He did not use a gun or a knife. He used a syringe, filled with lethal drugs. Efren Saldivar was a basically trained Respiratory Therapist, with only eighteen months training, who was left in charge without supervision of patients in intensive care, on life support systems, some bound to their beds to prevent injury from falling. The American Health Care System allowed this man to hold the life of his patients in his hands. But Efren was a deranged serial killer. Worse still, he influenced at least two other co workers to also kill helpless patients. A numerological profile and account of the man who may have killed more innocent people than any other American serial killer.