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."
