‘He was killing through­out’

Author pieces to­gether case of se­rial-killer nurse

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joe Carl­son

Edi­tor’s note: In The Good Nurse, jour­nal­ist Charles Grae­ber chron­i­cles the story of crit­i­calcare nurse Charles Cullen, who killed more than three dozen pa­tients at nine hos­pi­tals in New Jersey and Penn­syl­va­nia dur­ing the course of a 16-year ca­reer. Those are the deaths that can be proved—ex­perts Grae­ber in­ter­viewed say the real toll may be much higher and never known. The book doc­u­ments re­peated fail­ures by hos­pi­tal ad­min­is­tra­tors to stop Cullen as sus­pi­cions arose from a pat­tern of poi­son­ings, un­ac­counted doses of lethal med­i­ca­tions and elec­tronic records that put Cullen at the scenes of the crimes. Mod­ern Health­care re­porter Joe Carl­son talked to Grae­ber about what he learned from six years re­search­ing the book, in­ter­view­ing dozens of first­hand wit­nesses and par­tic­i­pants, in­clud­ing jail­house in­ter­views with the killer him­self. Here is an edited ex­cerpt: Joe Carl­son:

Why do you think it is so hard for ex­ec­u­tives, lawyers and ad­min­is­tra­tors at hos­pi­tals to go to the po­lice at the first sign of an in­ten­tional killing, let alone a pat­tern of killings? Charles Grae­ber:

I have to be very fair in say­ing that it’s be­yond the imag­i­na­tion, or at least re­quires a great deal of imag­i­na­tion for any ad­min­is­tra­tor, let alone any­one else, to ever think that their nurses are killing their pa­tients. That’s not the first thought that comes to mind, cer­tainly not that it’s in­ten­tional, cer­tainly not that you’re deal­ing with a se­rial killer.

The other larger point, though, is that hos­pi­tals are busi­nesses. They have a ten­dency to be­come worlds in them­selves, shut off from the out­side try­ing to deal with their prob­lems in­ter­nally, and largely for fear of—were it to ever go ex­ter­nal—li­a­bil­ity. And li­a­bil­ity is a real con­cern. Carl­son: “

60 Min­utes” had a fea­ture on this story re­cently, and they were able to in­ter­view Cullen as well, and I was struck by some of his words. Cullen said, “I think you can say I was caught at St. Barn­abas and I was caught at St. Luke’s. There’s no rea­son that I should have been a prac­tic­ing nurse at that point.” Yet he left St. Luke’s with­out even so much as a bad job ref­er­ence and went on to kill more than a dozen other peo­ple. Is it fear of neg­a­tive pub­lic­ity, or is it this fear of lit­i­ga­tion? Grae­ber:

That’s part of what took so long re­search­ing this book—re­ally try­ing to lay those facts out cleanly, so that the reader could de­cide, the pub­lic could fi­nally un­der­stand what that process was. When I started meet­ing with Char­lie Cullen a lit­tle more than six years ago, he was very up­front about the fact that he had been caught be­fore, par­tic­u­larly at those hos­pi­tals. There were sev­eral other in­stances.

Six­teen years and nine hos­pi­tals, a lot hap­pened to him and he was killing through­out. But the St. Luke’s ex­am­ple is, I think, a par­tic­u­larly oner­ous one. That was more than a fail­ure of imag­i­na­tion, I think. He was caught stash­ing empty bot­tles of danger­ous drugs at night. They knew that it was him that had been do­ing it re­peat­edly. The other nurses were very con­cerned about the mor­tal­ity rates. The ad­min­is­tra­tion has since de­nied that as­pect. They con­fronted him, al­lowed him to leave that same night with neu­tral ref­er­ences and didn’t re­port it. Carl­son:

A lot has been made of the fact that the hos­pi­tals didn’t seem to warn one an­other about Cullen dur­ing the job screen­ing process be­cause of le­gal reper­cus­sions for giv­ing out bad ref­er­ences. Isn’t there any le­gal risk in not telling an­other hos­pi­tal that their job can­di­date was let go for rea­sons like sus­pected harm to pa­tients or even just mis­use of med­i­ca­tions? Grae­ber:

The neu­tral ref­er­ence is a stan­dard cor­po­rate pol­icy through­out many in­dus­tries, and the rea­son is fear of be­ing sued for li­bel. And the flip­side of that is you don’t want to be black­balled be­cause of some in­ter­per­sonal is­sues that have noth­ing to do with true job per­for­mance. It’s a mat­ter of try­ing to shift the power, or keep the power, from be­ing en­tirely in the hands of ei­ther side, par­tic­u­larly in a small com­mu­nity. Hav­ing said that, they are com­pletely abused here, and there is a li­a­bil­ity in not in­form­ing a hos­pi­tal if you sus­pect some­one’s been harm­ing your pa­tients.

The hos­pi­tals main­tain that they did not have rea­son to be­lieve that Charles Cullen was harm­ing any of their pa­tients. St. Luke’s Hos­pi­tal did re­port even­tu­ally to the nurs­ing board that they couldn’t say for sure what he had been do­ing with th­ese di­verted med­i­ca­tions. Carl­son:

It seems like that might be a con­flict of in­ter­est, though, to ex­pect a hos­pi­tal to do a thor­ough in­ter­nal in­ves­ti­ga­tion to dig out in­for­ma­tion that could even­tu­ally be used to harm its rep­u­ta­tion. Grae­ber:

Absolutely. It’s a hor­rific sit­u­a­tion all around for all in­volved. You don’t want the killer to be there. You don’t want any­one to have been harmed. You don’t want to harm the rep­u­ta­tion of a fine hos­pi­tal or en­dan­ger the jobs of the fine men and women who work there and work hard there ev­ery day sav­ing lives, or to wrongly ac­cuse some­body. Carl­son:

In an ex­cerpt from your book that con­cerns Dr. Steven Mar­cus, who at the time was the di­rec­tor of New Jersey Poi­son Con­trol, you write: “Mar­cus knew of sev­eral cases in which hos­pi­tal staff mem­bers had poi­soned pa­tients—some in the lit­er­a­ture, oth­ers that he had worked on per­son­ally. They called th­ese killers An­gels of Death. All of those cases shared a sim­ple but dis­turb­ing pat­tern. Each time the doc­tors treated the rash of crash­ing pa­tients like a dis­ease to be stud­ied while the ad­min­is­tra­tion and the lawyers treated them as a po­ten­tial law­suit. The in­sti­tu­tion dragged its feet be­fore call­ing the cops, and while they dragged, peo­ple died.”

Do you think there are other Charles Cul­lens work­ing in hos­pi­tals to­day? Grae­ber:

I’d like to think not. I know that with some of the in­creases in tech­nol­ogy, greater ac­count­abil­ity for danger­ous drugs and even non-danger­ous drugs—any drug in suf­fi­cient quan­ti­ties is po­ten­tially lethal—and bet­ter over­sight, that this is not a sit­u­a­tion that we should be para­noid about. … But I don’t think it’s some­thing that we can let our guard down for. And I’m hop­ing that this book will pro­mote greater dis­cus­sion on that same is­sue.

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