mary lund somerset

How did sometime nurse Charles Cullen get away with murdering dozens, and perhaps hundreds, of patients during his sixteen-yr career? The new Netflix documentary "Capturing the Killer Nurse" places the blame squarely on hospital administrators determined to put the interests of their institutions alee of patient care.

The documentary, which is based on journalist Charles Graeber'southward volume, The Skilful Nurse, tells the story of how Cullen was able to move from hospital to hospital, even when he'd been suspected of causing patient impairment. In some instances, he was fired, merely was even so given proficient references so he could get a chore with a new employer.

Graeber said in the documentary that Cullen was "caught over and over and over again. ... Those who defenseless him or had a reason to suspect that something was incorrect, passed him on with positive or neutral references, and he always constitute some other job. That's the scandal."

The same may accept happened at Somerset Medical Eye in New Bailiwick of jersey, merely officials at the New Jersey Poisonous substance Command Centre who learned of four suspicious deaths at the infirmary pushed its administrators to brand a report, Steven Marcus, MD, director of the center at the time, told MedPage Today in a previous interview.

In the documentary, prosecutors said 3 months passed betwixt the poisonous substance command center's warning and the hospital making a study to the Somerset County Prosecutor's office. The hospital made the report subsequently conducting its own internal investigation, which detectives asked to review.

"I was expecting a binder," Detective Danny Baldwin said in the documentary. "But it was a document written by an attorney."

It did, however, mention the name of i nurse who'd been questioned -- Cullen. Detectives conducted a background cheque and institute Cullen had two arrests in the 1980s, for drunk driving and for criminal trespass. When Baldwin and Detective Tim Braun called Pennsylvania State Police for more data about those arrests, they discovered a detective there had already been looking into Cullen after medications went missing from St. Luke'due south University Hospital in Bethlehem.

Missed Opportunities

The case had been brought to Pennsylvania detectives' attention by a St. Luke'due south critical care nurse, Pat Medellin, who was on duty when Cullen had been escorted out of the hospital and was asked to resign.

She thought back to a fourth dimension when two patients who'd been very stable had coded within a week of each other. Medellin so looked at the records for 67 deaths, and calculated that Cullen shouldn't accept been on duty for more than a quarter of them.

She found he was on shift during 40 of those deaths -- more than than twice the number that would brand sense, Medellin said in the documentary.

When she reported this to her managing director, she said she was met with deprival. So she fabricated a written report to Pennsylvania State Police, but the investigation was slow and ultimately closed without evidence of wrongdoing on Cullen's part.

Medellin alleged that St. Luke'south was attempting to borrow money for the construction of a new site, and any tarnish on their tape could have stopped the project from moving frontwards, so it was easier to allow Cullen move on.

"They had a bond rating out for a whole new campus at the time," Graeber said in the documentary. "They just wanted him out of there as quietly every bit possible ... to minimize the danger of a lawsuit. They protected the institution at the cost of protecting the patients."

In some other case at St. Luke'due south Warren Hospital in New Bailiwick of jersey, a patient charged that a nurse injected his mother, Helen Dean, just before her death. An internal investigation turned up no evidence of wrongdoing, and in one case over again Cullen was allowed to motion on, according to the documentary.

Pyxis Reports and a Cloak-and-dagger Weapon

Detectives Baldwin and Braun were concerned that their investigation could end up at a like conclusion, with no evidence of harm. So Baldwin decided to focus on data from the infirmary'south Pyxis machines.

When hospital risk manager Mary Lund told Baldwin that the machines but stored data for 30 days, he suspected she was lying. A call to the manufacturer revealed there were no limits to data storage.

With those records in hand, prosecutors too fabricated the infirmary enlightened of a discrepancy on Cullen'south employment application, which the hospital used as a basis to fire him.

While that took Cullen abroad from patients for a while, he continued to await for new jobs, so detectives knew they would need something stronger to keep him out of hospitals.

That's when they met critical care nurse Amy Loughren, who had been close with Cullen during their time at Somerset. While she initially dedicated her friend, her perspective changed when Baldwin showed her the Pyxis paperwork.

"Information technology was so obvious that in that location was something sinister in that paperwork," Loughren said in the documentary. Cullen manifestly would open the machine to accept out potentially deadly medications, so cancel those transactions.

The revelation fabricated Loughren think dorsum to a code bluish, where she discovered Cullen standing over the patient and pushing lidocaine. When the resident arrived at the code, he said the patient was allergic to lidocaine.

"I walked in on him murdering someone and I didn't meet it," Loughren said.

At that moment she decided she would cooperate with law enforcement, and she concluded up becoming their most valuable asset. For one, she printed out records from patient charts when no i was looking -- at great personal risk.

"I had a lot to lose, a career, a family," she said. "I had cardiomyopathy, I was worried about being disabled and not existence able to have insurance."

The records helped, as did the family unit of a patient whose death at Somerset Medical Center was considered suspicious. The sister of Father Francis Gall allowed her brother's trunk to be exhumed to measure digoxin levels, which turned out to be excessively loftier.

Still, prosecutors had no confession, which would solidify their example. That'south when Loughren agreed to meet Cullen while wearing a wire.

When Loughren told him that she knew he killed Father Gall, she said his whole demeanor inverse. He replied that he wanted to go down fighting, and that was enough for detectives to arrest him.

He wouldn't confess to them, though, so once again, they relied on Loughren. They brought her in to the interview room, where she told Cullen that she had been implicated in the crimes. He would be the only ane who could exonerate her.

She asked how he killed Father Gall, and he admitted to doing and then with digoxin. The detectives took it from at that place, and on Sunday, Dec. 14, 2003, Cullen admitted to killing up to 40 people -- though experts suggest it was likely that he killed some 400 people.

Property Hospitals Accountable

Without the criminal case, Cullen may have just gotten a chore at some other hospital, where he could have kept on killing patients.

Bruce Ruck, PharmD, of the New Bailiwick of jersey Poison Command Center, described hospitals' motives in the documentary this manner: "The hospital is afraid of being sued. Doctors won't bring their patients there, the community doesn't want to go there. The hospital loses coin. The lath starts firing people."

Marcus, the erstwhile toxicant control heart managing director, had told MedPage Today that Somerset Medical Eye was never held answerable for any of the deaths. The hospital was fined, he said, merely that was a slap on the wrist.

New Jersey legislators did try to change the system by passing the "Cullen Police force," which requires hospitals to report any impairment, incompetence, or professional misconduct by any healthcare provider that pertains to patient safety to the state licensing board. Information technology also requires those reports to be disclosed to whatever potential futurity employers.

Still, while Cullen will spend the rest of his life in prison, Graeber noted that "those who were paid big bucks to be responsible accept never been held responsible. They did a very skilful job at their job, which has more to exercise with the institution of private, for-profit healthcare. They didn't practice good."

"They've been rewarded for their success in protecting the institution over the patients," he said.

Kristina Fiore leads MedPage's enterprise & investigative reporting squad. She's been a medical journalist for more a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Transport story tips to k.fiore@medpagetoday.com.