Deaths at a California Hospital

Hi I'm Wendy Zukerman - you're listening to Science Vs. Today – on the show… how a lab that that designs nuclear weapons^[1] …helped catch a serial killer.

And if you're going to do true crime… you better bring in the True Crime queen… . Host of Crime Junkie^[2] Ashley Flowers. Welcome to Science VS.

AF Hello. I'm so excited to be here.

WZ: So it's something that a lot of people might not know about you isran  that you graduated from  Biomedical science. That was your degree.

AF It was.

WZ: And we are twins.

AF:. Yeah.  

WZ: We both have this degree

AF: I thought I really wanted to be a doctor when I was young, and I was, I think, fortunate enough to have to work full time to put myself through school and I worked at a hospital, for all five years, and went to school at night, and I got to work side by side with residents who you have to be before you're a doctor, and I was like oh, that’s not the life I want. so I made a made a pivot with a focus in research

WZ And so what did you what do you like about science?

AF: I like facts. And I think so much in life can be so subjective. And what I love about science is it feels like there are real answers and not just opinions like there. Sometimes things get to be black and white and that's not very often do you get that.

WZ: Yes. Yes. I think that's one of the reasons I love science, too. It's a way to understand the world.

AF Yeah.

WZ If science is your sidepiece, I guess your true love is, is really mysteries.

AF Yes.

WZ: I've heard you say that you are obsessed with solving mysteries. What is it about a mystery that just grabs you and you cannot let go?

AF: I think I'm just overall like a very curious person. The more that the more that I've like really drilled into it. And I, I want to, I want the answers to everything, the universe. I want the answers to all the unsolved mysteries. Give them to me.

Well, today we have a real mystery for you, and it's got a whole bunch of science in it. So should we jump in?

AF Let's do it. 

It's two days after Christmas in 1996 and, and a woman named Salbi Asatryan (Ah-saat-ree-an)  is rushed to Glendale Adventist Medical Center in California^[3].  She's 75 years old and is having serious trouble breathing.^[4] One hospital worker told the LA Times about her ... he said she's a sweet old lady ...she got treatment at the hospital ….^[5][6] And on December 30th, she was breathing on her own, things are looking pretty good for her.^[7]  But then - 3 and half hours later, Salbi was dead.

That same day: Eleanora Schlegel goes into Glendale Adventist^[8]. She has some chronic illnesses – a nasty case of pneumonia. On New Year's Eve, her son Larry he says in a documentary that "she was sitting up and breathing as best as she could^[9]  — they apparently have this toast, and say "next year will be better".^[10] 

AF oh no

But on Jan. 2, Larry sees a message on his answering machine. And it's from the hospital.^[11] His mum had died.

WZ And they're just toasting the day before.

WZ Yeah. Yeah.

AF My gosh

Similar situation happens again. Jose Alfaro Sr. He was father, he’d fought in World War II^[12]. He arrives at Glendale with severe pneumonia and two days later is found dead^[13]

AF hmm

At the time, these deaths are sad, of course.. But they don't seem to raise any eyebrows. These patients were sick, had chronic illnesses ... you know it’s a hospital, people die.  

AF And how close together are all three of these? Like, pretty close?

WZ Really close. Within days of each other.

AF Okay.

A few months later^[14] , though, rumours have been circulating that the deaths of patients like these - didn’t happen just because they were sick and elderly. But that these people were killed on purpose. By someone who works at the hospital. The rumor is that someone is injecting something into their IV.

WZ And Ashley tell me what your face is doing right now.

AF Yeah, well, I'm just what do you mean rumors? Like, I feel like this isn't something that should be a rumor. If people know that someone's walking around, like, killing people.

WZ Yeah. We, we're going to get into what these rumors are, who everyone is blaming. Okay. What on earth happened here? And how the hell a lab that develops nuclear bombs got involved.

AF Naturally.

Naturally. Are you in?

AF I'm in.

WZ We're going to do this just after the break.

PRE ROLL

Welcome back. We've just found out that patients at a hospital in California are dying under perhaps… suspicious circumstances.. Ashley Flowers, host of Crime Junkie is here with us… hey Ashley…

AF Hello

Meet Efren Saldivar

Ok so it's now 1997^[15] whispers are going around that one guy might be killing these patients…  and his name is, Efren Saldivar.

So we talked about him with science journalist, Sarah Scoles, who wrote a book about nuclear weapons^[16] and stumbled across this case. So Sarah told us that back in Verdugo Hills High School, Efren was a bit of an oddball.

SS: He worked at a grocery store. He played the oboe^[17]. He didn't have a ton of friends, but he was a pretty well-liked kid and was kind of like the leader of the misfits.

In the senior wills section of his high school yearbook at Verdugo Hills^[18][19], he wrote "I Efren of great mind and hunk body hereby will three-quarters of Verdugo's female population my enduring love and passion. 

AF uuuuhhhh

The right to preserve me in their hearts and souls for the rest of their lives and other times.

Eternally Yours and Mine,

Efren

Stud at Large." ^[20]

AF Literally. Efren, no one asked. Like, what?

WZ It's a real oddball energy there

AF Was he actually — of hunk body?

WZ Ahhhh y’know it was the 80s – he was pretty nerdy. A hunk would not be– if I was, if I was making a film, a high school film he would not be cast in the Hunk category. It would be in sort of the dweeby oddball category.

AF I love it, okay.

So Efren makes it through to senior year, but ultimately drops out of school. So he's working at a grocery store and one day…

SS: His friend came in wearing a medical uniform. He had a friend who was working at a at a hospital. And he… he just really liked this guy's uniform. And he was like, I guess I'll do that. I guess I'll get a medical career. I like the clothing.

AF: Scrubs?

WZ Yeah

AF Is he talking about scrubs?

WZ He liked the scrubs!

Now this might sound like a weird reason to go into a healthcare profession. But when you’re 18^[21][22]— a cute fit, it’s as good as any reason …

AF I like cute fit - it’s pajamas! Like I used to wear scrubs - they’re pajamas.

WZ:  I think the person who came in also had a stethoscope. ^[23]So that might be kind of cool as well.

AF Just like, radiating power. Yeah. Yeah, I get it.

So, Efren enrolls in a respiratory therapy program.^[24][25] And respiratory therapists help patients who have trouble breathing. So they give patients drugs, oxygen, and manage ventilators, stuff like that^[26]. And so when Efren is just 19 years old, in 1989^[27] he gets a job at Glendale Adventist Medical Center^[28].

AF I see where this is going

This is the place where the patients at the start of the episode died.  

So at Glendale Adventist — part of Efren's job was to take care of really sick elderly patients. And Efren is put on the graveyard shift – and so he starts working other jobs too during the day^[29] — other hospitals^[30][31][32]

So Efren is working at all these jobs. He's a bit overwhelmed. And at one point Efren starts gaining some notoriety at the hospital. So here's Sarah, our journalist, again …  

SS: He had a reputation at work for having a magic syringe.

WZ: What did they mean by that?

SS: Not magic in the positive way, but magic in the deadly way. His patients died faster than other people's patients.

AF That's not magic. That's murder. Right??

WZ Magic feels like a really weird word to describe it.

And this is where from reporting about this hospital at the time – it seemed like these healthcare workers, particularly the respiratory therapists, had this really, you could call it a dark sense of humor, they’d play practical jokes on each other …

AF So having worked at a hospital, having worked with a ton of people in law enforcement, I have seen this. In a place where you see a lot of death or there's like a lot of trauma, having that like very dark sense of humor. Tends to be, I've seen a way that a lot of people deal with it. So it's not even super surprising to me to like, see that in the hospital setting.

WZ Yeah. Yeah

AF but still

But then other stuff starts happening, that's hard to pass off as a joke. Here's Sarah

SS Someone had seen him putting something in an I.V. line that they thought shouldn't be there^[33][34].

A co-worker also says he sees an empty syringe and bunch of drugs in Efren’s locker … drugs like morphine and this medication called succinylcholine^[35],^[36] which is gonna become important later. And so in April 1997, a co-worker ends up reporting Efren to a supervisor^[37] - but the supervisor doesn't know about the drugs in the locker^[38][39]… so they really don’t have that much to go on, in a place where there’s a lot of rumors and jokes … But still — they look into the hospital records to see if Efren's patients are dying more often than other patients.^[40] And they?

SS: Didn't didn't find anything because his patients weren't actually dying at a higher rate than anyone else's.^[41]

AF Oh

A Shocking Confession

Yeah, there was nothing unusual here, they let it go, Efren keeps working. And it’s not until almost a year later, in February 1998, that the hospital receives another tip…

SS:  From someone who says that there is a respiratory therapist who — the quote is "helped a patient die fast."

AF And is this like a euthanasia situation or — what is that like? What do they mean?

WZ The guy on the phone is, ends up being a pretty dodgy guy with a criminal record and seems to be implying that if he gets an extra $50,000,^[42] he'll give more information.

AF Well

WZ He's basically extorting the hospital.

AF Yeah.

WZ And so this time, the hospital calls in the Glendale Police Department. And by the way, we did reach out to the hospital to ask about parts of this story.

AF And let me guess. They didn't want to talk.

WZ Yeah, yeah.

AF Let me finish that for you.

WZ Thank you, yes. All questions should be directed at Glendale Police Department…

So enter Detective Sergeant John McKillop from the Glendale Police Department. He is put onto the case… And John and his team start poking around… and he is actually not buying this idea that Efren is a killer.

JM: I was a skeptic because it just seemed odd. The whole thing seemed odd.

WZ: What was so odd about it?

JM: Well, I mean, to be honest, you're talking about. Someone trying to extort money out of the hospital to give information versus a major serial killer … I just thought it was a bunch of bull, so to speak.

WZ How are you feeling at this point, Ash? What's your Spidey senses is telling you?

AF: I mean, I. Well, I understand what he's saying. And it's funny. Like, I feel like the way that I'm at least hearing this is that the hospital really brings in the police because of the extortion, not because of the, the threat of somebody actually killing their patient?

WZ Yeah, that's that's John's memory of it as well.

AF Yea yea. Yea. Yea. Yea. Yea. Gotcha. Gotcha. Gotcha. John. So I understand why he would kind of just come in with that thought of like, well this can't be true. It's just some guy, he wants $50,000 to out a serial killer. Like there's no way. I would probably think the same thing too.

Yeah so but still though, to sort everything out… on March 11, 1998, John's partner - Detective William Currie calls Efren into the station just to ask him some questions^[43][44].  But John had something else to do.

JM Will was going to bring Efren in to interview him, I'm like, I'm going to go play hockey. And so I went to my hockey game.

WZ: Oh haha ha. You were so sure that this is, this is silly!!

JM Yeah, exactly.

AF I love it.

WZ Right.

AF No need.

AF I’ve got hockey

WZ You take care of this.

But it turns out - this was not silly. When the cops start questioning Efren, he confesses to killing dozens of patients.^[45] 

AF He, like all they had to do, is ask some follow up questions. And the dude just, like, folds??

WZ pretty quickly …

He says he killed 40 to 50 people^[46][47]

AF Over. Like, what span of time?

WZ It's pretty vague at this point. He's it's very - the cops just found it very strange, particularly given this attitude of. I'm going to go play hockey. Sure. Bring him in. They want him to do a polygraph.^[48] [49]The way that the cops remember it is just all of a sudden he starts talking and they were in the room going - UH.

AF Someone get a pen. Like, write this down.

WZ Exactly. Exactly. And so John is playing hockey.

JM: I mean, they literally pulled me off the hockey rink to tell me, hey, your partner is on the phone.^[50] There's something going on. You need to go. And when I picked up the phone, Will says, this guy's confessing, he’s rolling over. You need to get in here right now, you know. Now we're talking about murders.

AF Oh my God. 

So not only does he say that he killed patients, but he also how the cops how he did it - like sometimes ^[51]… he would kill them with these drugs. He would either use this drug called Pavulon or Succinylcholine^[52] [53]

AF Which is what they found in his locker. Wow.

WZ Exactly

AF Does he say why?

WZ At the time he said that he did it to ease the suffering of these patients.^[54] 

AF But we had our homegirl over here who's like, cheersing to a brand new year.

WZ Yes. Yes. It doesn't, it doesn't really make sense. He sort of fashions himself as a little bit of an angel of death type character in that room,^[55][56] that he didn't like seeing the patients suffering, things like that.

AF Okay.

Pavulon and Succinylcholine

So we wanted to know a little bit more about what these drugs do in the body and why they are used by health care workers. So we talked about this with Dr Ian Musgrave. He’s a molecular pharmacologist at the University of Adelaide in Australia^[57] and he told us that Pavulon and Succynilcholine, they interfere with how a particular neurotransmitter in our body works^[58][59]. And ultimately they can paralyze your muscles.^[60]

IM They stop the nerve signaling so your muscles just stop working. Now you might be saying, okay, why would you want to paralyze respiratory muscles?

That is, if you don't want to kill someone, why are we using this drug in hospitals??

AF mhmm

Well we sometimes give them to patients before surgery … and it helps doctors to intubate them, y’know to put a tube down their throats

AF mhmm

It can stop you from gagging^[61].

AF mhmm

Or if you wake up - it'd keep you from moving around so a scalpel doesn’t slip.^[62]

AF mhmm

Because the drugs paralyze the muscles that allow you to breathe,  if you're using them in a medical setting –  you have to give someone a breathing tube or respirator. So you're giving them oxygen artificially.

IM Of course, if you give a paralyzing dose of these drugs without putting in a breathing tube and without artificially respiring them, guess what happens?

AF Everything shuts down.

WZ They die.

IM They suffocate because they can't breathe.

WZ: What would it be like to die like that?

IM Incredibly horrible. You're paralyzed and you can't move and you can't react and you're suffocating to death.

WZ: If some of his victims weren’t unconscious, they would have felt it?

They would have definitely felt it

AF Just like silent suffering.^[63][64]

WZ Yeah. That's right. Because you - Ian, we talked about it, and he said it would be almost like drowning^[65]. ^[66][67]

WZ Because you're not anesthetized

AF right

WZ Necessarily. So these drugs don't conk you out or, you know, put you to sleep. So you just can't breathe

AF and you can't even, like, move or scream. My gosh. I can't imagine.

WZ Awful. Awful.

It's worth saying that in his confession, according to the cops, Efren said he would only do this to patients who were unconscious.^[68] 

AF I don't, like there's no way. All 40 of them?

WZ Yeah, I don't know how we can know that for sure, exactly

So the cops hold Efren Saldivar on suspicion of murder. But, even though he'd given this detailed confession, admitted to killing dozens of people —  in the US that is not enough to go on because of this rule called ​​corpus delicti – 

AF Uh

WZ: Yeah, body of the crime, tell us what it is…

AF So the corpus delicti,  You can't convict someone just based on a confession^[69].^[70].. Their confession has to actually match some kind of physical evidence where basically, like, if you took the confession away, you have to still be able to prove that they did it with - by some other means. Whether that's physical evidence, circumstantial evidence, other witnesses. But you should not be able to convict someone just by them saying, I did this thing.

WZ Yeah. And in this case, all they have is a confession. They don't have any physical evidence because these patients really just could have died because they were sick.

AF Yeah. Okay.

So, John, the cops hold him for a couple of days while they're doing some detective work. But in 48 hours, what you're going to come up with. And so they have to let him go. ^[71] And when he gets out – Efren goes on national TV^[72] and says he lied about his confession^[73][74][75] Sarah, our journalist, told us that Efren basically says

SS: I didn't do it. I was depressed and suicidal and thought this was a way out. And the detective pressured me. And so I don't confess anymore.

AF A way out of what?

WZ: A way out of life. He sort of. Gave this idea that he was he was really depressed and basically suicidal ^[76]and thought that if he confessed to these killings, then maybe he would be given the death penalty and then that would be his way out. Okay.

AF But then he changed his mind. He says

WZ I guess so. I guess so.

He even said he was taking valium - and other sedatives - and barely remembered what he said to the cops^[77] … And even a hospital spokesman says around this time - quote "We don't know if anything happened.”^[78] 

AF Mm hmm

WZ Mm hmm

AF Mhmm did he get, you know, in a room pressured? Like, that's an easy thing to say. Like, do you also say the thing that's been weighing on you and then all of a sudden, when, like, the gravity of what that means and like, what the consequences are… when the gravity of that sets in, the story changes like, maybe I, oh gosh, I didn't know what I was like saying.

Yeah – meanwhile, the medical board responsible for respiratory therapists suspends Efren’s license to practice^[79][80][81]. So he’s no longer working at the hospital. And the cops, like John, they’re not totally buying that his confession was a lie. It was just soooo specific, the drugs he used, exactly how he did it. It felt like a weird thing to just say.  

Searching for Suspicious Cases

So the cops stay on the case and create a task force to work out what is going on here^[82]… and they start  going through every patient that died under Efren's watch … looking for suspicious cases... And this is a huge task –  it meant wading through more than a thousand complicated medical records…^[83]   

JM:I was completely cra—  I mean, we're cops. We're not doctors. So we had to learn how to read medical charts and do all that stuff quickly, trying to become experts at something none of us had expertise in.

But they talk to doctors, and they learn fast. And they’re looking for patients who weren't given Pavulon or Succinylcholine legitimately at the time of their death^[84][85][86]…so  they didn't need it for surgery. They start looking for patients who at the time of their death had this particular pattern in their breathing and heart rate moments before they died that might suggest they were given Pavulon or Succinylcholine

They're also on the hunt for situations like Salbi Asatryan (Ah-saat-ree-an) and other patients we talked about at the start of the show: where the patients were doing better, and then – they suddenly die, for no clear reason.

AF Like nose -dive… yeah

After months of trawling through these records they come up with 20 people whose deaths at the hospital were highly suspicious.

Now the plan is to exhume the bodies from the cemetery... and search for the drugs that Efren had said he used to kill the patients

AF: And are they the kind of thing that would last for a while? Like in the system? Like, would you still see them?

WZ Ashley, that is THE question, because the cops start asking around and they realize we don't have a good test for these drugs in this situation. Basically – you can't pull some easy peasy test off our Forensic Science shelf that would detect what's expected to be pretty low levels of Pavulon or Succinylcholine in a decomposing human body.^[87][88] So bottomline even if they exhumed those bodies… from the graveyards… there wasn't a reliable test to find these drugs inside them

AF They've got nothing. So now what??

WZ The story can't end here.

AF Obviously

WZ Obviously, they get a tip that there is this place that just might be able to help them. It's a lab that some call the Lab of Last Resort.^[89]

AF What a name

WZ It’s where we're at in this story, right?

AF Yeah, true.  

This lab is called the Lawrence Livermore National Laboratory^[90].   It's this huge, sprawling facility in California that that was created in the early days of the Cold War^[91] and does some truly bonkers stuff. They design nuclear warheads, they have one of the world's most powerful lasers^[92][93] … And they also have this Forensic Science Center that can trace tiny amounts of chemicals^[94]…

Why? What are they doing at this lab?

So they use it to find chemical weapons, evidence of chemical weapons in the environment… but also alleged murderers.

Here's how the cop John described it

JM: So it I don't know if you know about this place, but it's like I mean, they weigh you when you go in to make sure your weight is consistent with what's on your I.D. and, you know, fingerprint you. And it's like a really super high level, high security kind of village

After the break…   we'll get inside that high security village,  the lab of last resort ….

AF Let's do it

WZ Coming up.

BREAK

The Lab of Last Resort

Welcome back. Today on the show I’m here with Ashley Flowers, host of Crime Junkie – and we are cracking the case of Efren Saldivar, a health care worker who’s suspected of killing dozens of patients, wide open.

AF Let's do it

We're now heading to the Forensic Science Center at Lawrence Livermore National Laboratory in California^[95] …  

AF the Lab of Last Resort. 

And it's now up to some serious nerds to try to detect the tiny amounts of drugs in bodies that have been buried for years. Armando Alcaraz is an analytical chemist who works at Lawrence Livermore… .^[96] and he was on the team who had to create this test… and when he heard about what he had to do he was like

AA:  my God, are we gonna find this stuff? And I was a bit skeptical. I thought it was still going to be enough contamination — and at such low levels that we weren’t going to be able to see it. And we would then have to sort of pull that needle out of a haystack.

So here's what they have to do, let me describe the needle in the haystack. Needle is the drugs, the haystack are the loads of other chemicals that would be in these decomposing bodies. Armando told us that some of these patients were smokers, so that tobacco would have been contaminating their tissue, so would any embalming fluid that was used in the burying process^[97]… Dirty water would be seeping into the coffins by now, leeching in all of these chemicals from the soil surrounding it … and it meant that if you were looking in liquid in their bladder

AA: At that point, you don't know whether it was actually real urine or whether water seepage had gotten into that coffin and there was moisture in it. And that's what you're analyzing.

AF Uuugghh

WZ Right?

AF You don't even know if it's like body fluid or outside fluid or ugh.

WZ Exactly.

So they get to work and they quickly realize that one of the drugs that Elfren said he used to kill patients - succinylcholine– that is basically a lost cause. It's just too hard to identify it in a human body after all this time.

AA: And the reason is it breaks down real fast^[98][99]. And when it breaks down into the metabolites, those metabolites can be found in the human body anyway.^[100][101] So how could you go into a court, you know - a court of law, and say, well, here we found these metabolites? Well, the defense lawyers are going to go well, and what does that mean? They're normally found in a human body anyway. But with Pavulon - there's no reason why a person should have that drug in their system unless they had a procedure or somebody injected them with it.

So they zoom in on creating a test to identify Pavulon.^[102] And because they don't want to be doing this work using human bodies – they start with something that's pretty close to human bodies.

AF Pigs.

WZ Pigs. yes yes yes

AF Knew it

So Armando and his colleagues get pig livers …They add a tiny bit of Pavulon ^[103][104]…

AA: Spike it, you know, put the chemical in it and then just allow it to be putrefy . And then you take it out and homogenize it. You basically put it in a blender and make a milkshake out of it^[105].

WZ Your face in this moment

AF I know, it’s like the milkshake, pig liver

WZ Yeah, you can really feel it in your throat can’t you.

Yeah, things are going to get a little bit grosser. Because they would take this pig liver Pavulon milkshake … and in some cases, let it sit and decay for months^[106]… making it more like what these bodies that have been decaying would have been like.

At this point, Armando and particularly his boss Brian Andresen - are up to their elbows in decomposing pig livers …

WZ:  Word on the street is that the lab did smell kind of gross. What did it smell like?

AA: There's these two notorious chemicals, putrescine and cadaverine^[107]. So just just the names themselves kind of give you an indication of what it smells like.

WZ: Cadaverene Is that what you say?

AA: Cadaverine and putrescine.

AF: It had to have smelled so awful. I just went into my first morgue for the first time recently, and there weren't even like, that was bad. I have no clue what this place would smell like.

Yeah -- so decomposing bodies -- whether it’s pigs or humans or whatever– they emit chemicals and the two that he talked about, cadaverine and putrescine, they give off that particular smell of death^[108][109]. That smell that you described and here’s how Armando described it.

AA: It's everything awful you can think of that's rotting. That's what that's what it smells like. I have to tell you this story because I spoke to Brian and we would be working late at night, you know, trying to get these samples through. And he would be, you know, blending the these tissues up with the blender. And even though we were doing all this in the chemical hoods, you could still smell that stuff and it would penetrate your clothes, it would get into your clothes and there would already be maybe 930 at night was late, you know, And he said, I'm going to go and I'd leave, too. And he did go to the grocery store to go buy some stuff to eat. And so he would be standing in line and people would start to just move away from him because he had So, you know, that smell of death was just in his clothes and in his hair and everything.

AF: It stays on you. I've talked to detectives who have said that there are scenes that they come home from and they they have to just like burn their clothes or throw away their clothes because no amount of washing will get it out there are, there is just like a level that is beyond anything I think most people know. Yeah, bad.

So while covered with the smell of death.. they take the, we’re going to go back decaying pig milkshake… that have been spiked with Pavulon … and they pass it through this particular contraption^[110] called a solid-phase extraction polymer. It looks like a plastic syringe^[111][112]… and it has a kind of filter in it–  or what's called a cartridge — and inside it…  they're basically trying to separate Pavulon from all the other crap in these tissue samples. But what you have to know is there’s different cartridges out there that are used to isolate different chemicals …

WZ I had never thought about how one would isolate chemicals from a human body

AF nuh-uh, not what I spent my brain power on

WZ No

So basically they’re pushing tiny bits of samples through little syringes and the game is to find a cartridge that's going to trap Pavulon… and leave out

AF  Everything else yeah

WZ Everything else, or as much as possible of everything else…

So Armando's colleague has been working on finding that, and Armando is focusing on another piece of this puzzle, it's really tough –  just passing this milkshake through these filters can take DAYS… depending on how decayed the tissue is – and how much mucus is in it^[113]….  May turns into June…they're pulling 16 hour days^[114]…. it's just late night after late night …

AA They have that task force that was just sitting there waiting for the results so they could move forward. So that was putting a lot of pressure on us and that's why we were working late.

They’re not finding what they need … It was depressing, nothing is working^[115]

AA: What the heck is going on? And so the instrument would start leaking on me, the solvents, and I'd be frustrated and just like pulling my hair out.

But then one day…Brian is testing this cartridge that is designed to detect the residue of chemical weapons^[116]… and from across the room… Armando hears his colleague saying something

AA: He goes, I think we're there. It was solid, actually, what the cartridge did, was it acted like a magnet where it would just collect the drug or things similar to the drug and sort of gripped on to it. And then it allowed us to then wash off all of like the tobacco products and other biomaterials that were in the tissue. But the drug stayed attached. Yeah, that was amazing. That was the magic cartridge

​​AF Holy crap. That is incredible.

WZ isn’t it? They found the magic cartridge.

WZ So, Armando would now extract all the chemicals in the cartridge and using a bunch of tools like mass spectrometry^[117][118], oh my god. This is why we call it mass spec. There’s too many Rs in that word. Using tools like mass spectrometry which separates chemicals based on their weight^[119]... and try to identify: Pavulon in that sample. … And here,  Armando catches a break cause it turns out  that Pavulon created this really unique, signature^[120] which meant yes they could identify this drug. So now it's time to see if what works in pig livers... works in human bodies.^[121][122]

Testing the Bodies

So in the Spring of 1999, the Cops started driving out to the graveyards^[123][124]... and bodies start getting exhumed... ^[125][126] And John said even for him - this pulling bodies out of the ground - this was rough

JM: I've seen a lot of dead bodies, but when you exhume a body, you're. It's unnatural. You're pulling the casket out of the ground. You're cracking open the casket and you don't know what you're going to find. One time we opened the casket and the maggots inside the casket were jumping out. Like, I can remember them landing on my protective gear on my chest.

AF That is rough. That's like not part of the job description.

So, the caskets get opened, the bodies are removed. Tissue samples are taken out and then sent to the Lab of Last Resort^[127]. Finally – after all this time, Armando and his colleagues start testing their very first patient. And, you know, at this point, if they find Pavillon in these bodies, it really does mean, you know, there was no reason for Pavillon to be in their system unless Efren had put it in there. So they start testing patients.

AA We didn't see anything.^[128] I mean, there was no signal. And so we'd be then the second set of samples for the second patient, and there was nothing there. And then the third one, nothing there. And then I'm thinking, God, what's going on? Is there just nothing in some of these tissues? You start to. Doubt whether you're going to see anything

AF And??

Then they test the fourth patient^[129][130]

AA: I was like, I got something here. There's it's there. And so I ran over to Brian, a guy I pretty much ran over there saying, You've got to look at this. We got to hit on this. It's confirmed it's there. It was, yeah. Yes, we we did it. So then we were we were on a roll and we started looking at various tissues from that individual. And sure enough, we were getting positives, you know, on the kidney, on the on the bladder tissue, on the brain. So all of these that one patient was was hot.

AF: Wow.

WZ Yeah.

They test another body that didn't find it, but then they get another hit and another hit and they tell the cops, you know, this Pavulon, we are finding it. And John remembers how he felt.

 JM: So finding that drug was a huge moment. We kind of erupted in clapping and cheering type of thing. And then finding the drug in multiple patients. That was, the then we knew. We knew we had it.

AF  They did it. They did it. So do they have to go exhume every single patient that he's ever come in contact with? They're, like, hot. Like, where do they go from there?

WZ Yeah. So they picked out the 20 patients that were most suspicious because they couldn't exhume a thousand bodies

^[131]AF: OK

So these are the suspicious cases.

AF And do they think that the others truly didn't have it in their system? like they would have, they would have detected that or they're unsure about the other ones?

WZ I think we don't know. They could have been killed with Succinylcholine instead. Or it could have been that the Pavulon was at too low levels to detect. Or it could be that maybe they the rest of the patients actually weren't killed by it from. We don't know.^[132]That's the thing. When you don't find the chemical, you just don't know what the answer is. But finding the chemical showed that at least with six patients, there was this drug in there.

AF Wow.

Because that's how many patients - that’s how many bodies they found Pavulon –  six of the bodies^[133] – including Jose Alfaro —  who fought in World War II^[134], as well as Salbi Asatryan [ ASA TREE AN]  and Eleanora Schlegel who toasted to the New Year with her son.

And still after this test, the cops actually aren't ready to arrest Efren just yet. Because this was all happening just a few years after the OJ Simpson Trial… ^[135], and that case kinda fell on its face, because the cops messed up, and mishandled evidence ^[136][137] .

So Armando and his colleagues not only did they test the bodies for Pavulon, but all kinds of stuff around the bodies. Cause there was this suggestion that Pavulon could have been in the soil, or would have been in the crypt water or the embalming fluid and then made its way into the bodies. So they test that stuff, everything is looking fine. ^[138][139]

When Ian Musgrave, who is our pharmacologist, read details about their work -- he said – and I have never heard an academic describe a paper like this –but he said it was like seeing an experienced figure skater. Every move is smooth and beautiful.

AF I love that, this one can appreciate the art. Yeah.

WZ Yes

The Sto ry Ends

In January 2001^[140] - this is three years after Efren's first confession^[141] – the cops arrest him on his way to work at a construction site^[142]. John brings him in for questioning. He tells Efren all the evidence they have. That Pavulon was found in six bodies …

JM: Well, we kept asking him, how many do you think you killed? He's very soft spoken and you can barely hear him. I think sometimes he was like writing stuff down and passing notes to us in the in the interview

And, as John remembers it, Efren confesses to killing patients - and at first, he won’t say how many he killed.  And instead he tells John what it takes to kill patients using Pavulon. And he says that with just one vial you can kill a lot of people.

JM Well, I can kill ten people per vial. And I probably had used 10 or 20 vials over the years. And so it was probably 100 to 200.   ^[143][144] …

AF What?

WZ Yeah.

AF Oh my gosh!

WZ Your mouth fell agape when you heard these numbers. Tell me what you're thinking.

AF That's so prolific. Is. And it's a how do you even — has he kept a record of who these people were? How do you even go back and try and find out who they were?

WZ No, he didn't remember the patients. I mean, he even said that he, like, lost count at 60 patients.

AF And and he can't still be saying like, he was like, trying to save them from their own suffering.

WZ So as for the question of why he did it, John actually, when I asked him, the cop, you know, what do people get wrong when they report this story? And he, he got quite passionate and he just said, you know, this case has been reported as an angel of death case - that Efren was trying to reduce their suffering.

AF MM mmm

WZ But for this case, I mean, John says that they were specifically looking for victims who were getting better. You know, like you said, who would Toasting New Year's

AF Yeah.

WZ Who wanted to live. And in that confession room, Efren told John that there was a completely different reason for doing what he did.

JM: He would get irritated that he would have to go tend to a patient. So bottom line with him was every patients were irritants. They disrupted his day. You know, patients in the hospital are very needy and clicking that button a lot. And so he confessed to killing because of workload.

AF Sir, what did you think you were signing up for? Yeah. You could have worn scrubs at home. What the Fuck? I don’t know if I’m allowed to swear on this, but what the fuck? Yes.

WZ Yeah.

AF What?

He told the police that quote -  “It was not something that gave me joy,” And then he said quote, “Only when I was only at my wits’ end on the staffing, I’d look on the board. ‘Who do we gotta get rid of?’^[145] 

AF What?!

WZ Yeah, that is so callous

 we talked to Sarah, the science journalist about the victims.

SS: There was one woman who actually survived the attempt^{[146][147][148]} because he didn't give her enough. And she pressed the call button too much and annoyed him. And so he dosed her.

AF Is like that. Does it even like. That doesn't even, like, register. I just. Like, can someone be that cold? It almost would make more sense if he did, you know, get some kind of, like, joy or something from the actual killing like that almost makes more sense to me than just being like, well, too many people today. So like, which one's going to lose their life so we can, like, have a manageable schedule?

WZ Yeah.

Efren took a plea deal and was eventually convicted of killing the six patients that Armando and his colleagues found Pavulon in^[149][150]. Efren was sentenced to six consecutive life terms without the possibility of parole for the murder counts and 15 years to life for the attempted murder of Jean Coyle, who was the woman who survived.^[151]

And there’s this extra weird twist to this story, Ashley … Because if Efren had gone to trial, instead of taking a plea deal - he might have faced the death penalty.^[152] And at that time, if he got the death penalty — Ashley – do you want to guess?

AF They would have used the same drug

WZ Yes, one of the drugs they would have used to kill him was Pavulon.^[153][154]

AF Wow

So Ashley – that is the case of how some nerds used some smooth and beautiful moves to catch a killer…

AF I love it!

WZ Science saved the day

AF Yeah. I mean, I think science is always saving the day, right? Like in the world that we live in. And I love this because I love the idea that, oh we didn't know what to do, the test didn't exist. And so instead of being sorry, there's nothing to do, that doesn't mean it can't happen. Science is like happening all the time around us. If we like, make it happen, just because a test doesn't exist today doesn't mean it won't tomorrow. 

WZ Yeah exactly Thank you so much for joining us on the show

AF Thanks for having me

CITATIONS — Sarah Scoles' Book is "Countdown: The Blinding Future of Nuclear Weapons"

CREDITS

This episode was produced by Ekedi Fausther-Keeys and Joel Werner, with help from Wendy Zukerman, along with Meryl Horn, Rose Rimler and Michelle Dang. We’re edited by Blythe Terrell. Mix and sound design by Sam Bair. Fact checking by Diane Kelly. Music written by So Wylie, Bobby Lord and Bumi Hidaka. Thanks to Roland Campos,

Steve Wampler,  Audrey Williams,  the audiochuck team, Jasmine Kingston, Connor Sampson, Stupid Old Studios, and Penny Greenhalgh.

Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications.