug.

* Anderson similarly recalled seeing Saldivar erase a name from the board and heard him say he “took care” of the patient. But she proved to be “very difficult to interview,” according to the affidavit.

After she was given “use immunity” for her testimony--meaning anything she said could not be used against her--Anderson told investigators that she once saw Saldivar take succinylcholine chloride from a tray in the emergency room, but “took the drug away.”

Anderson admitted, however, once taking the same paralyzing drug from the hospital “and giving Saldivar the drug to be used by him to kill patients,” the affidavit states.

It was succinylcholine chloride, as well, that Saldivar allegedly injected into a patient who did not die.

Anderson said the woman went into distress but was then revived--and is still alive today, “living in a local nursing home,” according to the affidavit.

Saldivar told his co-worker that injection was accidental, the affidavit adds, and that he meant to give the woman Benadryl, “a drug which he was authorized to administer.”

It’s unclear how prosecutors will be able to use such testimony involving succinylcholine chloride.

When the task force began exhuming bodies in 1999, officials said they would be looking for both Pavulon and succinylcholine chloride. But Deputy Dist. Atty. Al MacKenzie, who is handling the case against Saldivar, said that Lawrence Livermore National Laboratory found only Pavulon.

Although some labs have reported getting “hits” for succinylcholine chloride in body tissue buried for a year or more, others say it is virtually impossible to detect because it breaks down so quickly into normal body chemicals.

Glendale Police Chief Russell Siverling said this week that investigators still might look into other deaths. But law enforcement officials say it is rarely possible to track down all the homicides in a large hospital poisoning case. Given that Saldivar did not name a single specific patient, police in his case faced the daunting task of considering 1,050 patients who died while he was on duty--or within an hour of his shift--since he began working at Glendale Adventist. They eventually concentrated on the most recent 171 deaths, mostly in 1997 and 1998, because the drugs were most likely to still be present.

Poor Witness Recall Hinders Case

The records unsealed Friday point up another challenge first for police, and perhaps for prosecutors at any trial--the vague recollections of some witnesses.

Anderson said she once saw Saldivar inject a drug into a patient’s intravenous tube, the affidavit states, “but could not remember which patient it was.” Another time, she stood outside a patient’s room while he went in “for the purpose of injecting the patient,” but could not say whether he carried out the act. She could not identify that patient, either, or say whether the patient died, the affidavit adds.

The affidavit also reports that it was a friend of Anderson’s who tipped the hospital in early 1998 that a respiratory therapist might be killing patients. But the friend has “an extensive criminal record” and made the call in hopes he would “receive a sum of money in return for his information,” the document states.

Anderson was one of several respiratory therapists fired soon after the scandal broke in 1998. The supervisor of the department was among them.

The state Respiratory Care Board subsequently revoked Saldivar’s license and reprimanded Baker, according to Cathleen McCoy, its executive officer.

Possible disciplinary cases against other therapists are still under review by the attorney general’s office, McCoy said, but have been stalled “basically because we got no cooperation from the hospital or Glendale police,” presumably because they could not release evidence during an ongoing criminal investigation.

Saldivar would have been eligible to reapply for his license this spring.

He worked at odd jobs over the past three years, including stints at a rental car agency and a phone sex company. In recent months, he worked for Pacoima-based Electra-Cal Contractors Inc., helping out at construction sites in the San Fernando Valley, fellow employees there said.

He was arrested at 5:45 a.m. Tuesday driving on an offramp of the Ronald Reagan Freeway near the latest construction site, in Granada Hills. Co-workers there said they had no idea Saldivar was a suspect in hospital poisonings and remembered him as thorough, friendly and polite.

“When he drilled a hole, he drilled it good,” said co-worker.

Another said Saldivar was considered trustworthy enough to be assigned to unlock the construction site some mornings, and that his medical knowledge came in handy, too--diagnosing injuries to fellow workers.

“If he was released tomorrow, they’d want him back,” the colleague said.

During his confession in 1998, Saldivar recalled how he decided to become a respiratory therapist as a teenager--while working at a supermarket.

He told the story after Det. Currie commented, “You became a respiratory therapist obviously because you have interest in taking care of people, right?”

“No,” Saldivar said.

“What was the reason?”

“My friend Carlos, he was just started the class and he comes over, ‘Efren, Efren, want to join?’ . . . and I would turn him down. The third time he came in he showed up in uniform, you know with the stethoscope, badge and patch.

“And I go, ‘Damn, that looks cool. I’ll join whatever it is.’ ”

*

Times staff writers Richard Fausset and Jean Guccione contributed to this story.