Jan. 26, 2001 -- Efren Saldivar — Los Angeles' so-called Angel of Death — is now part of the medical death club.
As he faces six counts of murder, the former respiratory therapist joins Dr. Michael Swango, Dr. Harold Shipman of Britain, Indiana's nurse Orville Lynn Majors and others in an infamous pantheon of health-care providers accused of a betrayal most would find unthinkable — killing the people who entrusted them with their lives.
Swango, Shipman and Majors have all been convicted of murder.
A prosecutor who tried the Majors case believes his counterparts in Saldivar's case face a stiff — yet not insurmountable — challenge.
"One of the biggest concerns is convincing a jury that people with underlying organic problems — the reason that they were in a hospital to begin with — died as a result of a crime being committed," said Vermillion County deputy prosecutor Gregory Carter, who helped convict Majors of six patients' murders in 1999.
Prosecutors say Saldivar, 31, injected six patients with lethal doses of the muscle relaxant Pavulin between December 1996 and January 1997 while he worked at Glendale Adventist Medical Center. All of the patients were ill, prosecutors say, but were not ready to die, and all had traces of the drug in their system.
Defense attorneys are expected to claim the patients were either terminally ill or died of natural causes.
Saldivar was charged earlier this month after a nearly three-year investigation. Prosecutors say he confessed to dozens of killings while he worked at the medical center between 1989 and 1997, telling police he was angered at the sight of seeing terminally ill patients kept alive. Considering himself the "Angel of Death," Saldivar allegedly told police in 1998 he killed patients by injecting Pavulin into their intravenous lines. Saldivar was arrested but released by police three days later because of lack of evidence.
Saldivar recanted his alleged confession in later interviews, claiming he was suffering from depression at the time and was suicidal. In a 1998 interview with 20/20 Friday he said, "I wanted the system to do to me what I couldn't do to me. I was looking to die. … I figured, you know, one death isn't gonna be enough for the death penalty so I said two."
"I couldn't believe how I started to embellish," Saldivar said later in the interview. "The detectives asked me for a motive. I couldn't think of one. Then I thought of Jack Kevorkian."
But police still believed Saldivar's initial confession and arrested him earlier this month. Saldivar's alleged victims include: Jose Alfaro, Salbi Asatryan, Myrtle Brower, Balbino Castro, Luina Schidlowski, and Eleanora Schlegel. According to court papers, their ages ranged from 75 to 87 and all had what could be considered life-threatening illnesses at the time of their deaths.
Three days before her death, Asatryan was admitted for near respiratory failure. Schlegel suffered from obstructive pulmonary disease and multiple sclerosis. Alfaro and Schidlowski each suffered from chronic pulmonary disease, among other illnesses, and Castro and Brower had been admitted for respiratory failure.
Mirror Image of an Indiana Case
These patients' illnesses, as well as the defense strategy used in Majors' 1999 trial, may provide a glimpse as what Los Angeles prosecutors must overcome to convict Saldivar.
Once a licensed practical nurse, Majors was charged with killing seven patients who died in his care while he worked at an Indiana hospital between 1993 and 1995. Prosecutors believed he gave patients lethal doses potassium chloride and epinephrine. Electrocardiogram test patterns showed that each of the deceased patients experienced a sudden rise in blood pressure before their hearts suddenly stopped — a pattern state medical experts said was consistent with high injections of potassium chloride and epinephrine.
But, as in the Saldivar case, Majors' patients suffered from potential life-threatening illnesses at the time of their deaths. The doctor of one testified she had been hospitalized on 20 different occasions for congestive heart failure in the two years before her death. Another suffered from chronic lung disease while one patient, a doctor testified, had diabetes and did not always follow his physician's advice.
With this knowledge, Majors defense attorney argued the patients were not murdered but died of either natural causes or their pre-existing illnesses, an argument trial prosecutor Gregory Carter feared jurors would find persuasive.
"I was concerned with convincing jurors that the fact that the people were old and sick, that the manner of their death was not consistent with their illnesses," said Carter. "We had to explain the that the interruptions shown in the electrocardiogram showed the presence of an unnatural substance in the system and that that caused the victims' deaths."
Another concern Carter faced was that potassium chloride and epinephrine leave nearly no detectable traces of residue, making it difficult for medical examiners to prove the fatal drugs were in bodies of the victims. But that, Carter said, became less of a concern because he had other evidence linking Majors to the drugs and the deaths, something prosecutors will also have to do in Saldivar's case.
"It's important to tie the defendant to the crime in cases like these," Carter said. "We didn't have witnesses who had seen him [Majors] load the vials with the drugs, but we had some who had seen him inject some of the patients. We also had found vials of the chemicals in his home and in vehicles he had driven as well as some of the needles."
God Did It
Carter also noted that investigators found lids on the vials which contained multiple punctures, suggesting they had been used several times. While prosecutors did not have to prove a motive, Carter said they presented a former friend of Majors who told jurors that he often referred to his patients as "white trash" who ought to be "gassed."
Despite the testimony about the patients' illnesses, Indiana jurors ultimately sided with prosecutors, convicting Majors on six of the seven counts of murder. (They were unable to reach a decision in one case.) Majors is now serving a 360-year sentence.
Both the prosecution and defense in Saldivar's case are not revealing much so far. Prosecutor Al McKenzie said he would not comment on Saldivar's statements to police but would wait until the arraignment and pretrial hearings to unveil other evidence against the "Angel of Death."
However, there is an indication he has tried to link Saldivar to the deaths through means other than his alleged confession: in addition to murder, Saldivar faces a charge for receiving stolen property for alleged illegal possession of the drug Versed, which investigators believe he used with the Pavulon in the alleged killings.
Saldivar has yet to enter a plea in his patients' deaths. But his past comments suggest that his defense may mirror Majors': God took the patients' lives, not me.
"All I can say is that I'm sorry, and it didn't happen. It's not true," Saldivar has said. "If they died, they died because it was God's will, not because of me."