`ANGEL OF DEATH' CASE AGONIZING; OFFICIAL SILENCE ADDS TO PAIN OF POSSIBLE VICTIMS' KIN.

Byline: Beth Barrett Daily News Staff Writer

At a closely guarded location, a task force of eight investigators grapples daily with the ``Angel of Death'' case - one of the most bizarre, complex and painful criminal puzzles in the city's history.

Three months after former respiratory therapist Efren Saldivar confessed to hastening the deaths of up to 50 patients at Glendale Adventist Medical Center, official silence cloaks the case, adding a new and bitter agony to the lives of hundreds of people whose loved ones may have been victims.

``I had been resigned to the facts in my father's death until I saw this on television, and it just opened everything up again, like it was overpowering me again,'' said Louise Bonasera, whose father died at the hospital in early 1997.

A doctor told her Saldivar wasn't on duty when her father died, but that hasn't eased her mind.

``My father met all of Saldivar's criteria: He was in a coma, he was considered terminal, and he had a `no resuscitation' card.''

For Bonasera, retired and living in Glendale, and dozens like her, there is too much silence, too few answers.

Saldivar is edgy, too. After recanting his confession on television, the 28-year-old Tujunga resident says he's now living as a recluse, reflecting and wondering what's next.

``I do a lot of walking,'' he told the Daily News in a brief telephone interview recently. ``I haven't got a clue what they're doing. I'd like to know.''

What police and prosecutors are doing is implementing an elaborate plan to test Saldivar's confession against the evidence. It hinges on a difficult search for traces of certain drugs in the bodies of people who weren't supposed to get those drugs.

The search for evidence that would prove the deaths to be the work of a serial killer is complex and challenging, sources close to the probe said.

All investigators have to go on is the confession Saldivar made March 11 when he walked into the police station and told an incredible story of how he used two drugs to end the lives of people he believed were terminally ill and suffering.

``Nobody knew there were potential murders until he admitted it,'' one source said. ``It's a good starting point. You know the cases to focus on, what to review, what drugs he says he used.''

The pattern of evidence investigators are looking for lies in the records of hundreds of people who died at the hospital while Saldivar was on duty there, an employment that dates to 1989.

In 1997 alone, 512 people died at Glendale Adventist, most of them elderly and very sick.

Approximately 500 people called the hospital's hotline in questioning the circumstances of a loved one's death after Saldivar's confession became public as part of a proceeding to suspend his license.

In the past few weeks, many cases have been eliminated by investigators, all hand-picked for their meticulousness, Glendale police Sgt. Rick Young said. Patients whose remains were cremated, for example, were taken off the list.

More recent cases tend to be higher on the list, more promising, because the longer bodies are buried, the more difficult reliable drug detection becomes.

That has left a preliminary batch that investigators began honing in early June. The review could take several months and likely will result in fewer than a dozen actual exhumations, sources said.

Patience, technical skill, intuition and luck are all playing a role.

Investigators are looking at cases in which the death certificate states the person died of natural causes. As such, they will be asking doctors, residents, nurses and therapists to recall doubts, unresolved issues or nagging questions.

They will be asking caregivers to revisit their patients' dying hours in an elaborate effort to reconstruct how their medical condition deteriorated, whether predictably or with unexpected rapidity.

``The initial assumption is that people die for a reason,'' a source said. ``It's difficult for doctors to think of someone working in a hospital killing a patient. It's just so unthinkable.''

Pattern of evidence

Investigators and experts who have worked similar cases said the details of Saldivar's confession will lead to a pattern of evidence that can be used in court - if it's more than a Valium-clouded story concocted in a suicidal moment to win a death sentence, as he later claimed.

Among the interviews with relatives of those who died at the hospital were several who said physicians expressed surprise at sudden deaths but explained them away as unpredictable turns in the course of serious ailments.

Though her father was 96, Bonasera said the former engineer seemed to be holding his own almost to the end. Though he then began to fail quickly and slipped into a coma, she said questions have lingered.

Most physicians are not eager to talk about this kind of medical retrospective, and those contacted by the Daily News declined to comment.

It is not a pleasant trek for Glendale Adventist, either, in that it will open to outsiders, at least to some degree, the most intimate medical practices and procedures of this 500-physician community hospital, venerated for 93 years of care and its state-of-the-art cancer center.

For the hospital, it is ``a worst-case scenario. It's what you'd call a major crisis,'' said the hospital's public relations consultant, Michael Chee, a managing director with Hill & Knowlton.

Detecting a poison

Surgical patients, even if they had contact with Saldivar before their deaths, likely will be ruled out.

Traces of the drugs Saldivar said he used - succinylcholine chloride (brand name Anectine) and pancuronium bromide (Pavulon) - would be expected as residue in those patients since they are commonly used by anesthesiologists.

Saldivar claimed to have stopped his killing spree in August 1997 after hearing that a co-worker had spotted morphine in his locker, police said. Therapist Bob Baker later told investigators he saw vials of morphine and succinylcholine chloride in Saldivar's locker as late as November.

Hospital officials said they received an initial tip in April 1997 that ``something may be happening to patients'' but were never able to verify it.

Of the two drugs Saldivar said he used, only Pavulon is reliably detectable in tissues or fluids after death. The drug is a derivative of curare, a plant residue used historically by some South American Indians to poison arrow tips.

Pavulon's identification in the body of a patient who had not been prescribed the medication could provide the strongest and most reliable clue in the case.

Succinylcholine chloride is much tougher to find. It was intended as a medical advance over Pavulon, breaking down into chemicals that are naturally found in the body and doing it quickly to minimize the postoperative paralysis of muscles. Still, sophisticated techniques have been developed to chase down evidence of the drug's presence, contributing to a handful of criminal convictions.

Chasing down evidence

The first and perhaps most sensational such case was the conviction of New Jersey Dr. Carl Coppolino, an anesthesiologist, in the 1965 killing of his wife, Dr. Carmela Coppolino. The initial cause of death was challenged by her father, and the exhumed body showed an increased concentration of chemicals consistent with succinylcholine chloride poisoning.

More recently, vocational nurse Genene Jones was convicted of killing a 15-month-old child in Kerrville, Texas, with an injection of the same drug.

Dr. Fred Rieders, who heads the private National Medical Services lab in Willow Grove, Pa., and who played a controversial role as a defense expert in the O.J. Simpson trial, said advances in lab equipment make it possible to detect succinylcholine in minute concentrations.

Rieders has offered to work with Glendale police, but acknowledges he is not on the best of terms with the Los Angeles County District Attorney's Office, which has oversight of the investigation and would handle any prosecution.

Dr. Michael Baden, New York State Police director of forensic science, has consulted with Glendale police a couple of times on the case, Young said.

Baden, a defense expert witness in the Simpson murder trial, has been associated with such high-profile cases as the assassinations of President Kennedy and Martin Luther King Jr. and the killing of civil rights leader Medgar Evers. He declined to discuss the Saldivar case.

He has worked with Glendale investigators before, however, providing key testimony against neurosurgeon Richard Pryde Boggs in the 1990 murder of Ellis Henry Greene, which was staged as part of an elaborate insurance scam. Baden's review of tissue samples and other evidence was central to a finding that Greene was suffocated, convincing a jury he hadn't died of natural causes aggravated by drug and alcohol abuse.

Deputy District Attorney Brian Kelberg, an aggressive and thorough prosecutor of cases that hinge on medical evidence, declined to discuss strategy.

Investigators need tangible evidence that Saldivar poisoned patients before they can expect to arrest him. The problem is that there is no guarantee the bodies the medical ``detectives'' select to exhume will be the right ones and contain the target drugs.

Police have indicated they have no intention of digging up hundreds of bodies, which might still be futile while causing families needless anguish and suggesting a kind of finality that might not be justified.

It is that kind of uncertainty, the knowledge that no one may ever know for sure, that makes this case so cruel, many family members said.

``The word `closure' will never apply to me,'' Bonasera said.

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PHOTO ``I haven't got a clue what they're doing. I'd like to know.''

--- Efren Saldivar

Confessed to aiding in the death of 50 patients, but then recanted