Efren SALDIVAR

Classification: Serial killer
Characteristics: "Angel of Death"
Number of victims: 6 - 50 +
Date of murders: 1989 - 1997
Date of arrest: January 10, 2001
Date of birth: September 30, 1969
Victims profile: Salbi Asatryan, 75 / Eleanora Schlegel, 77 / Jose Alfaro, 82 / Luina Schidlowski, 87 / Balbino Castro, 87 / Myrtle Brower, 84 (patients)
Method of murder: Lethal injections of the muscle relaxants Pavulon or succinylcholine chloride, and/or decreasing their oxygen intake if they were on ventilators
Location: Glendale, Los Angeles County, California, USA
Status: Pleaded guilty to six counts of murder and received six consecutive life sentences without the possibility of parole on March 12, 2002

Efren Saldivar (born 30 September 1969) is an American serial killer who murdered patients whilst working as a respiratory therapist.

Early life

Born in Brownsville, Texas, he graduated from the College of Medical and Dental Careers in North Hollywood in 1988. He obtained work as a respiratory therapist employed by the Glendale Adventist Medical Center, working the night shift when there were fewer staff on duty.

Murders

He killed his patients by injecting a paralytic drug which led to respiratory and/or cardiac arrest. These drugs could have included Morphine and Suxamethonium chloride as they were found in his locker with fresh and used syringes. Pancuronium (brand name Pavulon) definitely was used in six murders; this drug is used to stop a patient's respiration when they are about to be put on a medical ventilator. He was careful in the selection of his victims, choosing those who were unconscious and close to death.

This led to no easily detectable rise in the rate or distribution of patient deaths when he was on duty, as many patients simply died sooner than they would have without his intervention. This in turn hampered the investigation into Saldivar's activities, as there were no easily discernable correlations between changes in the distribution or rate of deaths and his shift pattern (a commonly used tool in examining whether malpractice is taking place).

After initial indications regarding his actions at the hospital, including a confession to fifty murders (which he later retracted), his medical employment was ended on March 13, 1998. In searching for evidence that would be strong enough to obtain a court conviction, the police exhumed the remains of patients who had died whilst Saldivar had been on duty and been buried (rather than cremated). The marker that was being sought was unusually high levels of Pavulon in the cadaver, as this drug remains identifiable for many months (unlike succinylcholine chloride and morphine which are decomposed into innocuous compounds relatively rapidly).

After twenty exhumations, six cadavers had evidence of a lethal concentration of Pavulon. On March 12, 2002 Saldivar pleaded guilty to those six counts of murder and received six consecutive life sentences without the possibility of parole.

The former head of the respiratory care department at Loma Linda University, Tom Malinowski, led the internal investigation by Adventist Health. Statistical analysis indicates total number of murders committed by Saldivar could be as high as 120, but no convincing physical evidence will ever be available to confirm or refute this possibility due to bodies being cremated after death or simply the effects of decay.

Wikipedia.org

Efren Saldivar

A former respiratory care practitioner at a Glendale hospital Efren confessed to killing 40 to 50 patients over a eight-year period. A suspected "Angel of Death," he allegedly targeted patients who were already near death. He would kill them with lethal injections of the muscle relaxants Pavulon or succinylcholine chloride, and/or decreasing their oxygen intake if they were on ventilators.

Saldivar allegedly told police that the killings began in 1989, six months after he started working at the hospital, and stopped in August 1997 when he heard that one of his co-workers had seen morphine in his locker. The hospital first heard rumors about hastened patient deaths in April 1997. Although the two-month internal investigation revealed nothing suspicious, a criminal investigation was launched after police received an anonymous phone call on March 3 from a person saying Saldivar "helped a patient die fast."

Not a random killer, Saldivar -- who co-workers said had a "magic syringe" -- prided himself on following an ethical set of criteria determining who to kill: they had to be unconscious, they had to have a "Do not resuscitate" order, and they had to look like they were ready to die. In an affidavit, Officer William Currie, who interviewed Saldivar, said: "He talked about his anger at seeing patients kept alive as opposed to the guilt he would feel at the failure to provide life-saving care." He said that a polygraph examiner asked Saldivar if he considered himself an "angel of death" and Saldivar replied: "Yes."

Bizarrely, police could only detain Saldivar for 48-hours after his March 3 confession because of lack of corroborating evidence. When his confession surfaced in the press on March 25, 1998, Saldivar was fired from the hospital and his license was revoked. Efren then went on the ABC-TV news magazine "20/20" were he recanted everything, saying he had lied because he was depressed, suicidal and wanted to be sent to death row. "I wanted the system to do to me what I couldn't do," that is, commit suicide. "I was looking to die, I wanted to die ... but I didn't have the courage."

"I figured, you know, one death isn't gonna be enough for the death penalty so I said two... And then I started to cry because I was ending my life." Allegedly, as the interrogation went on, he started embellishing his murderous tale and the confession snowballed into the 50 deaths that made the front page of newspapers worldwide. As for the co-worker who allegedly found morphine and succinycholine chloride in his locker, Efren said the man hated him and had "a plan to get rid of me."

Glendale police spokesperson Sgt. Rick Young dismissed Saldivar retraction as self-serving and insisted the remarks would not affect the criminal investigation. In fact, Glendale police said for the first time that they believe that at least one murder was committed. However, no arrest warrant has been issued because they still lack District Attorney Announces Filing of Capital Murder Charges in Hospital Deaths

January 10, 2001

LOS ANGELES -- District Attorney Steve Cooley announced today that a former Glendale Adventist Medical Center respiratory therapist has been charged with murdering six elderly patients who died in 1996 and 1997.

"After years of hard work, the combined efforts of both the Glendale Police Department and the District Attorney's Office have paid off in the filing of charges against Efren Salvidar," Cooley said.

He said the criminal complaint filed this morning in Glendale Superior Court alleges that all six victims were poisoned, a special circumstance under California law. The complaint also alleged a second special circumstance of multiple murder.

The District Attorney said his office will not make a determination on whether to seek the death penalty against the 31-year-old Saldivar (dob 9-30-69) until after a preliminary hearing of the evidence against him. Saldivar, of Tujunga, was arrested by Glendale police early Tuesday. He is being held without bail and is expected to be arraigned at 10 a.m. tomorrow in Division 1 of Glendale Superior Court, 600 E. Broadway, Glendale.

Cooley said that results of tests done on the exhumed bodies of the victims, coupled with recently discovered evidence found in Saldivar's home, led Deputy District Attorney Al MacKenzie to file the seven-count criminal complaint (case No. GA 044958). Besides, the six murder counts, Saldivar is charged with receiving stolen property, identified as a drug called Versed, which generally is used to induce sleep in patients.

The case has been under investigation by Glendale police since February 1998. In March 1998, Saldivar was questioned by police but released pending completion of the investigation.

MacKenzie said that during the investigation, 20 bodies of patients who had died at the hospital were exhumed and tissue samples were taken by the Los Angeles County coroner's office. Toxicological testing was performed on the tissue samples by Dr. Brian D. Andresen of Lawrence Livermore National Laboratory and the drug Pavulon was found in the remains of the six victims named in the complaint filed today. The finding was reviewed by another leading toxicologist, Dr. Graham Jones, who concurred with Dr. Andresen's opinion.

All of the six deaths had been listed as suspicious, MacKenzie said. And of the six, five did not receive any Pavulon as part of their legitimate medical treatment prior to their deaths, he said.

The victims were identified as:

Jose Alfaro, 82, who was admitted on Jan. 2, 1997, and died two days later.
Salbi Asatryan, 75, admitted on Dec. 27, 1996, and died three days later.
Myrtle Brower, 84, admitted Aug. 18, 1997, and died 10 days later.
Balbino Castro, 87, admitted Aug. 6, 1997, and died nine days later.
Luina Schidlowski, 87, admitted Jan. 20, 1997, and died two days later.
Eleanora Schlegel, 77, admitted Dec. 30, 1996, and died three days later.

Cooley said that Deputy District Attorney Brian Kelberg, in charge of the Medico-Legal Section, worked closely with Glendale police in an advisory capacity during the investigation. The District Attorney said it was Kelberg who helped guide Glendale investigators through the delicate process of having the bodies exhumed and examined.

In late November, Cooley said he asked MacKenzie to take a look at the case. MacKenzie, skilled in prosecuting technical medical cases, had worked before with Glendale police in the successful prosecution of a Dr. Richard Boggs, a physician, and two others in an insurance fraud murder in which the victim's body had been cremated some time before the case was filed.

necessary evidence.

Investigators reviewed the deaths of 171 patients who died while Saldivar was working at the hospital. Fifty-four cases were eliminated because bodies had been cremated. Of the remainder, 20 deaths were determined to have been suspicious and the bodies were exhumed. Toxicological tests revealed the presence of the drug Pavulon in the remains of the six victims. On January 10, 2001, police rearrested Saldivar and charged him with the deaths of six hospital patients.

Hospitals frequently use Pavulon to stop the normal breathing of patients who are put on artificial respiratory devices, said Deputy District Attorney Al Mackenzie, who will handle the case. "If you're going to do surgery, you're going to put the person on an artificial breathing device," Mackenzie said. "If you give the person the drug Pavulon and don't create an artificial means to breathe, they die."

Graveyard Shift

Digging Deep for 'Angel's' Terrible Toll

Glendale police endured nightmares and exhumed 20 bodies to find out what Efren Saldivar had been doing in the dark. 'Prepare to fail,' an expert warned.

By Paul Lieberman - Times Staff Writer

April 29 2002

A lieutenant told John McKillop, "Chief wants to see us."

McKillop was the sergeant of robbery-homicide. He hated "friend of chief" cases. They never did you any good.

There were three visitors in Chief Russell Siverling's office, led by a man nervously rubbing his head. The visitors were executives from Glendale Adventist Medical Center. The nervous one, Dave Nelson, had taken a call two weeks earlier from a man who identified himself only as "Grant." The caller said a "lady friend" at the hospital knew a respiratory therapist who had "helped a patient die fast." Maybe it was patients. Grant had been sketchy. He refused to name his lady friend, and he could not identify the killer. He suggested someone read him a list of the respiratory therapists--perhaps he'd recall the name. He left a pager number.

A hospital official beeped Grant the next day and read him the ledger of RTs, all 38 of them. He thought "Efren" sounded familiar.

Under other circumstances, the hospital might have written off the flaky caller. He admitted that he hoped to make money off his tip, even though his sponsor in Alcoholics Anonymous warned him that "smacks of blackmail." During other calls, about the only new tidbit he gave them was his last name, Brossus.

But hospital officials could not dismiss him. The year before, one of their own employees had alerted a supervisor to a rumor that a respiratory therapist on the graveyard shift, Efren Saldivar, was wielding a "magic syringe."

McKillop wanted to ask, "Why didn't you call us then?" Instead he said, "Here's what we do."

Minutes later, he was back at his desk, dialing a pager--and it did not belong to Grant Brossus.

On that afternoon--March 2, 1998--McKillop was about to get an education in a distinct breed of medical killer. "Angels of Death," they were called. People often saw them as agents of mercy. But McKillop would learn that there was nothing heavenly about these quiet executioners or how they often got away with murder for so long. It would take luck, nightmares and four years for him to get his "angel."

*****

A PAGER VIBRATED on the hip of Glendale's top detective, Will Currie. He was on a witness stand. He peeked down and saw that the call was from his former partner. McKillop was his sergeant now, but he'd have to wait.

They'd always been an odd pairing.

McKillop, 36, carried himself with the swagger of a former basketball point guard used to controlling the action, or trying to. He wore his dark hair slicked back and had piercing eyes with an edge of impatience. Raised by a single mother in Queens, N.Y., he saved his Halloween candy as a kid so he could sell it. By the time he switched coasts and joined the Glendale Police Department, he was still an operator. While other cops scrounged guard jobs on the side, McKillop started his own special events business, providing security, tents and red carpets for movie premieres.

Currie, on the other hand, was a sad-eyed man of 40 who spoke haltingly in an accent that was hard to place. He was from South Africa, where he had been a ranger at a game reserve, showing tourists lions and rhinos, until he followed one guest, a long-legged blond, to California. Their marriage didn't last, but Currie found a career when he bought a "how-to" book the day before a police civil service exam.

Now his Glendale colleagues marveled at how he used the play-dumb demeanor of TV's Columbo. Currie once told a Pizza Hut robber it was "too bad" how those newfangled security cameras could see through a ski mask. The fellow went for it and said, "OK, I was there. . . ."

Currie finished testifying against a Brand Boulevard slasher and called from the courthouse.

"Get your ass in here," McKillop said.

Next, they enlisted Investigator Tony Futia, who was 6 foot 3, bench-pressed 400 pounds and had a night law degree. Futia couldn't understand why his colleagues seemed so excited. When he ran a background check on Grant Brossus, he found arrests going back 15 years for burglary, grand theft and transporting cocaine. The hospital's tipster had done time at Folsom and Corcoran state prisons.

They tracked him down at his father's house. Brossus did not invite them in. The whole business about patients being killed had been a misunderstanding, he said. He'd heard wrong. "No disrespect," he said, and shut the door.

Next was Brossus' "lady friend," who supposedly knew the killer. Administrators at Glendale Adventist had guessed she was Ursula Anderson, who often worked graveyard shifts with Saldivar. Currie and Futia found her at the hospital, which overlooks the Ventura Freeway at the base of the Verdugo Mountains.

"Grant made it up," she said.

A few nights later, they returned to see Bob Baker, the respiratory therapist who had reported the "magic syringe" rumor to a supervisor a year before. Baker insisted they meet outside in the dark. He kept looking side to side. Did he want to talk in the car? No, he said, "I'm a little claustrophobic."

Baker told them the "magic syringe" gossip was not the only thing that made him suspicious of Saldivar. He'd once glimpsed vials of morphine and succinylcholine chloride, a paralyzer, in Saldivar's locker.

Currie felt himself flush. It's true. It all happened.

Then he had second thoughts. Baker seemed so conspiratorial. And what did policemen know about drugs like that, or respiratory therapy, or hospitals?

That night, the two detectives also talked to John Bechthold, technical director of the hospital's respiratory department, to whom Baker had originally passed along the "magic syringe" rumor. He said Baker and Saldivar hated each other. Besides, hospital officials had kept an eye on Saldivar after learning of the rumor and seen "nothing unusual."

Bechthold told them, "I don't think it's happening."

The cops settled on a theory: This wasn't serial murder, but a love triangle. Efren, Grant, Ursula. Grant had called the hospital to get rid of Efren.

"Nothing's panning out," McKillop said when the chief phoned him for an update. Siverling was getting calls himself, from Glendale Adventist. At McKillop's request, the hospital had used a ruse--a schedule change--to keep Saldivar off the job. But how much longer could they do that? And the administrators wanted to question him, right away, if the police didn't.

It was March 11, 1998. McKillop summoned Currie. "You're going to have to pull in Efren."

"I have nothing. How do I pull a guy in?"

"We got to."

*****

AT 3:30 P.M. THAT afternoon, Currie phoned the house in Tujunga where Saldivar had lived since he was a baby and where his parents, Mexican immigrants, still kept chickens out back. Efren answered. He wanted to come in immediately. He'd been "sweating for a whole week" about why the hospital was keeping him away from work.

"Can you come in at 6?" Currie asked. He didn't want to sound too eager. And he wanted to find Ervin Youngblood, a polygraph examiner for the Los Angeles Police Department who moonlighted for Glendale. Sometimes suspects said things you didn't expect when they saw Erv and his box.

McKillop left about 5 for a hockey game in the Santa Clarita Valley. That was his new sport, roller hockey. Why miss a game for an interview that was certain to be a bunch of denials? Besides, Tony Futia would be there to back up Currie.

Except that he wasn't. Minutes after McKillop left, Futia's wife called. She needed Tony to baby-sit their 2-year-old.

"Don't worry," Currie told Futia. He would handle Saldivar himself.

He would explain to the hospital worker why he'd been called in, then turn him over to Youngblood, who was already setting up in an interview cubicle.

The desk officer buzzed from downstairs. Currie's visitor had arrived.

"Where's that one-way mirror," Saldivar asked when he sat down in the 6-by-8-foot cubicle. He was wearing a blue T-shirt, baggy jeans, shorts and sneakers. He was 250 pounds but soft, his face round, almost puffy. He sipped a Mountain Dew.

"You've been watching too much television," Youngblood said. His machine was on a square faux wood table between them, a tangle of wires coming out, none hooked up yet.

"Efren, do you understand why you're here today?"

"To clear me up."

"To clear you up about what?"

"What he told me is that a--a anonymous call came in saying that I'm walking around injecting people for the purpose of killing them. Like an Angel of Death kind of thing."

"Are you an Angel of Death, Efren?"

"No."

"Have you done anything like that?"

"This is my reservation--there's been a lot of times where I've not actually done it, but kind of assisted in either directly or indirectly. That's why I know it's gonna say, yeah, that I'm lying."

"The only way you would fail my test tonight is if you deliberately lie," Youngblood said. "Why don't you tell me about the times that you help--assisted?"

"Oh, God. All right. I'll start with the very first time..."

Youngblood had told the truth--there was no one-way mirror. There was a microphone, though. It was hidden in what looked like a thermostat. It carried every word to a tape recorder in the Bug Room at the far end of the detective bureau. That's where Currie was sitting, headphones on, listening to Saldivar talk about 1989, his first year at Glendale Adventist.

"I was 19 years old. Fresh out of school... At about 11 o'clock, one of the ICU nurses tells me that there's a patient on life support that was assigned to me."

The patient had cancer, "spread out to the whole body." The family was "saying their goodbyes," and the doctors were planning to turn off the breathing machine. But when he peeked through the curtains, it "was still on. . . . I see the patient doing, like, you know, mild breathing motions. . . . And I told the nurse. She goes, 'Oh, we can't have that.' . . . She says, 'The patient's going to die.'

"I go in there. I get both tubes and I connect them."

Youngblood asked, "What did that do?"

"The patient basically suffocated."

"When was the second time?"

"OK," Saldivar said, "Now, the other times..."

Currie had planned his night: He'd be done by 9, pick up a California roll, feed the dogs, sit in front of the tube, fall asleep. But now he wondered if he'd be making the sushi run.

Saldivar was speaking of patients who were "super-elderly" and suffering, most classified "no code," or DNR, "Do Not Resuscitate." He had rarely done anything overt, like disconnecting tubes, he said. It was "more of lack of doing something," not giving oxygen, or administering inadequate CPR, and it happened both at Glendale Adventist and at hospitals where he moonlighted.

"About how many occasions can you recall ... where you just didn't do anything?" Youngblood asked.

"Oh, geez, in the nine years ... and it's not just me--the nurses do it too."

"Um-hum."

"I'd have to say at least 100."

In the Bug Room, Currie wondered: Was this a confession, or was it less than it seemed? Not "doing something" special to save a dying patient sounded a lot like the hard decisions doctors make every day.

"OK. When is the last time?"

"Last week."

Youngblood needed to confer with Currie, so he asked Saldivar if he wanted another soda. When he left, Saldivar muttered to himself, as if trying to make up his mind. "OK. Oh, yes. Yes. Yes. Yes. Yes. Maybe. Yes. Yes."

After the polygraph examiner returned, Saldivar asked, "What if, hypothetically . . . what would happen to me if, say, I tried something in the past and I found that it was such a wrong thing that I never did it again?"

"What did you hypothetically do?"

"Gave him something--something to paralyze him."

In the Bug Room, Currie tried the wall phone. Dead. He went searching for a phone to call McKillop at the hockey rink.

Youngblood was asking, "Why is it so hard for you to tell me that?"

" 'Cause I'm scared... 'OK, lock him up,' you know."

"Has anybody kicked the door down?"

"No."

"... What was the medication that you gave?"

"It was Pavulon... I went in ... and just shot it in."

"Did you put it through the IV or--"

"Right."

"Was that a male or female patient?"

"I don't remember," Saldivar replied. "It was lights off and quiet."

When Currie walked in, Saldivar seemed to know what was coming. "I got a lot of things to take care of," he said. "I got to get my money out, give it to my folks."

"Let's deal with one thing at a time," Currie said. "You have the right to remain silent. . . ."

Saldivar didn't. He talked--for two hours more.

He had to spell the drug's name for them. "P-A-V-U-L-O-N." He said he had come across a single bottle improperly discarded, and later carried it from room to room, looking at the old people with cancer or liver failure, feeling guilt at his thoughts but also "anger for why these patients are kept alive." He said he gave his first lethal injection the previous August, in 1997, then rushed out of the room, petrified. "About two hours later, I just walked by the nurses station and saw on the board that the patient expired. And they were expecting it. They didn't think anything."

He did it again days later--but that was it, he insisted.

"It makes little difference whether you helped out two patients or 20 or 100," Currie said. "Are there more than two?"

"No."

When joking around with other RTs, Saldivar said, "I took credit for a lot more." He had gotten the idea of helping people die from a TV report on a hospital killer in Chicago.

"Approximately when?" Currie asked.

"Six, seven years ago."

The detective had his opening--Saldivar's suggestion that he waited so long to start. "I'm gonna have to dig a lot deeper," Currie said.

"I wasn't the only one," Saldivar said.

Currie and Youngblood were not about to get sidetracked. They could talk about others later. Youngblood asked, "Is it more than 500?"

"No. No. No. No. No. Less than 50. Like I said, I took a lot of credit for stuff that I didn't do."

"Even if it is more than 50, be truthful."

"It has to be 40-something. I can't believe it's more than 50."

They were at a number: 40 to 50.

"I need to break here," Saldivar said.

"What do you want to do?" Currie asked.

"Take care of my stuff and turn myself in?"

"We can take care of your stuff, yeah. I've got help on the way."

Futia reached headquarters first. Then McKillop. He knew what to do: Call the chief. Call the captain. Get the brass in. That night.

Youngblood left without ever hooking up his machine. The questioning continued. "Did you have anything at your house, any mementos?" Currie asked. "A diary?'

"No. I try to forget."

Saldivar worried about his family. "I'm going to shame them," he said. Would they get stuck with a towing bill for his '87 Volvo, parked across the street? He worried about his room. Could he go clean it out? He had videotapes he didn't want his mom to see.

He worried about himself. "I'm going to be some guy's girlfriend," he said, thinking ahead to prison. "I just know it."

He wondered if he should have gotten a lawyer. He wondered what his 4-year-old nephew would think. " 'Efren--bad uncle.' Damn it."

Then he said, "I have a strict criteria. Not like those other ones--those other angels. My criteria was strict. They had to be unresponsive. . . ."

Would he mind talking on videotape?

"I've already said enough," he said. "I think that's enough to lock me away."

Efren Saldivar, 28, was placed under arrest at 11:25 p.m.

But not for long.

*****

THE NEXT MORNING, they searched his home. They discovered 101 pornographic videos, but no Pavulon or other killing drugs. Nor were there any in his hospital locker, though Currie did find the printout of a lung test. The patient was listed as "SALDIVAR, EFREN HEY YOU." The doctor was given as "KEVORKIAN, JACK."

It was provocative, but nothing you could hold him on.

Brian Kelberg told them so. Kelberg headed the medico-legal unit of the Los Angeles County district attorney's office. In the O.J. Simpson trial, he kept the coroner on the stand for eight days. "I am thorough," he explained.

He met with the cops March 13 and laid down the law: Just because a man said he killed someone, or lots of people, didn't make it so. They needed evidence. They had 48 hours from the time of the arrest to charge Saldivar or let him go.

Chief Siverling said there had to be "some way" to keep him in jail. What if he fled to Mexico?

"Have a nice trip," Kelberg replied and waved.

Currie prepared the 849B papers, "Release From Custody."

Saldivar was confused. He started sobbing as he was given back his wallet and small black flashlight. "Thank you," he said. "Thank you."

With that, the hard work began.

McKillop assembled a task force with Currie, Futia and four others. They needed a place close to hospital records and witnesses. So McKillop, the born operator, went into a meeting with Glendale Adventist officials and came out with a 1920s house across the street, hidden in a grove of fruit trees, with a fireplace in the living room and a barbecue terrace. Others called McKillop's hideaway "Club Adventist" or "Club Med."

That's where he brought in a series of experts to tell them what they were up against.

An LAPD psychologist produced lists of notorious serial killers, loaded with medical murderers, from Boston nurse Jane Toppan, who gave at least 31 patients poison cocktails in the 1800s, to the roving Dr. Michael Swango, then in the news, who relished the "close smell of indoor homicide." Another popped up every year, a Genene Jones killing up to 20 infants in Texas with an anticoagulant, or a Donald Harvey, pleading guilty to 37 patient murders in Ohio and Kentucky, and killing a neighbor too, with an arsenic-laced pie.

Compassion rarely was a motive. Some killed for money, others to look like heroes, trying to revive their victims. And their drugs rarely eased anyone into a merciful death. Take Pavulon. It kept patients from gagging when doctors inserted breathing tubes down their throats. It temporarily paralyzed them. Without the breathing tubes, they suffocated--conceivably while fully aware of their inability to move, breathe, even scream. All they could do was panic and die.

Another guest at "Club Med" was forensic scientist Henry Lee, the star defense witness at the Simpson trial. He said this was the easiest kind of serial killing to get away with. You had to figure out who the victims were long after they were buried. "You have to dig up [bodies]. You are going to have a difficult time finding true trace drug or elements in there. The next issue is how to link to the suspect. Why him? What's the proof?

"Prepare to fail."

*****

ON THE DAY Efren Saldivar was released, he was fired. Then a judge suspended his state RT's license.

The public still did not know he had confessed to killing up to 50 patients. Glendale Adventist wanted to announce it right away, but McKillop asked the hospital to hold off so his detectives could work out of the spotlight. In two weeks the news leaked, and Saldivar recanted.

First, his brother, Eddie, told reporters: "He knows this is going to blow over. . . . He's not an 'Angel of Death.' He's just an angel."

Then Saldivar himself appeared on two TV magazine shows. On one, the host said: "If his confession is true, Efren Saldivar has murdered more people than Jeffrey Dahmer, Ted Bundy or John Wayne Gacy."

But Saldivar said it wasn't true, that he had told the police what he did because "I wanted to die." People were making allegations, he was depressed, a detective claimed they had him cold. "I started to embellish. . . . I lied."

Days later, Saldivar phoned Glendale Adventist to apologize about what he had done to its reputation and to its other RTs. All had been suspended pending an internal investigation, and four were fired, apparently for not sharing their suspicions about him. He acknowledged telling the police that others had killed as well, but now said they "were clean."

Then he telephoned the task force to complain about Currie. "He's out to get me." He also wanted his property back, his videotapes. Did they think the porn would show him having sex with dead patients?

"I had over 100 porno movies, and they had nothing to do with this," he griped. "They think I'm a necrophiliac. Do you believe that?"

*****

THE DETECTIVES BEGAN with a number: 1,050.

That was how many patients had died while Saldivar was on duty, or within an hour of his shifts, during his nine years at Glendale Adventist.

The next number was 171. That was how many deaths were left after they decided to ignore his first seven years--figuring the more recent cases offered a better chance of finding traces of paralyzing drugs.

Then 117. That was how many remained after they eliminated the bodies that were cremated. If he'd killed those people, he'd gotten away with it.

That left a daunting challenge: picking which of the 117 to exhume and test. Doctors had declared that every one of those deaths was due to natural causes. McKillop and his detectives had to prove the doctors wrong. Otherwise, no case.

They'd hoped to get help, first from Saldivar himself. But during his confession, he had recalled no names or specific dates.

His co-workers also were of little help, even after limited grants of immunity--anything they said couldn't be used against them. Ursula Anderson was brought back time and again for questioning. She finally admitted seeing Saldivar in a hospital room with a syringe in his hand, the plunger back--and "I just hollered . . . 'Efren!' " But she said she did not know who the patient was, or whether the patient died.

The detectives hoped that some patients' family members might have a lead. More than 500 called police or hospital hotlines. But most had not been the least bit suspicious about their loved ones' deaths. Other callers stunned the cops: people who said that Saldivar had done the old folks a favor. One doctor said, "Let them rest in peace."

There were no shortcuts. The cops and medical consultants had to sift through more than 100,000 pages of records. It took them until March 12, 1999, one year and a day after Saldivar confessed.

The new number was 20. That was how many bodies the higher-ups decided were realistic to exhume.

It was guesswork of sorts. The death of Salbi Asatryan, 75, had inspired the "magic syringe" talk. A nurse recalled seeing Saldivar with Luina Schidlowski, 87, minutes before she died. And Eleanora Schlegel, 77, had fed herself the night before and was talking of going home after the Rose Bowl.

They and 17 others would be dug up.

*****

EXHUMATION DAYS BEGAN at 6 a.m. Groundskeepers erected tents for privacy at that day's cemetery and a lab worker took soil samples, in case a defense attorney tried to argue that chemicals found in the bodies had seeped in. By 7:45, a van was taking the casket to the coroner's office. Currie discovered rosemary by the entrance, and the detectives stuffed handfuls into their masks to counteract the stench inside.

There was a checklist of tissues to be removed: liver, bladder, thigh muscle, etc. Wearing smocks, booties and gloves, the detectives carried jars containing pieces of heart or brain. By 11:30 a.m., the bodies had been sewn up and put back into the caskets for reburial.

They began in April and examined the first four bodies in six days, then exhumed one a week through the summer of 1999.

McKillop and Currie personally took the first batch of samples to the lab--and not a local police lab, whose work defense lawyers would love to pick apart. For this case, they would make the 334-mile drive to Lawrence Livermore National Laboratory outside Oakland.

A highway patrolman spotted their unmarked car going 100 mph up Interstate 5. McKillop flashed his lights over the back seat, but the officer pulled them over anyway.

He walked to the passenger window, so Currie did some fast talking. "We got frozen body parts in the trunk. We've got to get them to the lab before they melt."

"Oh, really?"

Not really. The tissue had been preserved in jars and boxed. But who would check to see if pieces of a lung were frozen?

"You got any ID?"

Currie flashed his badge. The fellow thought about it.

"OK, then. See you later."

On every trip after that, they kept a dummy box on the back seat. It was empty, but if another cop stopped them for speeding, he'd see the big sticker: "CAUTION BIOHAZARD."

It could be a lark, an investigation like this. Except for the nightmares.

In McKillop's, he was in a morgue, and bodies were moving, getting up off their gurneys. Or one of his four sons was on a gurney, and McKillop was trying to stop the autopsy, but couldn't.

And that was not the only way he felt powerless.

*****

BRIAN ANDRESEN GAVE them the bad news upfront. The head of forensic science at Livermore did not think he could find even a trace of one of the drugs Saldivar may have used. Succinylcholine chloride--the drug glimpsed in his locker--broke down too quickly. If he killed with "Succs," investigators were sunk.

Andresen felt confident testing only for Pavulon, which left a distinct chemical fingerprint and had been detected in some cases years after burial.

But after six weeks of preliminary testing, there was no evidence of that drug either.

Then, finally, the "first unusual finding." The catch was that it was on tissue from Balbino Castro, 87, who had gotten Pavulon nine days before he died as part of his regular medical care. Any defense attorney might argue that this was why traces were in his system.

The brass began thinking of pulling the plug on the investigation, maybe if there were no clean "hits" after 10 exhumations. The lab work alone cost $150,000 to start, and Capt. Jerry Stolze, who supervised all detective units, had to dismantle his gang squad because of the manpower drain.

Even if they thought the guy did it, Stolze wondered, "When do I say, 'Enough is enough? We couldn't prove it. It's over.' "

McKillop quickly set up a conference call between Andresen and their bosses. McKillop asked the lab director, "In your opinion, should we continue with the testing, or should we cease it?"

"In my opinion," Andresen replied, "you should continue."

He revealed why on Aug. 21, when he came down to "Club Med" for a presentation. Exhumations were not finished, but he had "hits" on three patients: Castro, Asatryan and Schidlowski. He found Pavulon in their lungs, kidney, bladder, chest fluid, pericardial fluid, heart tissue, liver and brain.

In the weeks following, he reported three more hits: on Jose Alfaro, 82, a Filipino who had come to the United States to accept citizenship for soldiers who risked their lives for the Allies; on Eleanora Schlegel; then on Myrtle Brower, 84, a mentally retarded woman cared for by her family for decades.

Now the number was six.

*****

WHEN HE WAS first set free, Saldivar dyed his hair red and hid out for a while in the Woodland Hills apartment of some fellow respiratory therapists. But then he got on with his life. He went to work for Budget Rent a Car, cleaning and gassing cars. Evenings, he delivered pizza.

He held the Budget job for eight months, into the spring of 1999. Then he signed on as a customer service agent with TeleChat, a telephone dating service in Spanish and English. Customers could post voice-mail ads seeking "long-term relationships," "casual dating," etc. Saldivar chose the night shift, 6 p.m. until 2 a.m.

Co-workers loved him. If their computers weren't working, he fixed them. When pregnant Carmen Lozano needed a ride home, he waited two hours until she got off. When Lizbeth Bolanus won a TV as a bonus, he carted it to her house.

He asked Lizbeth to the movies. They shared their hopes, and she mentioned having children.

He did not want any, she recalled him saying. "He said, 'What if my sons are born, and what if something happens to me? What if I'm not all great as a father? . . . What if my children become criminals?' "

"I said, 'You haven't killed anyone.' ...

"He said, 'I don't want to bring them into the world.' "

Saldivar passed his 30th birthday at TeleChat and stayed through the end of 1999. Then he told his boss that he had omitted a detail about his past when applying for the job. A few civil suits had been filed by families of former patients at Glendale Adventist, and the name and photo of the suspected "Angel of Death" might surface again. "That was me," he said. "Now I'm going to leave."

The employees took a vote. They would take him back, if ever that were possible. A weeping Carmen Lozano phoned to tell him. "Efren, we miss you," she said. She assured him that he was still invited to her child's baptism in the spring of 2000.

The remarkable thing was, he would be free to make it.

*****

KELBERG WANTED THE cops to do a few more things.

The prosecutor tried to imagine how a defense attorney would attack their evidence. Those "hits," for instance: They already knew that one patient, Castro, had gotten Pavulon legitimately at Glendale Adventist. What if some of the other five had received the drug sometime in the past? Could that be why it was in their bodies?

Before long, the cops were chasing down years of medical files, going back to 1978 in one case.

To McKillop, it was like investigating a drunk driver and being asked to document every drink the man had had in his life. But he had faith in Kelberg, the purest soul he had ever met in law enforcement. Kelberg kept saying their job was not to win but to "find the truth."

Soon the Livermore lab was injecting Pavulon into pig tissue to determine how long it remained detectable.

By the summer of 2000, the delays were driving Capt. Stolze nuts. It was two years-plus since the confession. Saldivar was still on the loose, the police budget was paying for pig studies, and McKillop and his boys were barbecuing rib-eye steaks on the patio at "Club Med."

Whatever his detectives thought of Kelberg, Stolze was becoming fed up with their prosecutor's "thorough" approach. He very quietly sought the opinion of another. Deputy Dist. Atty. Al MacKenzie had helped Glendale win a murder conviction in an earlier medical case. His take on Saldivar: The man should be in prison. Today.

But MacKenzie was on the outs in the district attorney's office. He thought it had become way too cautious after its Simpson case fiasco. He was backing challenger Steve Cooley against incumbent Gil Garcetti in November. If MacKenzie's guy won, and they still hadn't arrested their "angel," Stolze knew where to find him.

That summer, McKillop began dreading trips to headquarters. It wasn't only Stolze asking, "When? When? When?" Other guys would spot him and say, "You still work here?" "Let's see your ID." "You still riding that gravy train?"

Occasionally, Glendale Adventist officials would drop by "Club Med." One time, McKillop thought they were suggesting that the public might not be so outraged if Saldivar's victims were old and arguably on their deathbeds.

That's when McKillop blew up.

He wasn't convinced that all of Saldivar's targets were so sick. One woman he was suspected of injecting, Jean Coyle, had survived and was still alive three years later.

And so what if some victims had been failing? "There are two stages of life when you're the most vulnerable--when you're an infant, and when you're elderly in the hospital," McKillop said. "In both, you're totally dependent on other people to take care of you. Are we going to trivialize their lives?"

By summer's end, Kelberg had another request. He wanted the charts of every patient in the hospital at the times their six had died. What if the defense found a chart showing Saldivar was treating someone at the far side of the hospital when he was supposedly killing elsewhere?

But every patient? Did he know how long that would take?

*****

SALDIVAR SPENT THAT summer of 2000 working as an electrician's apprentice.

Once again, his bosses trusted him. They gave him keys and the job of opening up a San Fernando Valley work site where Electra-Cal Contractors was helping to build an assisted-living condominium complex. He also found a protector, Edward Journet, 53, a journeyman electrician from Cajun country.

The hard hats might get on Saldivar because he was fat and hardly macho, but nobody picked on Journet. By his own account, he had spent 17 years on heroin and two years in prison, and had gone through four marriages. He was amazed by the apprentice's expensive new tools. Saldivar had more of them than most old pros. He was buying tools as if he were sure he'd be working as an electrician for 20 more years.

The two men grew closer as Saldivar went to Journet's home to install a new hard drive in his computer and play with Taco, his pet Chihuahua. When Saldivar confided who he was, Journet told him he had been stupid to confess if he didn't do it.

Saldivar wasn't worried. "They don't have any evidence," he said.

He didn't pay much attention in November 2000 when Steve Cooley was elected district attorney. How could he know what that might mean for him?

"What case?" Saldivar said dismissively when asked if his was still alive.

Near Christmas, he and his new friend took a trip to Tijuana to pick up some cheap medicine. Journet remembered Saldivar explaining, "You mix this and this together, you gonna get this kind of reaction."

The trip was largely to boost Journet's spirits. He had grown almost suicidal over a breakup with his girlfriend. "I told him, 'I don't feel like I can go on.' "

Saldivar reacted casually.

"He didn't try to talk me out of it or anything," Journet recalled. "He said, 'I'll help you.' "

*****

ON JAN. 9, 2001, Saldivar was up two hours before sunrise. The cops had risen earlier. They assembled at "Club Med" at 3 a.m. The brass all wanted in on the action, to be part of the caravan. Chief Siverling brought his camera. Their new prosecutor, Al MacKenzie, was a phone call away.

McKillop and Currie would stay behind and put on their suits. That's what you wore when you interrogated a suspect under arrest.

For three years, it had been a case of the night. That was when the victims died. That was when Saldivar first confessed. That was when McKillop dreamed of bodies coming alive.

Now, before sunup, Saldivar made a quick breakfast: oatmeal and coffee. The construction site was 13 miles away, and he had to be out the door by 5:30 so he could open up.

By the time he reached the 118 Freeway, then eased onto the Balboa Boulevard exit, a procession of unmarked cars was behind him.

McKillop and Currie got the news at 5:45 a.m. They took their time going to headquarters. They wanted Saldivar to undergo the full ritual: the drive in, hands cuffed behind him, the fingerprinting at the jail, the change into a blue paper jumpsuit. This wasn't like the last time, when he strolled in on his own.

At 6:42 a.m., Tony Futia led the suspect through the heavy brown door of another windowless cubicle.

"I'm very cooperative," Saldivar said. "I may be a big guy, but . . . hey, I'm a pushover."

"You gotta get to the gym," Futia said.

"Jim's Burgers, I think," Saldivar quipped.

McKillop stuck his head in and said, "Remember me?"

"Yep."

Currie was grim-faced.

"Hey, Efren."

"Hey, smiley."

Currie said, "Let me take your handcuffs off."

"You know how it works," McKillop said. "You have the right to remain silent."

"Yeah."

Saldivar asked, "Well, are we talking in private?"

The last time, there had been a mike in the thermostat. This time there was a camera hidden in a bookcase, in a three-ring binder. The two cops ignored the question.

"There's no point in jacking us around," Currie said. "Obviously, if we didn't have positive hits, you wouldn't be sitting here."

Saldivar asked, "How many counts?"

McKillop said, "How many do you think we have?"

"You don't have any."

"You're only kidding, right?" Currie asked.

"Yeah."

Currie took offense at Saldivar's public statements about the first confession being "false, coerced."

"What I said to you in here and what I said out there are two different things," Saldivar replied. "Go by what's in here. Everything out there was BS. That was for public relations--"

"OK, I understand."

"--to keep the hospital in a good position, for public morale."

McKillop asked, "Why aren't you concerned about yourself? You're worried about the hospital looking bad, but you're not looking too good."

"You don't understand self-destructive people."

McKillop said, "So we've established the ground--the deal here. We know people were injected with drugs that they weren't supposed to get. . . . What's your feeling? You know. Why? Are you sorry?"

It was out of the textbook--inviting the suspect to explain the "why," while hoping he might, in the process, admit serial murder.

Saldivar said, "So can I get my lawyer? He wanted to be here."

"These are your decisions to make," McKillop said.

The cops were walking in a legal minefield. The U.S. Supreme Court has ruled that when a suspect invokes his right to remain silent, "questioning must stop."

McKillop gave Saldivar incentive to continue. He asked, "Do you want to ask the next question?"

"Sure. . . . What's the number?"

Instead of answering, McKillop pulled out charts from the tests for Pavulon. "Every one of those indicates a positive, OK, for the drugs. It's just inundated throughout the body."

"Let's go back to '97," Currie said.

"OK."

"How many people do you think you personally--for lack of a better term--killed?"

"In '97, seriously slowed down," Saldivar said. " '97 was like a new leaf."

Saldivar was starting down a path of no return. He said, "The motivation is so flippant. I'm--I'm shameful to even say. . . ."

"How flippant can it be, Efren?"

"Oh, God, you can't believe how flippant. It was not for personal pleasure. It was not a rush. It was not--it wasn't any of your typical ideas."

"Well, what was it?" McKillop asked.

"Can we barter?"

"Like what? You want me to wash your car for you?"

"No. I want--I want to make my phone calls."

"Absolutely."

" 'Cause I want to call work. . . . People are out there standing. 'Where's Efren?' I've never missed a day."

"I understand."

"Now, as for my lawyer, it's not that I want him in here to stop you guys, but I want him to know that I'm in here."

"Is that what you were bartering with?"

"Yes."

They led him to a room with a phone, then stayed by the door, out of earshot. If he reached his lawyer, the message would be "Stop! NOW!" But it was early, when most people, lawyers included, were still at home, having their coffee.

Elsewhere at headquarters, other detectives were also on the phone, calling the 20 families that had been living with uncertainty since their loved ones' bodies were exhumed. The cops wanted to notify them of Saldivar's arrest before it hit the news.

Eleanora Schlegel's son, Larry, was in Chicago on a consulting job for the federal government. He had been with his mother two nights before her death, offering a New Year's Eve toast: "Hopefully, next year will be better." Now, his cell phone rang. Investigator Dan Hinojosa told him that Saldivar was being charged with six counts of murder. Hinojosa wanted to wait and tell him the rest in person.

"I said, 'Just tell me," recalled Schlegel. "He said that my mom was one of the six. Then I went back to the meeting."

In Glendale, when Saldivar was brought back to the cubicle, he was in a joking mood. He said into the thermostat, "Testing, testing."

He had not reached his lawyer. He was ready to talk about motive.

"It's not ethical or humane," he said. "I--I, in addition to others . . . had the role--responsibility--of staffing. We had too much work. We can't find nobody to come in."

"Just basically workload, too much work," McKillop said.

"It was not something that gave me joy," Saldivar said. "Only when I was only at my wits' end on the staffing, I'd look on the board. 'Who do we gotta get rid of?' "

It reminded McKillop how people clung to the belief that these "angels" killed to relieve suffering. A VA nurse in Massachusetts had just been convicted of murdering a patient so she could leave for a date. Saldivar might have talked of compassion in his first confession, but now it was about trimming his workload.

"What do you think was your highest year?" McKillop asked.

"It wasn't just at Glendale."

"What were the other hospitals?"

"Arcadia Methodist. Glendale Memorial."

In the first confession, he had spoken of letting patients die at other hospitals by not doing all he could to save them, "passive stuff." Now he was talking about killing with injections.

"Maybe two or three" at Arcadia Methodist, he said, where he moonlighted near the start of his career. "It has to be less than five."

He moonlighted at Glendale Memorial for three years.

"Over at Memorial, maybe 10."

McKillop asked for the "total in all the hospitals."

"I lost count after 60," Saldivar said. "And that was back in '94."

For so long, they had lived with the 40-some estimate in his earlier confession. Now he was saying the total was higher, much higher.

"I know it's over a hundred," he said.

Currie wanted to get more specific. How many more patients had he injected after he stopped counting at 60? Currie asked Saldivar to think backward from 1997, the year he had slowed down. "What about '96?"

"I don't know if it was 20, 30 or 40."

"OK, how about in '95?"

"Yeah. '95, same thing--30, 40."

" '94?"

Saldivar took off on a tangent. "It was a gradual thing... I did it without thinking. I don't know if you ever shoplifted a piece of gum or something. You don't plan it. After that moment, you don't think about it for the rest of the day, or ever."

They had spent months analyzing the records of patients who died during one of his nine years, 1997, groping to pick names off a big board in "Club Med," deciding which to exhume. Now McKillop believed there might have been an easier way.

"If we went into '96, '95, '94," he said, "you could have thrown a dart."

"Uh-huh," Saldivar said.

The rest was mopping up. Why had he slowed in '97?

In part because he was happy being around Ursula Anderson on those long night shifts. "I would be with her and I wasn't worried about the patients."

What about Coyle, the pesky woman who had gone Code Blue but survived?

"Oh, her. Yeah. I did try... I gave her, I think, a half dose... Something in me just held back."

He now said, yes, two other RTs did it also.

"I would be a lookout... I don't know if they stopped, if they held back, or if it was a rush for them, or it was an experiment... You only need to teach a person how to fish once... I didn't have to hold their hands after that."

McKillop started to tell him, "They said--"

"That they participated?" Saldivar asked.

To the contrary. The others admitted no wrongdoing, and his word alone would not get anyone prosecuted. All still held their licenses.

Saldivar too might still be a respiratory therapist somewhere had he kept his mouth shut.

After 2 1/2 hours, other detectives got their turns with him, bringing in charts from the cases they investigated. He could recall none of their dead. "It is a blur," he said. "Because I knew that it would haunt me. . . . I made a conscious effort not to remember. . . . I'm not denying anything."

He wanted to make sure they still had his tools, especially his cordless circular saw.

Futia asked him, "You done with your Coke there?"

"Yes."

"Come on, Efren."

*****

THEY WOULD NEVER know for sure why he did it. The last motive he offered--killing to ease his workload--appealed to their practiced cynicism as cops. But it was hard to ignore what he'd said years earlier, when he suggested that killing was his secret revenge on a world that saw him, all his life, as a "goody-goody." No one would call him that anymore.

McKillop figured they'd at least get to find out how many people their "angel" had killed. Saldivar's own account placed him near the top of any list of serial killers. McKillop was sure the brass would let the task force keep digging up bodies. His detectives had only checked the year Saldivar called his slowest, after all. They would have to go back to deaths in '96, then '95, and keep on going until they couldn't find Pavulon in any bodies. How else would they learn the truth?

How could he have been so wrong?

At news conferences after the arrest, Cooley and Chief Siverling said they saw no need for more exhumations, or for any investigation of earlier deaths, whether at Glendale Adventist or other hospitals. With the six "hits," they had enough evidence to put Saldivar away for life, if not get him executed.

There was no public outcry, no great demand to learn how many more lives he had taken.

There wasn't even a flood of lawsuits. Just a dozen or so. Glendale Adventist had begun offering settlements even before the arrest and a few families accepted, one getting $60,000. Others waited to see what the task force came up with, and were out of luck. A judge said they'd waited too long, past the statute of limitations. Business was up at Glendale Adventist--the hospital was filling more beds than it had before the world ever heard of Efren Saldivar.

One by one, McKillop's men were sent back to routine assignments. They had a barbecue at "Club Med" when Futia returned to robbery-homicide. Currie began bringing in his sheep dog for company while he assembled the files for trial. Soon even he began helping out at headquarters, called in when robbers got $400 from a Taco Bell. Currie didn't object--he welcomed a case where there was no doubt a crime had been committed and where you got the bad guys in two days.

McKillop's old job was taken. There was talk of him filling an opening in the substation at the Glendale Galleria. He might have become sergeant of the shopping mall had rain not intervened. It seeped into the basement of "Club Med," soaking boxes of records. As McKillop helped carry them upstairs, he yelped, "My back!"

It was crazy--jock around all your life, then hurt your back pushing paper. Disability retirement wasn't a bad deal for a 40-year-old, though. Half pay for life, tax free. Maybe "friend of chief" cases weren't all bad.

McKillop was at home when Saldivar, now 32, pleaded guilty last month, four years and a day after his first confession. The cops had been expecting him to contest everything: the validity of the confessions, the lab tests, the circumstantial evidence linking him to the six patients. But he didn't, deciding that the best he could do was save his own life. Though he would never get out of prison, the plea bargain spared him execution with the same drug he had used to kill others.

McKillop bounced from room to room, watching the news on four TVs. He couldn't help but notice how Saldivar's plea drew less attention than the dog-mauling murder trial at the same L.A. courthouse.

He wondered whether it was because the public did not know, even then, of the chilling second confession, in which Saldivar gave his 100-plus body count and compared killing to shoplifting gum. It had been sealed by a judge on grounds that it might prejudice jurors, and was not unsealed until this month, when the case was over.

Or maybe it was because people didn't want to think of themselves in the position of Saldivar's victims, old and ailing and alone in a hospital bed. It was much easier to trust the strangers who roamed the floors than to think that you might be at their mercy, especially at night.

Or maybe it was because Saldivar gave up so quietly. He bowed his head at his sentencing two weeks ago and asked forgiveness, "though I don't expect any," he said. His lawyer said he wished to "make peace with God."

The self-described "Angel of Death" already had made peace with prison.

Saldivar wrote Ed Journet, his friend from the construction job, that he was managing well behind bars, though he had one complaint, "the rats." They came out at night.

But the guards treated him well, and the other inmates did too.

"He's comfortable. It's relaxed," said his brother, Eddie. "When it comes to the pecking order, he's now reached the top."

*****

ABOUT THIS SERIES

This series is based on interviews with more than 100 people, including police investigators, people who knew or worked with Efren Saldivar and relatives of his victims. The Times also reviewed more than 2,000 pages of court and investigative records, including witness statements, police search warrants and grand jury proceedings. The quotations in the story are drawn from Times interviews or from transcripts of police questioning of Saldivar and other personnel from Glendale Adventist Medical Center. Staff writer Richard Fausset assisted with the reporting.

(EXCERPTS OF POLICE INTERVIEWS WITH EFREN SALDIVAR)

Efren Salvidar

A former respiratory care practitioner at a Glendale hospital Efren Saldivar confessed to killing 40 to 50 patients over a eight-year period. A suspected "Angel of Death," he allegedly targeted patients who were already near death.

He would kill them with lethal injections of the muscle relaxants Pavulon or succinylcholine chloride, and/or decreasing their oxygen intake if they were on ventilators.

The hospital first heard rumors about hastened patient deaths in April 1997. Although the two-month internal investigation revealed nothing suspicious, a criminal investigation was launched after police received an anonymous phone call on March 3 from a person saying Saldivar "helped a patient die fast."

Saldivar told police he might have contributed to "anywhere from 100 to 200" deaths during his 9-year career as a hospital worker and had actively killed up to 50 patients by giving drugs or withholding treatment.

In an affidavit, Officer William Currie, who interviewed Saldivar, said: "He talked about his anger at seeing patients kept alive as opposed to the guilt he would feel at the failure to provide life-saving care." He said that a polygraph examiner asked Saldivar if he considered himself an "angel of death" and Saldivar replied: "Yes."

Efren then went on the ABC-TV news magazine "20/20" were he recanted everything, saying he had lied because he was depressed, suicidal and wanted to be sent to death row. "I wanted the system to do to me what I couldn't do," that is, commit suicide. "I was looking to die, I wanted to die ... but I didn't have the courage."

Investigators reviewed the deaths of 171 patients who died while Saldivar was working at the hospital. Fifty-four cases were eliminated because bodies had been cremated. Of the remainder, 20 deaths were determined to have been suspicious and the bodies were exhumed. Toxicological tests revealed the presence of the drug Pavulon in the remains of the six patients ages 75 to 87. On January 10, 2001, police rearrested Saldivar and charged him with the deaths of six hospital patients.

On March 12, 2002, Saldivar, after striking a deal with prosecutors to avoid the death penalty, pleaded guilty to murdering six elderly patients and was sentenced to seven consecutive life sentences without the possibility of parole. "It still seems so unreal," said Larry Schlegel, whose 77-year-old mother, Eleanora, was found dead in her hospital bed in 1997. "It's just that whole thing that it can never happen to you."

Seven lawsuits have been filed against the hospital. Four have been dismissed. The family of Salbi Asatryan, one of the victims, accepted a $60,000 settlement. Another family, that of Jose Alfaro, also settled for an undisclosed amount.

Efren Saldivar: Hospital Executioner

by Katherine Ramsland

Dark Rumors

Hospitals are supposed to be places of healing, but they also can attract people who like to play God and decide when someone else should die. Those people may act out of a need for power or excitement, but many claim they do it from compassion. They just believe that certain patients would be better off dead.

It's not clear when the suspicious deaths began in the Glendale Adventist Medical Center near the Ventura Freeway in southern California. Elderly people die every day of natural causes. It doesn't take much to push them over the edge. If they're poor or have few relatives around to remark on it, they may die without anyone noticing that something was amiss.

Reporter Paul Lieberman for The Los Angeles Times describes the respiratory failure of a 75 year-old woman in 1996. Her name was Salbi Asatryan and she was an Armenian immigrant. She was taken to the hospital on December 27 for extreme difficulty with breathing, so she went right into critical care, accompanied by her worried daughters, and was stabilized. Several respiratory therapists worked with her and felt sure that she would pull through and improve. They expected her to be able to leave the hospital and go home. She was even breathing on her own and feeding herself. That's why everyone was surprised when three days after she'd begun to look better, she was found dead in her bed.

Well, not everyone. There was talk around the hospital about the night shift and the "magic syringe." A few workers had their suspicions. When staff members are alone with patients and no one else is around, they're free to do as they please. Presumably they're trustworthy and want only the best for those in their care. However, not everyone interprets that relationship in the same way and not everyone feels a nurturing connection to his patients. Efren Saldivar became a hospital therapist, Lieberman points out, because he "liked the uniform." That's not much of a reason to go into healthcare.

The Development of a Psychopath

Saldivar was born in Brownsville, Texas, on September 30, 1969. Apparently his mother, who lived in Mexico, wanted her children to be U.S. citizens, so she went into Texas to give birth. It's not unknown and every border state faces the dilemma of treating nonresidents who come in seeking better medical care than they can get in Mexico. It's not illegal, but it drains American resources. Before he even had any awareness, Saldivar had a role model in his mother of exploiting others for her own gain and of acting with little regard for medical protocol.

His father, Alfredo, then moved his wife and two sons to Los Angeles in search of a job as a handyman. Efren's mother, Isaura, worked as a seamstress. She was a Jehovah's Witness and she raised her children to learn the faith and to spread it to others. They could get to heaven, they were told, only by piling up brownie points through their good deeds.

Efren applied himself in school but worked below his abilities. Teachers liked him because he had an extroverted personality. Then he began to observe the kids in gangs. They looked so cool and full of a form of personal power that he himself never felt. He desperately wanted to be a member. They were in high school and he was in junior high, so that was out of the question. Then to his disappointment, he got to high school, but all those cool dudes were gone. In fact, he didn't really fit in with anyone, not the jocks and not the scholars. He played in the band, and at 170 pounds, he was large and awkward, conspicuous in ways that he disliked.

Girls didn't seem attracted to him, at least not the ones he wanted, but he would become obsessed with them anyway. He'd risk ridicule by sending them intimate notes. Despite being outgoing, he had a shy side, so rejection was painful. He remained fairly withdrawn and stayed close to his family.

Saldivar had no life goals to speak of. He might go to college or enlist in the military. His plans were vague, with no real sense of direction. He didn't want to start a business or work for himself and he did not want to work around other people. As soon as he did get a job, which was in a supermarket, he acted irresponsibly. It was just a menial job with no future, but he'd steal things from the store for other guys.

In the meantime he was not keeping up with his grades and he ended up flunking out in his senior year, so he did not graduate in 1987 with his class. He stayed at the supermarket and decided to just do that. It was good enough.

Then he saw a friend in a uniform who was enrolled in the College of Medical and Dental Careers in North Hollywood. He wanted to look as good as his friend did. He had no particular medical aspirations but that kind of employment seemed better than working all his life at a grocery store. He took a high school equivalency test to finish his degree and then enrolled in the technical school himself in 1988. In less than a year, he had his certification, and a job waiting for him close to home. He was 19, uniformed, and ready to enter the working world. He had no interest in work as a caregiver. He saw himself as a technician. Eventually he hoped to work on the night shift when there would be less people around.

Part of his job was to learn to use a stethoscope and to put needles into arteries. He had to determine if patients were having difficulty breathing and if there was enough oxygen in their blood. His job also included respiratory rehabilitation and putting tubes down patients' throats when they couldn't breathe well on their own, especially during a Code Blue emergency. He placed people on ventilators that had to be monitored and adjusted. He had a lot of responsibility. Saldivar also did his homework. He knew a lot about drugs and computers, and he had a reputation for being able to talk with doctors about these things.

He quickly developed a real knack for the work, partly because he enjoyed talking with patients as they waited for some medication to activate and help them breathe better. They would tell him all about themselves and thank him for his help. Eventually he went on the "graveyard shift" at night. Just as he'd hoped, he ended up working pretty much on his own, without supervision or much accountability. During that time, there was only one other technician like him in the hospital. Their patients were scattered so they might work all night and rarely see each other. The work wasn't difficult, emergencies were few, and Saldivar was even able to offer his services part-time to other area facilities. It's likely now that they regret hiring him, but they were short-staffed and he had said he was working overtime to help pay expenses for his family.

To all who knew him, he seemed like a competent, responsible guy who was a bit awkward with women but always willing to do a favor. He even still lived with his parents and he had bought his mother a car. It was difficult for many to see how his perspective was becoming warped. For a while he took Zoloft to ease a longstanding depression, but then he stopped. That may have been a mistake.

One at a Time

Nurses and respiratory therapists on the night shift could go in and out of patients' rooms without anyone seeing them, since during those quiet hours from 11 p.m. to 7 a.m. the halls were usually empty. Besides that, people doing their medical routines would hardly come to anyone's attention. After a while, it all becomes a blur and each person takes for granted that everyone else is doing his job---and nothing more.

Yet some patients would be awake at night and needing attention—even demanding it. A few were lonely and wanted some company, but some were chronic complainers and wanted a treatment any time, day or night. It was like they were in a resort hotel with staff at their beck and call, and not all of the hospital staff appreciated that. Especially when such patients showed up in the hospital time and time again.

One of these was a woman named Jean Coyle. On February 26, 1997, she pressed her button to get some help and Saldivar responded---again. He went in and as Coyle recalled the incident in the Los Angeles Times, she blacked out. She did not know how it happened, but she came to and didn't give it another thought. Not until she heard about what was going on in that hospital. Then she viewed her experience in a different light.

In April that same year, one of the other respiratory therapists, Bob Baker, suggested to his boss that Saldivar was doing things to patients at night, injecting them with something. It isn't unusual in hospitals that people spread rumors about others, especially when patients are dying in ways that seem inexplicable. Yet there had to be proof. Without that, no one would be suspended or fired.

At that time, John Bechthold was head of the department and he did not like Saldivar. Neither did the therapist who had squealed. The easy thing would be to turn him in, but since their personality clashes were known, it might look like he was undermining a guy just because he didn't like him. Bechthold needed more than innuendo, so he told another supervisor what he had heard and together they beefed up their vigilance.

Often when a health care worker is viewed as an "angel of death," or a medical professional who kills patients, a pattern begins to show up on that person's shift. Genene Jones, working on the children's ICU in a Texas hospital, had a high incidence of respiratory arrests among children over whom she had watch and who had entered the hospital without heart problems. It turned out that she had been injecting them with drugs like succinylcholine chloride, a muscle relaxant that suppressed breathing and could paralyze a person, because she enjoyed the excitement of an emergency. She also acted strangely around dead babies, yet the hospital administration did only a lax investigation. Then she moved on to a one-doctor clinic, and the constant cardiac arrests and seizures finally brought attention to the problem, but only after one child died. She was convicted of murder and no one knows how many other babies she had killed.

In Saldivar's case, the records on his shift indicated nothing unusual. If he was doing something to patients, he was being careful.

However, to those who worked closely with him, his shifts appeared to be jinxed. They would talk about patients who needed to die, and then that person died. Sometimes several people died in one night. Occasionally the other therapists joked that Efren had the magic touch. What he had was the "magic syringe." But eventually he got careless.

Discoveries

As a practical joke, a couple of the other respiratory therapists decided to put someone else's clothing in Saldivar's locker, so on his night off, they pried it open. Someone noticed a bag and when the contents were examined, the bag proved to contain some very potent drugs, including morphine, succinylcholine chloride, and Pavulon, a drug used to stop the breathing rhythms of patients who were going onto a respirator. On a shelf inside the locker were also some empty syringes. No respiratory therapist was allowed to handle these drugs and now they had real evidence to support their suspicions.

Yet because they had discovered this stash by breaking into the locker, they remained mute on the subject. They'd reported on Saldivar the year before and nothing had happened. Chances were good that they would get into trouble, not him. Still, they now knew that it was true that Saldivar had a magic syringe.

Then one of the therapists, a female named Ursula Anderson, happened to mention Saldivar's after-dark activities to a man in a bar. His name was Grant Brossus, and he saw an opportunity to make some money. He thought it might be worth something to the hospital to have this information to keep it out of the hands of the police. Lieberman indicates that Brossus was estimating that he might be paid somewhere in the neighborhood of $50,000.

So in February of 1998, he called Glendale Adventist Medical Center. He didn't even have a name to offer in this tip, but when they went down the list of almost forty therapists who worked there, he recalled something that sounded like Saldivar's name.

Since this tip had come from a source unrelated to the first one—just someone named "Grant"--the hospital administrators were alarmed. They felt it was time to hand the case over to the Glendale Police Department, but they also continued to conduct their own investigation. During that time, two more patients died on the Respiratory Unit.

The investigator who took the case was Sergeant John McKillop in robbery-homicide. He met with the three administrators and they told him about the previous tip the year before. They also provided the pager number of the caller who had left the most recent tip, so McKillop tracked him down. Then he contacted his former partner, a top detective in Glendale named Will Currie. They also brought aboard Tony Futia, who ran the background check on Brossus. The guy turned out to have a lengthy record, which could make his so-called tip a bit suspicious. He'd done time and had participated in a range of crimes from cocaine to grand theft. Yet they still had to follow it up. If it was a good tip, they could stop a killer and save people's lives.

The Investigation

When confronted by police, Brossus had suddenly decided that he didn't really know much and he wasn't at all sure of the information he'd been given. It appeared to the investigators that he just didn't want to have anything to do with cops. His call had been to the hospital in an effort to be paid off for keeping quiet, and he wanted no part of a formal investigation. Given his 15 years of run-ins with the police, they could see why, but they still needed reliable information in order to move forward.

Hospital administrators went through their lists and offered the possibility that Ursula Anderson had initially mentioned what Saldivar was doing. The investigators questioned her and she insisted that she'd said no such thing. Mr. Brossus had obviously made it up.

Another dead-end.

Yet to their credit, the investigators didn't give up. If someone was killing patients who had entrusted themselves to the care of this hospital, they were going to find out who it was. The year before, Bob Baker had mentioned the "magic syringe." Perhaps he knew something more. In fact, he did. He knew about the vials of muscle relaxant found in Saldivar's locker.

That observation sent Currie and crew to an expert, the director of the respiratory therapist unit, John Bechthold, who informed them about some of the rivalries in the unit—notably Baker and Saldivar. Baker could have made up his accusations to get Saldivar fired. That possibility had to be considered, which presented the investigators with a whole new problem. Bechthold mentioned that when Baker had first told them about Saldivar's late-night activities, they had run their own investigation but found no substantive proof. In light of the hostility between the two men, they had dropped it.

McKillop was disappointed. He reported what he knew—and what he didn't know—back to his chief. They decided to approach Saldivar himself to see what he would say. The hospital had shifted some schedules to keep him away for several days, so he was available on the afternoon that Will Currie invited him to come down to the station. If he was a killer, they hoped for a reaction but no one expected quite the one they got, or what would happen next.

Saldivar was introduced to a polygraph examiner, who asked him if he understood why he had been asked to come in. He responded that he expected to get his name cleared. He was confused about why he had not been back to work and he'd heard that some anonymous caller had fingered him as a killer. He wanted to talk so that people would know he was innocent.

The investigators asked him if he had ever done anything like what he was accused of doing. At first he denied it but then quickly admitted that he'd been injecting people since he'd started to work at Glendale. The first case occurred when he was 19 and fresh out of school.

He had been assigned an elderly female patient, he said, who was on a life-support system. She had a terminal case of cancer and there was no hope for her. In fact, she was almost over the edge. The doctors would soon turn off her machines and the family had already taken their leave. After everyone was gone, Saldivar looked in on the woman and saw that, although she was unconscious, she was still breathing. He felt sorry for her. Out of mercy, he claimed, he connected two tubes, effectively suffocating her.

Then he admitted that years later he'd injected Pavulon into one patient by shooting it through the IV tube. He'd found a discarded bottle of the stuff and had kept it.

Immediately, he was read his rights, but then he continued to talk freely. Lieberman indicated that Saldivar talked for two hours.

He said that his first lethal injection occurred in 1997. He'd only done that twice. Or that's what he said at first. Currie mentioned that he'd probably do some investigating on his own and Saldivar blurted out that he wasn't alone in this; there were others, too. They would sometimes go from room to room injecting people who shouldn't have to live any longer. He said he did it because he felt sorry for them.

Currie asked if this involved more than 500 patients and Saldivar assured him it was less than 50. He thought just over 40. So now within moments, he's climbed from two to 40-something. Possibly 50. He had been convinced they were "ready to die."

To a BBC reporter later, Currie said that Saldivar's criteria for murder were that the patient had a "do not resuscitate" order, he or she was "ready" and he or she was unconscious. "He prided himself on having a very ethical criteria as to how he picked victims."

Saldivar may have injected both succinylcholine chloride and Pavulon, which are difficult to detect in human body tissue at autopsies and would not show up unless a specific test was done. That meant finding the illegal drugs in his possession and possibly even exhuming bodies.

That evening, he was placed under arrest.

The next day the police searched his home and found plenty of pornography but no incriminating drugs. That was bad news for the investigators. Since a person cannot be held on what they say alone, no matter how much they confess or how brutal the crime, Saldivar was released after 48 hours to await the results of a more thorough investigation.

Based on this shocking information, however, Efren Saldivar was terminated on March 13, 1998, and just to be safe, the hospital suspended 37 other people in the respiratory department.

Then he recanted his confession and said he hadn't really killed anyone. He'd had a mental disorder along with depression, and had been pressured to confess. He'd just made it all up.

Now without his confession, the physical evidence would be important. McKillop formed a task force of six investigators and rented a house near the hospital for a command post. Then they consulted some experts on this phenomenon of "Angels of Death." Some do it out of mercy, they learned, some for profit, some to look like heroes when they revive the patient, and some from a pure sadistic delight in playing God. One doctor, Michael Swango, had gone from hospital to hospital, killing just to kill.

Despite what Saldivar said, the detectives learned that making someone die by using Pavulon was hardly merciful. Derived from an African drug, Curare, the patient went into a conscious paralysis and felt every minute of the death-by-suffocation process. It was no easy experience and they couldn't even scream for someone's attention. Their throat closed up and they had to lie there helpless until it was over.

Understanding all this made them realize that they had an enormous job ahead of them. They had numerous records to sort through, because over 1,000 patients had died at some point on Saldivar's shift during the eight years he had worked at the hospital. They couldn't very well exhume all of these people, so they began to narrow down the list to recent cases, specifically those deaths that appeared to be the most mysterious (the patient had seemed okay) and where the body was still available (not cremated). It took them a year at the command post to finally settle on twenty.

"Who Do We Have to Get rid Of?"

To put Saldivar in jail for life, they only needed a few obvious murders. One by one, throughout the summer months of 1999, the investigators brought potential victims up out of the ground. The pathologists examined them and took tissue samples from the livers, bladders, and muscles and the toxicology lab then went to work. Brian Andreson, at the Lawrence Livermore Forensic Science Center in Oakland, California, demonstrated a new scientific protocol for the proper procedure to retrieve and preserve the biological evidence. He concentrated on Pavulon, because succinylcholine chloride breaks down into elements natural to the human body and because the test recently discovered for its detection in Sweden was expensive. Pavulon was a synthetic muscle relaxant sometimes given in low doses to patients on respirators, and it could remain detectable in the body for years. In order to prove that a homicide had taken place, Andreson and his team looked for dosage levels out of the normal range.

At first, they reported only negative results, which disappointed the task force. They hoped they had not just spent a year and a half of their time for nothing. Then Andreson got some hits. First there were three, and then after the 20 exhumations were complete, he found six that gave positive results.

In January 2001, criminal charges were prepared. The officers followed Saldivar, now 31, to work one morning on his way to a construction job and then arrested him for the murder of six patients—all of them elderly and one of them a retarded woman. He was booked and reminded of his rights. He began to talk once more, but this time he said that he'd been understaffed on some shifts, so to ease the workload, he'd eliminated a few patients. As Lieberman describes it, when he was at his wit's end, he would look at the board and decide, "Who do we have to get rid of?"

He admitted that he'd killed patients at other hospitals, too, where he'd worked part-time. He had mentioned this before but had not admitted to actually giving injections. After 60 victims, he'd lost count. He figured it was more than 100. It had just been a gradual thing, an act that had bothered him a little at first but then he'd grown used to it and let it all slip from his mind. "You don't plan it," he said to the investigators. "After that, you don't think about it for the rest of the day, or ever."

Between this confession and the evidence, it was enough to go to court. Lead prosecutor prepared the case, finding a star witness in Jean Coyle, the complaining patient whom Saldivar had attempted and failed to kill. Thus, along with the six murder charges was an attempted murder charge, too. Ursula Anderson, the female respiratory therapist who knew what Saldivar was doing, got immunity in exchange for her agreement to testify that she had given Saldivar the Pavulon and knew what he was doing with it.

Around this time, three full years after the murders first came to light, the Glendale Adventist Medical Center put out a statement in a press conference. They apologized to the families and assured them that they were helping the police, who had already expended thousands of man-hours, with the investigation. They were disheartened by the way someone would so shockingly abuse a position of trust, especially one to which people were so vulnerable. The hospital spokesperson said that they had no idea how Saldivar obtained the drugs that he used, but as a result of this case they had tightened their own controls and procedures.

Hereafter, they would institute a "mortality analysis," in which a single physician would review all records after a death, thus making it possible to spot suspicious trends and patterns. The data would be set in columns for easier visibility.

They would have greater controls over the types of drugs that could be used to induce death.

The respiratory therapists would now be subject to the orders of a physician for the use of a ventilator. In addition, there would be computer surveillance of all ventilator settings, so that changes made would be recorded on a printed report.

Any medications not used during a Code Blue resuscitation would be secured at the conclusion of the incident.

The hospital offered settlements and a few families accepted.

In March 2002, Saldivar pleaded guilty to six counts of murder in exchange for life imprisonment rather than the death penalty—although the prosecutor had never intended to go for the ultimate sanction. Saldivar contested nothing about the investigation and accepted his sentence, which was formally meted out on April 17. Judge Lance Ito, who had presided over the O.J. Simpson criminal trial during the mid-1990s, gave Saldivar six consecutive life sentences and fifteen more years for attempted murder.

Saldivar did offer an apology to the families. "I know there is nothing I can say," he mumbled, "that can sooth their anger or bring relief to their anxiety. I want to say that I'm truly sorry and I ask for forgiveness although I don't expect any."

Had he been executed, Lieberman points out, he'd have been given the same drug as the one he'd used on his patients.

In May 2002, the California Department of Consumer Affairs Respiratory Care Board petitioned a judge to suspend the license of Ursula Anderson. She had aided and abetted a criminal and had acted unprofessionally and with extreme neglect. Three other therapists who worked with Saldivar were put under investigation as well.

Right away there was film interest in this story. Disney-based Spyglass partners Roger Birnbaum and Gary Barber bought the rights for a feature-length film, which plays the cold and cunning "angel" against the shrewd but fatigued Detective McKillop. A script is written and production is scheduled for the summer of 2002.

Bibliography

"Angel of Death Euthanasia Toll May Never be Known," Reuters, March 14, 2002.

"California man Arrested After Multiple Euthanasia Killings," www.prolifeinfo.org, January 9, 2000.

Fleming, Michael. "Dark Angel Takes Wing in Hollywood," Sympatico.ca Movie news. April 30, 2002.

"LA Angel of Death Sentenced to Life," Washington Post, Thursday April 18, 2002.

"Lab Forensic Work aid in Angel of Death," www.llnl.gov, April 2001.

Lieberman, Paul. "Angel of Death Compares Overdose Killings to Shoplifting Gum," The Morning Call, Allentown, PA, April 28, 2002.

"Corpses, Clues and Confession Sank Angel of Death," The Morning Call, May 5, 2002.

"Nurse says He Killed Fifty Patients," BBC News, March 28, 1998.

"Respiratory care Board Requests Licenses Suspension for Practitioner Linked to Angel of Death Case," www.dca.ca.gov, May 31, 2002.

"Salvidar Sentenced to Six Consecutive Sentences of Life without Parole," District Attorney County of Los Angeles Media Relations News Release, March 2002.

"Statement Regarding Arrest of Former Employee," by Mark Newmyer, Glendale Adventist Medical center, January 10, 2002.

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