One day after former hospital worker Efren Saldivar pleaded guilty to killing six patients at Glendale Adventist Medical Center, the head of the state board that oversees respiratory therapists said its highest priority now is to pursue disciplinary cases against former co-workers who may have aided him, or who knew what he was doing but did not report it.
Saldivar's license as a respiratory care practitioner was suspended immediately after he told authorities in 1998 that he had injected paralyzing drugs into the intravenous lines of dozens of patients. In the four years since, however, there has been almost no action taken against the co-workers who kept quiet about their suspicions that he was killing patients.
According to court records unsealed last year, Saldivar's frequent partner on the graveyard shift told Glendale police that she stood outside one patient's room while he went in "for the purpose of injecting the patient," once got him a vial of a potentially deadly muscle relaxer and heard him confide that he had injected such a drug into a woman by mistake. She still has her state license.
Other co-workers admitted seeing unauthorized drugs in Saldivar's locker but did not inform hospital officials.
The only co-worker disciplined by the state--with a reprimand--was the one who alerted the hospital's respiratory supervisor to rumors that Saldivar wielded a "magic syringe" and who then cooperated most readily with police. That worker was one of those who saw potentially lethal drugs in Saldivar's locker but did not tell hospital officials.
The head of the California Respiratory Care Board said Wednesday that other potential disciplinary cases were stalled by the difficulty of obtaining police records and a desire not to interfere with the criminal prosecution of Saldivar--or, potentially, of other therapists.
"We definitely have this case as our highest priority now," said Stephanie Nunez, the board's executive officer.
Merely failing to report an isolated incident of seeing drugs in a co-worker's locker might not be enough grounds for a disciplinary action, Nunez said, but "I would say we definitely are looking at all those individuals."
In addition to implicating himself in "40-something" killings, Saldivar told Glendale police in his 1998 confession, "I wasn't the only one." He then named two other respiratory therapists, according to a transcript unsealed last year.
Saldivar later recanted that confession, though, and prosecutors said Tuesday that they do not anticipate filing criminal charges against any of his former colleagues. Several were given limited immunity from prosecution in exchange for their testimony against Saldivar, but that would not prohibit the licensing board from pursuing disciplinary actions against them.
Some did lose their jobs, even as they kept their licenses. After Saldivar's 1998 confession, he and four other respiratory therapists were fired by Glendale Adventist, which conducted its own internal investigation. Those fired included Saldivar's frequent companion on the graveyard shift and the pair he accused of following his lead in killing patients.
Glendale Adventist officials said they could not voluntarily turn over their internal records to the state licensing board, but invited it to subpoena the records. "At the time it was a big concern of ours," said hospital spokesman Mark Newmyer. "Any of our former employees that we let go, [state officials] had access to and knew who they were. We were concerned about them following up."
Nunez said the state board has at least been monitoring those therapists in new jobs they obtained after being fired.
Saldivar finally was arrested in January 2001 after authorities exhumed 20 bodies of former Glendale Adventist patients and found the drug Pavulon in the tissue of six of them. Prosecutors and police officials disclosed this week that Saldivar gave a second confession at that time, in which he said he had killed 60 patients by 1994 and then lost count.
Despite such shocking revelations, the dearth of disciplinary cases is not the only way that the murder case has had limited impact.
After Saldivar confessed in 1998, Glendale Adventist sent some of its officials to Indiana to see how a hospital there was handling its own "Angel of Death" scandal.
One of the consequences for Vermillion County Hospital was a torrent of lawsuits. One of its nurses was eventually found guilty of murdering six patients, but the hospital was swamped with 80 wrongful death actions brought by patients' families. A year after the nurse's 1999 conviction, the state's Patient's Compensation Fund had already paid out $5.8 million to 17 families. In addition, the hospital was under new management.
At Glendale Adventist, in contrast, officials said business was up by about 20 patients a day from the time the investigation was made public in 1998 to the time of Saldivar's arrest last year. The hospital said Wednesday that its census was up an additional 15 patients this year, to 300 on an average day.
In addition, Newmyer said the hospital had paid settlements to the families of only three of Saldivar's six documented murder victims. Though the terms are sealed, one family said last year that it received $60,000.
Newmyer said Glendale Adventist also paid settlements to two families of patients whose bodies were exhumed during the police investigation, but whose deaths did not produce murder charges.
"The hospital has fared very well through this on all fronts," Newmyer said, "and we're extremely grateful."
In all, perhaps only about a dozen suits have been filed. The long delay between the onset of the investigation and the filing of charges clearly helped the hospital on the civil front--relatives of deceased patients who waited for Saldivar's arrest found their suits dismissed by a county judge on grounds that they were filed too late, after the one-year statute of limitations had lapsed.
The daughter of another of Saldivar's victims, Jean Coyle--the only one known to have survived one of his injections--said she was told by lawyers "there was nothing they could do ... it was past the statute." Saldivar also pleaded guilty this week to an attempted murder charge in the case of Coyle.
Burbank Superior Court Judge Carl J. West, who presided over the hospital cases, similarly told the son of Eleanora Schlegel, 77, that he should have filed suit within one year of March 1998, when Saldivar was first identified as a suspect--and when the son phoned a police hotline to report his suspicions of wrongdoing.
The son, Larry Schlegel, eventually gained a settlement rather than appeal.
But he complained earlier this year that the ruling encouraged people to go to court before they had real evidence that malpractice, or in this case, murder, had occurred.
"My advice to anyone is that if someone dies in a hospital, sue 'em," said Schlegel. "Tie up the courtroom with a lawsuit over every death."
Only one suit is pending, filed in January on behalf of the estates of three victims--one of whose relatives already have settled with the hospital. The suit alleges that they were victims of elder abuse, an offense with a three-year statute of limitations.
The attorney who brought it, Chris Nicoll, said he has not yet served the legal papers on the hospital and is waiting to get records from the Saldivar grand jury.
Saldivar was named as a defendant in all the suits and under the terms of his plea agreement, any victims have another year to sue him. But he has minimal assets, noted the civil lawyer, Terry Goldberg, who has handled his cases for free. "He doesn't have anything," Goldberg said of Saldivar, who will be sentenced next month to six terms of life in prison without parole.
Goldberg said there was a simple explanation for the relative lack of suits in the case: "Litigation is very expensive."
Parties in the civil cases several times tried to force Glendale police to turn over their findings during the investigation, only to be rebuffed. That meant some families had to exhume their relatives' bodies--if police had not done so--and duplicate the elaborate work done for authorities by Lawrence Livermore National Laboratory, which devised new tests to find Pavulon in buried bodies.
Since Saldivar, unlike the hospital, did not settle any cases, he has so far suffered no civil judgments at all, Goldberg said.
"None. Zero. Not one."