On Sunday, November 16, 2003, Discovery Channel aired a two-hour presentation, "The Angel of Death," recounting one of the most horrifying and destructive events ever to take place in a Seventh-day Adventist hospital. "Angel of Death" is the title Efren Saldivar, a respiratory therapist at Glendale Adventist Medical Center (GAMC), applied to himself after he murdered an unknown number of patients.

No one is sure exactly when Saldivar began to practice his nefarious interventions. What is known is that he received his respiratory therapist credentials in 1989, and he was arrested in January of 1998, released for lack of evidence, rearrested in 2001 and convicted of murder and sentenced to prison in 2002.

From the time of his first arrest, when Saldivar confessed to the murder of more than 50 patients (which he later denied), until his conviction for six murders, authorities investigated more than 230 potential homicides, disinterred 20 bodies from five cemeteries, and examined more than 2,000 medical charts. It is doubtful anyone will ever know how many people he killed, authorities say.

Saldivar's methods for taking life were difficult to trace. Evidence exists that he injected patients with two muscle relaxants, succinylcholine chloride and Pavulon. The first chemical rapidly breaks down in the human body, but the second persists.

The question that begs answer is, "How could this have happened?" There are no simple answers.

Suspicion was first raised about Saldivar when a GAMC employee reported that he suspected Saldivar had killed a patient. Administrators began to examine the therapist's behavior and conducted a statistical study to determine whether a higher incidence of deaths occurred when Saldivar was on duty. No deviations were found. People were assigned to monitor Saldivar, but they did not observe any suspicious activities.

About a year after the first accusation, an individual called to say he heard that one of the medical center employees might be killing patients. When administrators asked for his source, he named a different GAMC employee from the first accuser. Immediately they decided to contact the police.

This led to Saldivar's arrest. He confessed to the police, then recanted and claimed innocence. The police released him for lack of evidence, but he was fired from the hospital. The police continued to look for evidence for two years, found it, arrested him again, and put him up for trial. He pled guilty and was sentenced to six life sentences without parole, one for each of his confessed killings, as well as "15 years to life" for trying to kill a seventh person.

These are facts of the case that anyone can find by typing in "Angel of Death" on a web search engine. But there is more to the story than a recitation of facts. Some may find it significant that no one knows for sure where Saldivar procured the drugs he injected into patients. He told investigators that he got drugs from another hospital where he also worked because they were easier to get there. Others may take comfort in knowing that Efren was not nor ever had been a member of the Seventh-day Adventist Church. The hospital administrators' response to the unfolding crisis is another important factor.

Fighting or fleeing are the first and natural response choices most living creatures make when under threat. Glendale Adventist Medical Center administrators and its governing board resisted these tropisms. Early on they decided to get out the truth; nothing could be held back. They also decided to present the worst and most damaging data first. In this way, they believed, the hospital could control the information stream and assure authorities and the media that they were committed to sharing the whole story.

The administrators pledged to law enforcement officers that they would cooperate in every way. They provided a house to the Glendale police on the GAMC campus. This became the 24-hour-a-day investigative command center.

The day GAMC called the first press conference to brief the media on the unfolding events, dozens of TV trucks jammed the area around the medical center. News helicopters filled the skies overhead. Reporters crowded into the room to demand answers. Mark Newmyer, at the time a GAMC hospital vice-president, had been assigned the role of hospital spokesperson. To prepare him for the media frenzy that lay ahead, he had been put through intense mock press-conference grilling. This experience had prepared him for the reporter's harsh and at times hostile questions. Through it all, Mark stuck by the rule: tell the truth.

The media circus was but a minor part of the unfolding events. The more critical concern to the health professionals was to maintain patient and community trust and to care for the families whose loved ones may have been killed by a hospital employee. GAMC announced to its employee family that volunteers were needed to meet with those in the community who were affected by Saldivar's actions. The medical center worked with the Red Cross, Delta Airlines and other organizations to help develop a training program for the GAMC counselors as they met with distraught and angry families. Each counselor was given emotional and financial resources to apply as needed. For example, each counselor could, at their discretion, dispense up to $2,000 for any reason to meet family needs. If more money was needed, the counselor had only to make a request.

Patient and community support remained strong during the four-year investigation. Community trust remained high. The Glendale City Chief of Police wrote to hospital administrators that he needed a knee replacement and that he would have it done at GAMC.

Not all who were affected by the events were mollified. Lawsuits did result and some are still pending. But the medical center is doing well; community support remains high and staff morale is strong.

Newmyer announced at the first press conference back in 1998 that Efren Saldivar had been dismissed from the hospital staff and that all other respiratory care practitioners were removed from their jobs until each was cleared for return to work. This action was in response to media statements that other respiratory therapists might have known what was going on, or were potentially involved in taking patient lives.

Those early decisions for truthfulness and openness paid off, as had been the case with Johnson and Johnson's response to the Tylenol tampering case years before.

GAMC's response to the "Angel of Death" event has the potential to be the benchmark for health-care institutions, just as Johnson and Johnson is the benchmark for corporate crisis management. It is a story other organizations need to hear and to heed, including the church that shares the name with Glendale Adventist Medical Center.

Larry Downing, D.Min., is senior pastor of the White Memorial Church in Los Angeles. He also teaches in the La Sierra University School of Business and Management.