One day after former hospital worker Efren Saldivar pleaded guilty to killing six patients at Glendale Adventist Medical Center, the head of the state board that oversees respiratory therapists said its highest priority now is to pursue disciplinary cases against former co-workers who may have aided him, or who knew what he was doing but did not report it.
Saldivar's license as a respiratory care practitioner was suspended immediately after he told authorities in 1998 that he had injected paralyzing drugs into the intravenous lines of dozens of patients. In the four years since, however, there has been almost no action taken against the co-workers who kept quiet about their suspicions that he was killing patients.
According to court records unsealed last year, Saldivar's frequent partner on the graveyard shift told Glendale police that she stood outside one patient's room while he went in "for the purpose of injecting the patient," once got him a vial of a potentially deadly muscle relaxer and heard him confide that he had injected such a drug into a woman by mistake. She still has her state license.
Other co-workers admitted seeing unauthorized drugs in Saldivar's locker but did not inform hospital officials.
The only co-worker disciplined by the state--with a reprimand--was the one who alerted the hospital's respiratory supervisor to rumors that Saldivar wielded a "magic syringe" and who then cooperated most readily with police. That worker was one of those who saw potentially lethal drugs in Saldivar's locker but did not tell hospital officials.
The head of the California Respiratory Care Board said Wednesday that other potential disciplinary cases were stalled by the difficulty of obtaining police records and a desire not to interfere with the criminal prosecution of Saldivar--or, potentially, of other therapists.
"We definitely have this case as our highest priority now," said Stephanie Nunez, the board's executive officer.
Merely failing to report an isolated incident of seeing drugs in a co-worker's locker might not be enough grounds for a disciplinary action, Nunez said, but "I would say we definitely are looking at all those individuals."
In addition to implicating himself in "40-something" killings, Saldivar told Glendale police in his 1998 confession, "I wasn't the only one." He then named two other respiratory therapists, according to a transcript unsealed last year.
Saldivar later recanted that confession, though, and prosecutors said Tuesday that they do not anticipate filing criminal charges against any of his former colleagues. Several were given limited immunity from prosecution in exchange for their testimony against Saldivar, but that would not prohibit the licensing board from pursuing disciplinary actions against them.
Some did lose their jobs, even as they kept their licenses. After Saldivar's 1998 confession, he and four other respiratory therapists were fired by Glendale Adventist, which conducted its own internal investigation. Those fired included Saldivar's frequent companion on the graveyard shift and the pair he accused of following his lead in killing patients.
Glendale Adventist officials said they could not voluntarily turn over their internal records to the state licensing board, but invited it to subpoena the records. "At the time it was a big concern of ours," said hospital spokesman Mark Newmyer. "Any of our former employees that we let go, [state officials] had access to and knew who they were. We were concerned about them following up."
Nunez said the state board has at least been monitoring those therapists in new jobs they obtained after being fired.
Saldivar finally was arrested in January 2001 after authorities exhumed 20 bodies of former Glendale Adventist patients and found the drug Pavulon in the tissue of six of them. Prosecutors and police officials disclosed this week that Saldivar gave a second confession at that time, in which he said he had killed 60 patients by 1994 and then lost count.
Despite such shocking revelations, the dearth of disciplinary cases is not the only way that the murder case has had limited impact.
After Saldivar confessed in 1998, Glendale Adventist sent some of its officials to Indiana to see how a hospital there was handling its own "Angel of Death" scandal.
One of the consequences for Vermillion County Hospital was a torrent of lawsuits. One of its nurses was eventually found guilty of murdering six patients, but the hospital was swamped with 80 wrongful death actions brought by patients' families. A year after the nurse's 1999 conviction, the state's Patient's Compensation Fund had already paid out $5.8 million to 17 families. In addition, the hospital was under new management.