HOSPITAL KILLERS RARE BUT REAL THREAT IN U.S.; CASES SHOW DETECTION DIFFICULT.

Byline: Eric Wahlgren Daily News Staff Writer

If police are ever able to conclude that Efren Saldivar did indeed hasten the deaths of as many as 50 terminally ill patients, he'll join the dubious ranks of medical professionals who killed dozens of their patients in what they often considered acts of mercy.

Reports that Saldivar confessed to mercy killings at Glendale Adventist Medical Center gave the chills to Joseph Deters, a prosecutor who helped convict nurse's aide Donald Harvey on 24 counts of aggravated murder in Ohio in 1987.

Harvey confessed to hastening the deaths of more than 50 critically ill patients in the mid-1980s at Drake Memorial Hospital because he reportedly felt sorry about their condition and considered killing them an act of mercy.

``Some killers use that to explain away horrific behavior,'' said Deters, speaking from his office in Ohio. ``That's all bullcrap. People who do this have a compulsion to kill.''

Deters was working as an assistant prosecutor in Hamilton County when Harvey, then 35, confessed to using rat poison, cyanide, arsenic and cleaning fluid to kill patients. Harvey is now serving three consecutive life prison terms.

Rogues' gallery

In the past two decades, there have been a handful of other cases of rogue health care workers who have taken it upon themselves to decide when a patient should die, in blatant disregard of the law and the Hippocratic Oath.

Robert Diaz, a nurse at Community Hospital of the Valleys in the Riverside County town of Perris, received the death penalty in 1984 for murdering 12 elderly patients by injecting them with huge doses of a heart-regulating drug.

Diaz, who is now on Death Row at San Quentin, was arrested in 1981 after a series of mysterious deaths at various hospitals where he worked, said Ingrid Wyatt, a spokeswoman for the Riverside County District Attorney's Office.

Michael Swango, an Illinois physician, is now in custody in New York as federal prosecutors build a case against the doctor they suspect in a string of strange and sudden patient deaths at hospitals across the country, officials said.

Overly sensitive

``Someone who commits crimes like these may be mentally impaired,'' said Elyn Saks, a professor of law, psychiatry and behavioral sciences at the University of Southern California.

``In other cases, it could be someone who is overly sensitive to pain and suffering and thinks they should end it,'' Saks said. ``What makes a person who just feels this vs. other people who act on it, we don't really know. That is the big question.''

Officials said Saldivar, a respiratory care therapist, told police in a taped confession that he killed terminally ill patients at Glendale Adventist by suffocating them or injecting them with lethal drugs between 1989 and 1997.

But after being detained from March 11 to March 13, the self-described ``angel of death'' was released by the Glendale Police Department because investigators had no other evidence that he actually committed crimes.

Glendale Adventist fired the 28-year-old Tujunga resident after his release, and the Verdugo Hills High School graduate has remained in seclusion while the department attempts to build a murder case against him.

He told investigators in his March 11 confession that he got the idea for overdosing patients with drugs from news reports about a Chicago health care worker who killed patients, court records show.

Hospitals jarred

The possibility of yet another hospital killer has prompted much soul-searching among the members of the American Hospital Association, an organization representing 5,000 community hospitals across the nation - including Glendale Adventist - said the group's spokesman.

``What we have been hearing since the story broke is that a lot of our members are wondering how you can spot something like this through background checks and reference checks before it becomes a problem,'' Rick Wade said.

Wade, who is based in Washington, D.C., said there is no epidemic of hospital killers - they are extremely rare - and that all hospitals have strong security measures in place to safeguard patients.

``This is an unusual occurrence of someone who has an unusual problem,'' Wade said.

Hospital staff are required to keep dangerous drugs under lock and key and have elaborate tracking systems to prevent theft of medications, Wade said. Wade also noted that physicians review medical records at regular intervals, making sure that proper procedures are being followed.

And hospital workers are required to report any suspicious behavior on the part of colleagues, he added.

Prevention, proof not easy

But despite an array of oversight measures, Wade said it can be hard for hospitals to determine if a health care worker is hastening the death of critically ill patients, because their deaths are not always unexpected.

``You really have to establish a pattern in which there is no reason for a patient to have died,'' Wade said. ``It becomes very difficult to do that.''

Mark Newmyer, Glendale Adventist spokesman, said an outside expert has reviewed the hospital's procedures and is ``very pleased'' with oversight at the facility.

``He said they (the procedures) are very much in line with what other hospitals have in place,'' Newmyer said.

Newmyer defended drug storage policies at Glendale Adventist, which has been cited in the past by the Los Angeles County Department of Health and Human Services for failure to properly lock up medicines and other shortcomings.

In all cases, the county found that the hospital quickly corrected all of the problems.

``There is no connection'' between the hospital's control of its drug supply and the Saldivar allegations, Newmyer said.

Glendale Police Sgt. Rick Young has called the Saldivar case a very difficult one to prove.

The investigation will involve the exhumations of one or two bodies of patients who died at Glendale Adventist to search for traces of two paralyzing drugs, Pavulon and SUCC, that Saldivar said he used. Authorities said these drugs may be hard to detect in some cases.

In the Ohio case, Deters said nurse's aide Harvey often used drugs like arsenic, which were fairly easy to test.

Harvey also kept a record describing how he killed patients, Deters said.

``When he claimed he used a certain poison to kill someone on the list they recovered, they exhumed the body,'' Deters said. ``In every case, that poison was present in the body, just like he said.''