Efren Saldivar pleaded guilty in a Los Angeles courtroom on March 12, 2002, to murdering six elderly patients and to trying to kill a seventh. The patients had been in Glendale Adventist Medical Center, in Glendale, California, in 1996 and 1997, when he was a respiratory care therapist there on the night shift. He was 32. Under an agreement with the Los Angeles County District Attorney's Office he admitted the two special circumstances that could have led to a death sentence, multiple murder and murder by poison, and the prosecution gave up any attempt to have him executed. On April 17, 2002, Judge Lance Ito sentenced him to six life terms, plus 15 years to life for the attempted murder.
The case had begun four years earlier with a confession and nothing else. In March 1998 Saldivar told Glendale police that he had caused the deaths of 40 to 50 patients since 1989. He was held for two days and released, because there was no evidence that any crime had happened. He then took back what he had said, telling a television audience that he had lied because he was depressed and wanted the state to kill him. Proof came only after a police task force reviewed the deaths on his shifts, the Los Angeles County coroner exhumed 20 patients, and a chemist at Lawrence Livermore National Laboratory found the drug Pavulon in the remains of six of them.
How many patients Saldivar harmed has never been settled. He gave police different numbers at different times, and the deputy district attorney who prosecuted him said the true total would probably never be known. The courts dealt with seven patients.
Saldivar grew up in the Tujunga area. In 1998 CBS News reported that he lived in the Tujunga area with his mother and sister. He went to Verdugo Hills High School. A former classmate told CBS that he had been an average student, active in student government and somewhat awkward. "He was a nice guy, a little goofy," the classmate said, describing him as harmless, and he wondered aloud whether Saldivar had made up his confession to get attention.
The brother of one of his co-workers, a woman who was a good friend of his, gave the Associated Press a similar picture in 1998. "He was pretty nice," he said. "He seemed normal."
A 2022 history column in the Crescenta Valley Weekly, a local weekly newspaper, said that after high school Saldivar went to a technical school to train in respiratory therapy, in part because he liked wearing a uniform and having technical responsibilities. The column described him as competent at the work and as someone who enjoyed dealing with patients.
As a respiratory care therapist, the Associated Press explained in 1998, Saldivar was authorized to give patients medication for breathing problems. Saldivar joined Glendale Adventist Medical Center in 1989, according to the account he gave police, and by 1998 he had worked there about nine years. CBS News, reporting for 60 Minutes II in 2003, said he had a good reputation. The Crescenta Valley Weekly column said he worked the graveyard shift from 1989, when the hospital was quiet and he was largely unsupervised.
Many patients died during his shifts, the column said, but no alarm was raised because they were already close to death. Over the years, some of his co-workers began to talk. One respiratory therapist later told police that a colleague had said, more than a year before the investigation, that Saldivar had a "magic syringe." According to the 1998 police declaration described by the Associated Press, that therapist had already been surprised by the death of a patient in Saldivar's care before the remark was made. The Crescenta Valley Weekly column said staff joked that he had the "magic touch," and that in the spring of 1997 a fellow therapist raised his suspicions with a supervisor, though there was no proof and the two men were known not to get along.
Some months before the police became involved, the same therapist who had heard the "magic syringe" remark looked into Saldivar's locker at the hospital. He told police he saw several vials of morphine and two vials of a paralyzing drug there. He had not reported it, he said, because he had been in the locker without permission while playing a prank on Saldivar. The Crescenta Valley Weekly column, written more than 20 years later, gives a fuller version: staff on the graveyard shift pried the locker open intending a prank, found syringes and vials of medication that he was not supposed to keep there, and kept quiet for fear of getting into trouble.
On March 3, 1998, Glendale police received an anonymous call. The caller said that on or about February 16, Saldivar had "helped a patient die fast," according to a declaration by Glendale police Officer William Currie that the Associated Press quoted. Currie and two colleagues opened a criminal investigation. The Crescenta Valley Weekly column said that the tip first reached the hospital, which called the police, and that detectives traced it to a man who had heard the locker story in a bar from one of the staff members; the man denied making the call. Hospital spokesman Mark Newmyer said the hospital had reported the matter to police at once.
Detective Will Currie and his partner, Detective John McKillop, told 60 Minutes II in 2003 that they had expected to clear Saldivar, who was one of many hospital employees they planned to interview. On March 11, 1998, Saldivar came to the police station at Currie's request. When Currie raised the idea of a polygraph test, Saldivar said he did not want to take one. He was worried it would be "inconclusive," according to the declaration; 60 Minutes II reported that he said he "would fail it."
He then began to describe things that worried him. He said he had been responsible for a patient's death at the hospital in 1989, early in his time there, and that there had been other times when he had "failed to act" and patients had died. He agreed to the polygraph. With Currie listening from outside the room, he told the examiner the same things, and then described an incident in August 1997 in which, he said, he had given a patient a paralyzing drug and the patient had died. The examiner asked whether he considered himself an "angel of death." He said yes.
Currie went into the room and read Saldivar his rights. Saldivar waived them and went on talking. According to the declaration, he said he had caused between 40 and 50 deaths at the hospital since he began working there in 1989. He said he had used two paralyzing drugs and other means. He said he chose patients who were unconscious, who had do-not-resuscitate orders and who looked ready to die, and he spoke of being proud of what he called his "very ethical criteria." He said he did not begin giving drugs until about three years after he joined the hospital, and that he had taken the idea from a television news report about a therapist in Chicago. He said other therapists sometimes gave him the room numbers of patients they thought should die. He said he stopped in August 1997, after a co-worker saw drugs he was keeping in his locker.
Currie's declaration quoted him as torn between anger at seeing patients kept alive and guilt at failing to give them life-saving care. The Crescenta Valley Weekly column said he talked for about two hours after he was read his rights, and that the number he gave rose as he spoke, from three to 40 and then to 50.
The confession was all the police had. A search found nothing, according to the Crescenta Valley Weekly column, and the patients he described had been buried or cremated. Saldivar was held for 48 hours and released for lack of evidence; Glendale police Sergeant Rick Young said he was never booked. An ABC News report in 2001 put his time in custody at three days.
The news broke at the end of March 1998. On Friday, March 27, the state Respiratory Care Board suspended his license to practice. The board's executive officer, Cathleen A. McCoy, confirmed that he had confessed. The hospital said it had fired him and placed its whole respiratory care staff, about 40 people, on paid leave while it investigated. "This has been an all out search for the truth for this hospital," Newmyer said. The district attorney's office, which had known about the case for weeks, said more investigation was needed before any charge could be filed.
Four days later, CBS News reported that Saldivar faced a hearing before an administrative law judge, not a criminal court, on whether his license should be suspended indefinitely or revoked, which would keep him from working in any California hospital. CBS said police had singled out three other respiratory therapists, who would not be returning to work for some time, and that sources close to the case said those therapists were being investigated for possible involvement. No charge against any other therapist was reported. By January 2001 his license had been revoked, according to Lawrence Livermore National Laboratory.
Sergeant Young told CBS that calls were coming in from across the United States and abroad, from people who had lost relatives and from other hospitals worried that Saldivar had worked for them. He said what the police needed was a single provable case. "I just need one case to put him behind bars," he said.
Within weeks Saldivar had changed his account. He told ABC's 20/20 in 1998 that he had invented his confession because he was depressed and suicidal. "I wanted the system to do to me what I couldn't do to me," he said. "I was looking to die." He said he had reasoned that one death would not be enough for a death sentence, "so I said two." In later reports, both the Associated Press and Lawrence Livermore National Laboratory described the retraction in the same terms: he said he had lied out of depression and a wish to be executed.
He stayed in the area, and by 2001 he was working as an electrician's apprentice. As 60 Minutes II put it, he never strayed far from Glendale.
The Glendale Police Department set up a task force to find out whether any of the deaths could be proved to be murders. The Crescenta Valley Weekly column said a six-member team worked from a house rented near the hospital, and that detectives studied research on health care workers who kill patients. About 1,000 patients had died during Saldivar's years at the hospital, according to the column. Investigators narrowed the list. Lawrence Livermore's account says that 171 patients had died on his shift in his last two years at the hospital; the column says 54 of the 171 had been cremated, leaving nothing to test.
Police gathered thousands of pages of medical records. Dr. Mark Nelson reviewed the charts of 150 patients who died while Saldivar was working and found 50 that he regarded as suspicious, 60 Minutes II reported. From these, 20 cases described as the most unexplained were referred to the Los Angeles County coroner for exhumation.
The difficulty was chemical. Some experts told police that the drugs Saldivar had described could not be traced after death, and the deaths had all been put down to natural causes. One of the two drugs he had named breaks down quickly into substances that occur naturally in the body. The other, Pavulon, the trade name of pancuronium bromide, is a synthetic muscle relaxant given in hospitals in very small doses. It was widely thought to leave the body quickly as well.
Early in 1999 Michael Peat, then president of the American Academy of Forensic Sciences, recommended that the Glendale investigators take the toxicology to the Forensic Science Center at Lawrence Livermore National Laboratory, the federal laboratory known for designing nuclear weapons. The center's main work supports nonproliferation and counterterrorism programs, but it also does unusual analyses for police. Its director, the forensic chemist Brian Andresen, received his first outline of the case at the Glendale task force's headquarters in March 1999, according to a laboratory news release of January 26, 2001.
Andresen decided to concentrate on Pavulon. He first worked out a way of recovering the drug from animal tissue, according to the National Library of Medicine's exhibition Visible Proofs, and then applied it to tissue from the exhumed patients. 60 Minutes II reported that he worked 16-hour days for a month, running samples through some 200 kinds of chemical filters, using a method first designed to detect traces of chemical weapons. His laboratory notebook for the case, which runs from May 1, 1999, to December 11, 2001, is reproduced in the Visible Proofs exhibition.
The exhumations began in the last week of May 1999. Andresen attended the first four autopsies to show coroner's staff how to collect and preserve samples, and the remaining exhumations took about 16 more weeks. The Crescenta Valley Weekly column, describing the same work, called it a summer of digging for the detectives.
Andresen found Pavulon in six of the 20 patients. He told the laboratory's news office that he had been surprised to find anything at all and had gone into the work with an open mind. In a 2004 quotation used by the Visible Proofs exhibition, he said the first positive result "took the wind out of" his lungs. Outside laboratories checked his results. In December 1999 he gave a preliminary presentation to the district attorney's office, and on January 5, 2001, he gave a final presentation at the coroner's office to Deputy District Attorney Al MacKenzie and the task force. The district attorney "felt it was time to act," Andresen said. MacKenzie said Andresen had invented a new scientific protocol that he hoped would be useful in future investigations.
The six patients named in the charges were elderly and seriously ill, and died at the hospital in 1996 and 1997; ABC News reported that prosecutors placed the deaths between December 1996 and January 1997. Prosecutors said they were ill but not ready to die, ABC News reported in 2001, and that each had traces of Pavulon in the body. According to CBS News, prosecutors said the drug had not been part of the treatment of five of them.
Eleanora Schlegel was 77. She died in January 1997. Her son, who was 50 in 2002, followed the case to its end. "It still seems so unreal," he said on the day of the plea, and he called the agreement "the best outcome for everybody."
Salbi Asatryan was 75. Her family later sued the hospital and accepted a settlement of $60,000, according to news reports in 2002.
Jose Alfaro was 82. He died in January 1997. In January 2001 his family told CBS News that Pavulon had been found in his body and that they had hired a lawyer to bring a wrongful death claim. They later settled with the hospital for an amount that was not disclosed.
Luina Schidlowski was 87. Balbino Castro was 87. Myrtle Brower was 84.
Beyond their names, ages and the dates of their deaths, little was reported about the six.
A seventh patient, a woman, survived. She later testified before the grand jury, and at the sentencing in 2002 she described how a drug had nearly killed her. The Crescenta Valley Weekly column said that she told investigators she had blacked out while Saldivar was in her room.
Saldivar was arrested in early January 2001 as he arrived at work as an electrician's apprentice, CBS News reported on January 9, 2001. He was 31. He was held without bail and was to be arraigned on six counts of murder, with special circumstances of murder by poison and multiple murder. The charges could bring the death penalty or life in prison without parole, CBS reported. A lawyer who was representing him in the civil suits said he appeared very distressed.
He was interviewed again after his arrest, and he confessed again. The Associated Press reported in 2002 that in this later confession he said he had killed 60 people by 1994 and then lost count. Police said he compared the killings to stealing a piece of gum: something one does not think about again "for the rest of the day, or ever." Detective McKillop told 60 Minutes II that the motive he described this time was workload. In McKillop's account, Saldivar killed patients who made a lot of work for him or for the staff, to "thin out the crowd." The Crescenta Valley Weekly column said that in this second confession he estimated about 100 deaths, including patients at other hospitals where he had worked part time. None of these figures was ever tested in court.
Cases against health care workers accused of killing patients had been brought before. ABC News placed Saldivar's case beside those of Dr. Michael Swango, the British doctor Harold Shipman and the Indiana nurse Orville Lynn Majors, all of whom had been convicted. Gregory Carter, a deputy prosecutor in Vermillion County, Indiana, who had helped convict Majors of six patients' murders in 1999, told ABC that one of the main challenges would be convincing a jury about people who already had serious underlying illnesses. Defense lawyers were expected to argue that the patients had been terminally ill or had died of natural causes.
The prosecution had more than the confessions. According to the Crescenta Valley Weekly column, its case rested on the exhumation results and on two witnesses: a fellow respiratory therapist who had given Saldivar access to drugs and who received immunity, and the patient who survived. The column did not name the therapist, and no other report did.
On Tuesday, March 12, 2002, Saldivar pleaded guilty before Judge Lance Ito in Los Angeles County Superior Court to six counts of first-degree murder and one count of attempted first-degree murder, the Associated Press reported. He admitted the special circumstances of multiple murder and murder by poison, the poison being Pavulon. A count of receiving stolen property, involving vials of the sedative Versed, was dismissed.
When MacKenzie told him in court that he would spend the rest of his life in prison and asked whether that was what he wished to do, Saldivar answered softly, "Yes." His lawyer, Deputy Public Defender Verah Bradford, said he had pleaded guilty not to escape punishment but to accept responsibility and, as he saw it, to make peace with God.
District Attorney Steve Cooley said the plea avoided a long and costly trial and assured the public that Saldivar would no longer be a danger to society. MacKenzie said the six murders and one attempted murder were what four years of police work could prove. Saldivar "has told so many different stories," he said, and the true number would probably never be known. "What I know is what we can prove in a court of law."
The hospital said in a statement that the scrutiny brought by the case had led it to make "significant improvements" in its standards of patient care. By then seven lawsuits had been filed against it, and four had been dismissed.
Reports from the day of the plea differ on the timing of the sentence. The Associated Press, in a report carried by CBS News, said he was sentenced at once to seven consecutive life terms; another version of the same day's report said he was to be sentenced on April 17. The sentencing took place on Wednesday, April 17, 2002. Judge Ito imposed six life terms for the murders and 15 years to life for the attempted murder of the patient who survived. She was in court and told the judge how close she had come to dying. The Crescenta Valley Weekly column describes the six life terms as consecutive.
In February 2003, 60 Minutes II reported that he was serving a life sentence and had declined to be interviewed.
In February 2003, 60 Minutes II reported that he was serving a life sentence in prison.
The case left lasting questions for hospitals. On 60 Minutes II, Dr. Nelson estimated that a health care worker who kills patients comes to light in the United States every two to five years. He pointed to the nurse Kristin Gilbert, convicted in 2001 of killing four patients, as another case in which the killer's workload appeared to play a part.
For the forensic sciences, the case showed that a drug thought to vanish could be found in tissue long after death. The National Library of Medicine made it one of the cases in its exhibition Visible Proofs: Forensic Views of the Body, under the heading "A 'lab of last resort' solving the Efren Saldivar case." The exhibition's gallery includes Andresen's notebook, a laboratory sample check sheet, hospital pharmacy records for one patient and a photograph of Saldivar in court in 1998.
For the families, the plea ended the criminal case. The civil cases against the hospital were mostly settled or dismissed, according to the 2002 reports.
The number of deaths. Saldivar was convicted of six murders and one attempted murder. Everything beyond that rests on his own changing statements or on estimates. In March 1998 he told police he had caused 40 to 50 deaths since 1989. The Associated Press reported in 2002 that he had also told police in 1998 that he may have contributed to "anywhere from 100 to 200" deaths and actively killed up to 50, and a 2001 Lawrence Livermore release described his first confession as covering 100 to 200 patients. He then said all of it was invented. After his arrest in 2001 he said he had killed 60 people by 1994 and lost count; CBS's 60 Minutes II places the "lost count after 60" statement in his first confession instead. Detectives Currie and McKillop told 60 Minutes II they believed he had killed 100 to 200 patients, and Glendale police were reported as regarding him as possibly responsible for as many as 200. None of these numbers was charged or proved.
When he began. He told police in 1998 that he was responsible for a patient's death in 1989 and that he began giving drugs about three years after he started at the hospital. 60 Minutes II reported him as saying he killed his first patient six months after starting work. The Crescenta Valley Weekly column dates his first claimed killing to 1988 and his time at the hospital to 1988 through 1998; the Associated Press, from the police declaration, gives 1989 as the year he began working there.
Other hospitals. The Crescenta Valley Weekly column says he worked part time at other hospitals and that his later estimate included patients there. No charge was reported concerning any other hospital, and none was named in connection with a death.
Others at the hospital. Saldivar told police in 1998 that other therapists sometimes gave him room numbers. CBS reported that three therapists were under investigation in 1998. Apart from the co-worker who, according to the Crescenta Valley Weekly column, received immunity and was to be a prosecution witness, no other employee is reported to have been charged.
The motive. In 1998 he spoke of anger at seeing patients kept alive and of choosing patients by what he called ethical criteria. In 2001, according to the detectives, he described killing to reduce his workload. Neither account was tested at a trial.
1989: By his own later account, Saldivar begins work at Glendale Adventist Medical Center, working nights.
1996 and 1997: The six patients named in the murder charges die at the hospital.
Spring 1997: A fellow therapist reports his suspicions to a supervisor, according to the Crescenta Valley Weekly column.
August 1997: The last death Saldivar described to police in 1998; he said he stopped after a co-worker saw drugs in his locker.
March 3, 1998: Glendale police receive an anonymous tip.
March 11, 1998: Saldivar is questioned, takes a polygraph and says he caused 40 to 50 deaths; he is held for 48 hours and released without charge.
March 27, 1998: The Respiratory Care Board suspends his license; the hospital says he has been fired and puts its respiratory staff on paid leave.
March 31, 1998: Administrative hearing on his license.
1998: On ABC's 20/20 he retracts his confession.
Early 1999: The Glendale task force turns to the Forensic Science Center at Lawrence Livermore National Laboratory.
Late May 1999: Exhumation of 20 patients begins; the work runs about 16 more weeks.
December 1999: Brian Andresen gives a preliminary report to the district attorney's office.
January 5, 2001: Final presentation of the Pavulon findings to prosecutors and the task force.
January 2001: Saldivar is arrested at work and charged with six counts of murder with special circumstances.
March 12, 2002: He pleads guilty to six counts of first-degree murder and one count of attempted first-degree murder; the death penalty is taken off the table.
April 17, 2002: Judge Lance Ito sentences him to six life terms plus 15 years to life.
February 2003: 60 Minutes II reports that he is serving a life sentence.
February 16, 2006: The National Library of Medicine issues its Visible Proofs case page on the investigation.