The 28-year-old respiratory therapist alleged to have made a bizarre confession that he killed patients is one of a large but little-noticed group of medical technicians whose work carries the emotional freight born of close proximity to the dying.
The therapists often draw and test blood, administer oxygen, give breathing tests, help with high-risk births and monitor patients on ventilators, both those just out of surgery and those with terminal illnesses on long-term life support systems. They generally do not administer drugs except for inhalants.
Their jobs are supposed to be performed under doctors' supervision, meaning that the toughest decisions are out of their hands. Still, the role is considered far from easy.
"It is very frustrating to see people lose their dignity," said Greg Basile, a Sacramento respiratory therapist. "You see people who suffer: They have bed sores, gaping wounds from staph bacteria, or they may blow up like Pillsbury dough men with severe infections. And there is nothing you can do. . . . The frustration builds up over many years."
Even so, medical professionals say they are shocked and puzzled by the possibility that Efren Saldivar may have taken it upon himself to kill patients in his charge.
They questioned how such a thing could happen in a hospital, where drugs are supposed to be closely tracked and many people attend patients.
And they wondered why Saldivar, if angered by the plight of dying patients, didn't work through existing mechanisms to voice his concerns, especially as respiratory therapists have more of a voice than ever in suggesting patient care.
Working Within the System
Hospitals are required to have processes in place to address ethical problems, said Vicki Michel, bioethics attorney for the California Medical Assn.
A spokeswoman at Glendale Adventist Medical Center, where Saldivar allegedly confessed to killing 40 to 50 terminally ill patients, said she could not say what kind of ethics procedures the hospital uses. But most take the form of bioethics committees, which meet to discuss patient problems. These may be accessible to "anyone--a patient, a doctor, a nurse, the janitor, anyone who sees anything," said Dr. Maureen Sims, a UCLA professor of pediatrics who works with respiratory therapists overseeing newborns at Olive View Medical Center. "There is a process, and it works."
As difficult as it is to work with the dying, "these things shouldn't happen," Sims added. "There isn't any excuse." And if the allegations are true, "he was playing God."
Agreed Steve Vinci, a Grass Valley respiratory therapist: "This is very atypical. . . . You do think about some of the tragedies you see, but you don't think in terms of what this guy supposedly thought. If he did do this, he's crazy."
The news is especially dismaying to those pushing for respiratory therapists to take a more active role in patient care--a move seen as a benefit to their very ill patients, said Edward R. Lind, Olive View's manager of pulmonary/respiratory care service.
"Fifteen years ago, therapists would take an order from a physician and carry it out, right or wrong," he said. "Today the role is as patient advocate."
Respiratory therapists typically receive one or two years of junior college training, similar to nurses' training. They are required to study anatomy, chemistry and biology in addition to taking specialty courses. Once certified, they can draw a starting salary of $30,000 to $35,000 annually; experienced therapists can earn upward of $46,000, said Basile.
There are about 19,000 respiratory therapists in the state--the second-largest group of ancillary hospital staff next to nurses, said Aaron Read, legislative representative for the California Society for Respiratory Care. Despite the therapists' large numbers and the critical function they perform, patients are often unaware of their presence.
However, many people, not just lung patients, may have encountered respiratory therapists without realizing it, especially if they have had major surgery.
Typically, said Basile, who works at Mercy General Hospital in Sacramento, therapists who work with patients on life support check in every few hours for 15 or 20 minutes--time in which the therapist may be alone with the patient.
"We check their heart and lungs, take their pulse, check their skin color, their extremities, and we check to make sure that the machinery is working according to the protocol or the physicians' instructions and record that on a chart," he said.
Always, the therapists are supposed to be working under a doctor's orders, or what's called a protocol, a list of specified procedures for given conditions, Lind said.
So although the therapists usually move independently from patient to patient, their activities are expected to fall within rigid guidelines. "They are not just running around on their own," Sims said.