“And these are lawyers,” Tim said. He was driving hard, flashing cars out of the fast lane. “What else are they good for, except making paper? How did they even do the billing?”
“Maybe they just don’t wanna look stupid,” Danny said. “Show a couple detectives how bad they fucked this thing up.”
Tim could imagine it—Rocco, the private investigator, looking through those medical charts, probably making as little sense of it as they did. It was a nice picture, but it didn’t change the facts.
They’d given them nothing but a memo and a name: Charles Cullen. An “odd duck,” who wasn’t a suspect. A guy with red flags in his past. Danny sat, watching the highway, wondering why they’d given them that, if they didn’t have anything else.
35
Danny took the morning, driving west to Pennsylvania to the Pennsylvania State Police barracks. He was briefed for several hours by Corporal Gerald Walsh and State Troopers Egan1 and Bruchak, soaking up all he could about their investigation into Charles Cullen and the incidents at Saint Luke’s Medical Center. He was back on 78 East in time to meet Tim and talk it out over late lunch. They chose the diner this time, taking a booth in back where Danny could lay it out. The investigation in Pennsylvania was barely a year old, and it had been a whopper. They had bodies, physical evidence, dozens of cooperative witnesses, and a strong suspect—everything a homicide detective could want in a case, except a happy ending.
According to the Pennsylvania State Police file, it wasn’t the Saint Luke’s administration that had called the cops, it was a Saint Luke’s nurse named Pat Medellin. She had seen some unusual deaths on her unit at Saint Luke’s, and she had also seen Charles Cullen marched out for diverting dangerous meds. Medellin felt certain that Cullen was responsible for the unusual deaths on the unit, and pressured the hospital administration to do something;2 the Saint Luke’s hospital administration told Medellin that Cullen had not harmed any patients. Their investigation into the matter was closed.
Pat Medellin wasn’t satisfied with that answer. On August 29, 2002,3 Medellin stepped out and told her story to an acquaintance who worked as a cop with the Easton, Pennsylvania, Police Department.4 It snowballed up the command from there: the cop told his captain, the captain pushed it to the coroner, the coroner carried it to the office5 of Lehigh County district attorney James B. Martin.6 One by one, the Pennsylvania state troopers called the Saint Luke’s staffers to the carpet.7 Their stories of death on the night shift were damningly consistent.
Many mirrored that of Nurse Lynn Tester,8 who noticed that “people on the mend” had been dying, suddenly and strangely, and soon after Nurse Cullen changed their IVs.9 Nurse Robin Saulsberry observed Charles Cullen sneaking from her patient’s room shortly before her patient unexpectedly coded and died; Saulsberry later shivered when she recalled how Cullen had watched the unit’s EKG monitor, too transfixed to even look away when he spoke. Saulsberry, who held a PhD in chemistry, strongly believed the patient had been given Pronestyl—the drug Cullen was discovered to have dumped from the med closet shelves.
She was certain more patients were coding and dying since Cullen had begun on the CCU. Nurse Tester calculated that while Cullen worked only 26 percent of the hours, he was somehow on hand for 58 percent of the deaths.10 Another nurse11 recalled that when Cullen worked the CCU, they’d average twenty to twenty-two Code Blues a month, but after Charlie left, they didn’t have a code for six months.12 Charged by the state, coroners Zachary Lysek and Scott Grim had gone to work on a caseload of medical charts; privately, Lysek worried how many deaths Cullen might ultimately be responsible for; for all he knew, it might be fifty; then again, it might be none. He had his suspicions, but speculation was useless, even dangerous, in such a situation. Certainty could only come from the science. To that end, the DA had hired an outside medical pathologist, Dr. Isidore Mihalakis—the same doctor involved in the investigation into Helen Dean’s suspicious death at Warren Hospital years before. Dr. Mihalakis spent months reviewing the charts of seventeen patients that Saint Luke’s had selected, but found nothing prosecutable in the paperwork. Meanwhile, Charlie Cullen had moved on, with neutral references, to Somerset Medical Center.
Cullen’s personnel file at Saint Luke’s presented a simple and unremarkable story of a nurse who resigned after being repeatedly reprimanded. “Charles resigned” was the way it was phrased in the Employee Change of Status Record. “Would not consider for rehire—medication issue.” The words vecronium bromide or vec never appear, nor do the names of any of the other powerful drugs that Cullen had stashed and used. It was easy to understand that Saint Luke’s administrators did not have the sort of concrete evidence required to conclusively determine that their nurse had definitely and intentionally administered an overdose to a specific patient. At the same time Danny Baldwin and Tim Braun couldn’t help but notice that whether by design or accident, Saint Luke’s Hospital had consistently dealt with the Cullen problem in a manner that created the fewest possible legal ramifications for themselves and the slightest possible paper trail for others.
Tim Braun and Danny Baldwin had worked hundreds of cases and seen as many variables on the means and motives of murder. None provided the slightest context for this. DA Martin’s investigation was a shocking document, but it was the final page that surprised the detectives the most. Only five months before Braun and Baldwin started their investigation,13 the Lehigh County DA had closed his. Eight months of work had been, from a prosecutorial standpoint, a waste of time and paper.14
Why would DA Martin drop the case against Cullen? The most obvious answer was that he didn’t believe he could win it. Could he even prove he had a victim, much less that Cullen was to blame? Braun tried to imagine the next eight months: traveling the same road with fewer resources, no witnesses or evidence—and, somehow, reaching a different destination.
Danny had no choice but to start back in on the medical reports. Danny spread the files across a table in the conference room. Each of the six potential victims had a file, mostly scribbles and printouts tracing their progress, prescriptions, and decline. The medical Greek was starting to make some sense, thanks in part to hours spent flipping through a Physician’s Desk Reference and the patience of Danny’s OB/GYN wife, Dr. Kimberly Baldwin. But even clarified into laymen’s terms, the charts and lab reports were little use. The hospital had already told them as much: the dig had somehow gotten into the patients, and it was apparently in their labs. But it wasn’t in their charts. The smoking gun was nowhere on these pages. That was the whole point.
The dig might not be the smoking gun, but they were fairly sure it was Cullen’s murder weapon. It was useful to think of the dig in a syringe, loaded and pointed at someone. Picturing the weapon like a gun made this medical murder stuff less abstract.
Like any other weapon, the dig had to come from somewhere. The most obvious source was the medical cash register machine—the Pyxis drug dispenser on the CCU floor. The record of that withdrawal should have been recorded in the Pyxis records. But here, the detectives had another dead end; Mary Lund had already told them Gall’s death was over thirty days old, so those records didn’t exist anymore.
“But somebody saw them,” Danny said.
“What do you mean?”
“The Pyxis records. When Gall died, they knew he was a digoxin OD, right? They must have looked at his Pyxis. For when they called in the lawyer, talked to Cullen.”
“This is from the pages we got, what Fleming faxed Mary Lund.”
“Right,” Danny said. “The interview.” Danny squared the paper to Tim and fingered the sentence:
“ ‘Mr. Cullen was aware that requesting medication from the pharmacy would show up on the Pixis [sic] computer including cancellations.’ ”
“Yeah, what the fuck is that about?”
“Dunno,” Danny said. “But they’re looking at the Pyxis.” That interview with Cullen was July 14. It was within Lund’s thirty-day Pyxis window.
/> “So the lawyer and Lund had access to his Pyxis report,” Tim said. “They’d seen his drug pulls from the night Gall died?”
“That’s how I read it,” Danny said. That would make sense. They would have been looking for the smoking gun, too—maybe Cullen ordering huge amounts of dig, or for suspicious patterns in his activity. And for whatever reason, they were focused on his canceled orders, too. So where were those Pyxis pages now?
“Their investigation was ongoing until the day they called us,” Tim said. “You’d think they’d have a file.”
“Yeah, well,” Danny said. They’d been down that road. “Maybe they just looked them up on the computer, never made a printout.”
“Yeah, maybe,” Tim said. It sounded like bullshit to him, but so many things did in this case. As far as they were told, Cullen wasn’t a suspect, the paperwork never existed, and, apparently, the Pyxis showed nothing interesting anyway. He read the words again, out loud. “ ‘There was nothing so overtly suspicious… that would necessitate a call to the authorities.’ ”
“Meaning, there was no reason to call the cops.” Danny said. “It’s like they were thinking about it five months ago, asking and answering the question.”
Tim was finding this investigation uncomfortably familiar. Homicides and hospitals and suspects they couldn’t figure a way to touch—the connections between this redball and the Duryea case would catch him in the shower or the car, conjuring the cold-case file box stuffed in his closet, and a feeling he didn’t want to name. The Duryea case had stung him, sent him scurrying toward the refuges of apathy and retirement, but it was hard to be indifferent when the clock was ticking. Tim was convinced it continued to tick every night that Cullen returned to work. It was still ticking now.
That afternoon, Danny Baldwin paid a visit to Mary Lund. He told her that their nurse Charles Cullen had a criminal record and a checkered work history, which included several hospitals that had fired him for nursing-practice issues, and that Charles Cullen was, at this point, a strong person of interest to the Somerset County Prosecutor’s Office. Danny needed the hospital’s mortality rate on Cullen’s wards, and he needed Cullen’s work schedule for that year, too. He knew a request like that would tell the hospital who they were looking at, but they had no choice. There was no access to the hospital except through the front door.
Lund assured Danny that the hospital would take measures to closely monitor Cullen while on shift. But Danny knew watching this guy wasn’t going to be enough. If their investigation was going to catch Cullen, they’d need to come up with something no previous investigation ever had. At the moment, they had no idea what that was, or how to get it.
Charlie had figured out months before that he was going to have to abandon some of the ways in which he usually got his drugs. He knew it even before the meeting with Fleming on July 14. He didn’t need a corporate lawyer to spell it out for him.
He had been a nurse for fifteen years. He had seen the Pyxis arrive and he’d seen it change. Now digoxin would be treated with the same security protocols previously reserved for narcotics like OxyContin or morphine. They’d already taken those precautions with insulin. His actions were subtle, his effects public. That affirmed him. That pleased him.
One of those effects was the investigation. Charlie had been through several, and they were each, in a way, affirming. The process rolled out as a slow-motion game of hide-and-seek. Charlie found that the lawyers told you where they were going to look. And then, eventually—Boo!—they looked there. End of game.
He was aware that Reverend Gall’s death had thrown up red flags. Obviously the man was important, a reverend, and the consequences would outlive him. Somewhere, surely, a whole congregation was swaying like wheat before the wind. They’d been noticing his canceled drug orders on the Pyxis as well. So Charlie decided: no more canceled dig orders for him. In fact, no more dig orders. He would never order dig at Somerset again, even if he had a patient for whom it was required. Another way to show them. To ride one-handed. He’d played this game before. He adapted quickly. In fact, only the day before his chat with the lawyer Charlie had used dobutamine and it worked fine.15
Charlie had discovered long ago that when you change the contents of the IV bag, you change the man—simply cause and effect, with Charlie starring as the cause. There was no reason for him to stop.
36
Their grunt work had yielded red flags in a half dozen counties, a strong person of interest in Charles Cullen, and a growing mountain of paperwork. In squad meeting that day, Tim filled in the larger Somerset County Prosecutor’s Office team on Danny’s investigation, one that had already flooded beyond the tidy bounds of Somerset Medical Center and was expanding rapidly across hospitals and state lines. And yet they had no hard evidence, and no case. In order to make one, they’d have to sort through every piece of information they could gather in every jurisdiction, and hope to piece together a pattern. Tim told his prosecutor that the fastest way to do that was to form a task force.
Tim outlined his thinking for Prosecutor Wayne Forrest, starting with the limitations of the Somerset County Prosecutor’s Office. The SCPO had never before taken on an investigation of this scope, and they weren’t outfitted for it. This redball was a type of investigation nobody in the office had any experience with; added to their usual nine-to-five police work, it threatened to overwhelm their tiny office and jeopardize the case. A task force would allow Tim and the SCPO to piggyback on other counties’ manpower and resources, including a hot new piece of FBI software called Rapid Start, which consolidated a sprawling pool of data into one searchable database. Tim heard Prosecutor Michael Rubinaccio’s office had it over in neighboring Morris County, as well as a girl who was whiz-bang with it. For gathering and connecting dots, a bigger team and better software seemed infinitely more efficient than flipping through notebooks in a conference room. But it also meant opening up their investigation to join forces with detectives from other counties, in other prosecutors’ jurisdictions. It meant giving up solo possession of the redball.
Forrest wasn’t interested. In fact, to Tim he seemed angry at the suggestion. Tim followed Forrest to his office after the meeting broke up, but the fifteen minutes spent making this point behind his boss’s closed office door got him nowhere. This was their case, Danny was the lead, it was Forrest’s call. They weren’t sharing it, period.
That afternoon, Somerset County detectives Douglas Brownlie, Nick Magos, Stuart Buckman, and Edward Percell all filed into the twenty-four-hour diner behind Danny and Tim, six armed guys in crew cuts and ties eyeing the rotating pie case. They took the usual table in the back. This was as close as they were going to get to a task force.
Brownlie and Magos could keep chasing down details at the hospitals. They could start the paper on the subpoenas, working with Assistant Prosecutor Tim Van Hise on pulling personnel files and old investigations and whatever else they could find. Buckman and Percell would help with still more loose ends, pulling the bulk of Cullen’s family-court file over at Warren County, chasing nursing records from two states, doing legwork canvassing Cullen’s coworkers. Meanwhile, Tim and Danny would stay focused on the case at Somerset.
The problem was, whatever happened to the Somerset Medical Center patients was apparently locked up in the mysteries of medicine, and Tim and Danny didn’t have a clue about that stuff. Somerset Medical Center was full of experts, but their five-month internal investigation had yielded exactly four pieces of paper and no answers. They knew that the patients had been poisoned, with drugs; but Mary Lund couldn’t offer any drug records from the Pyxis, Paul Nittoly couldn’t offer any interviews or background, and nobody seemed to have any physical evidence. They were running out of places to even investigate.
As for the victims—right now, they still didn’t even have one, not technically. The ODs at Somerset weren’t confirmed homicides; they were “incidents” and “unexplained medical occurrences,” only potentially related to a bunc
h of screwy numbers on some lab reports that any defense lawyer who’d ever won a drunk driving case could easily dispute. All they had was Charles Cullen. The evidence that Charles Cullen was involved with incidents at other hospitals was circumstantial at best. They had no evidence against him at Somerset. All their background research pulled up were approaches that had failed. They needed another source, and some paperwork that mattered.
During their initial briefing from the Somerset Medical Center administrators, Dr. Cors had told them that in addition to calling in the police, they’d also notified the appropriate state medical departments. Danny put in a call to the New Jersey Department of Health and Senior Services, what everyone else called the New Jersey Department of Health, or DOH.1 His calls bounced between DOH Investigator Edward Harbet, Investigator Kathey Demarkey, and Assistant Director Alma Clark, but didn’t yield anything beyond confirmation that the DOH investigation had uncovered some issues at Somerset. Danny thought it logical to join forces and share information with the state agency. But the DOH rep couldn’t provide any further information without a subpoena, which would take time.2 Meanwhile, the DOH investigation had been turned over to something called the Center for Medicare/Medicaid and Social Service. That sounded to Danny like some sort of licensing issue rather than anything homicide related.
There had to be a way to go over the heads of the DOH.
Danny dug back through his original notebook, flipped to page one. “Okay, so, Cors said Somerset had alerted the DOH about these incidents. Blah blah—here. He says they also called the State Nursing Board.”
“We’ve got a call already in,” Tim said. “Same issues as the DOH.”
“And he also said, ‘The New Jersey Department of Poison Control was also involved in this matter.’ ”
“Okay,” Tim said. “They reported the same shit there. When was that?”
The Good Nurse: A True Story of Medicine, Madness, and Murder Page 16
