The Good Nurse: A True Story of Medicine, Madness, and Murder

by Charles Graeber

  CHAPTER 6

  1 Details of Cullen’s application process and the events at Warren Hospital come from Warren Hospital’s file on Charles Cullen, police investigation documents, police witness statements, and court records.

  2 The exact dates of Cullen’s termination at Saint Barnabas are unclear, but his interview at Warren Hospital occurred January 21, 1992.

  3 The available records from this time contain Cullen’s inclusion of these references and numbers, but leave it unclear as to whether anyone from the Warren Hospital HR department did call to confirm references at Saint Barnabas Medical Center or Medical Center Health Care Services.

  CHAPTER 8

  1 Details from court documents, interviews with Adrianne Baum, and police reports.

  2 He’d learn later that his mother’s body was still there.

  3 Charlie turned eighteen three months after his mother’s death, and at the Navy recruiter’s suggestion he got his GED. He enlisted in April 1978 for eight weeks of basic training at the Great Lakes training facility in Illinois, then seven months at the Naval Guided Missile School in Virginia Beach, Virginia, followed by three months of submarine school in Groton, Connecticut. He would ultimately be stationed in Charleston, South Carolina.

  4 Several captain’s masts, or disciplinary hearings, stemmed from his refusal to urinate in front of another sailor for the mandatory drug tests; Charlie maintained that while marijuana use was common in the Navy, he never personally tried it or any other illicit substance, and he bristled at the humiliation of exposing himself during public urination. His inability to void publicly would cause him conflict for his whole life.

  5 This included an incident, reported later but unverified, in which one of Cullen’s shipmates reported finding him at the nuclear controls in a full gown and surgical mask from the medical supply closet.

  6 Finally, Cullen was transferred off the sub to a supply ship, the USS Canopus.

  7 Cullen was anxious about his upcoming discharge from service, which was expected to be dishonorable; he told Navy psychiatrists that he wanted to kill himself because he “didn’t want to return home a failure.” In previous alcoholic suicide attempts, the Navy doctors had found him to be sane and fit for service, and they prescribed alcohol counseling and Antabuse. Charlie had used the drug to attempt suicide again.

  8 He was treated for methyl salicylate poisoning.

  9 “Eye contact poor and voice soft,” the physician noted. “Verbalizations concise and evasive.” The physician also noted that Cullen showed poor insight as to his alcoholism, and was passive-aggressive and resistant of ward routine and rules. But soon he became more verbal, particularly about his sense of loss of his mother (with whom Cullen was “unusually close”) and an unnamed fiancée. “He has always been shy with few friends,” the report noted. “He has shown dependency, particularly in relationships with females, becoming intensely involved in a short time.”

  10 Cullen’s older brother, James, who died of a drug overdose in 1986 at the age of thirty-six, had been an apparent suicide.

  11 January 31, 1993.

  12 Civil Action docket no. FM-21-229-93, Superior Court of New Jersey, Warren County, October 19, 1994.

  13 It was located at 263 Shafer Avenue.

  CHAPTER 9

  1 Phillipsburg, Pennsylvania, police records.

  CHAPTER 10

  1 All quotes come either from my interviews with Charles Cullen, from his confession to police, or from Pennsylvania State Police transcripts.

  CHAPTER 11

  1 Of course, Greystone was the “State Asylum for the Insane,” itself an updated version of the “New Jersey State Lunatic Asylum at Morristown.” The name changes provided a coded history of the public perception and private care of diseases of the mind (the term itself a more modern take); it was, by the time of Cullen’s incarceration there, a “psychiatric hospital.”

  2 Sources conflict as to the exact dates of his treatment. On March 24, Cullen was first checked into the Carrier Clinic, in Belle Mead, New Jersey; he was then transferred to Greystone Psychiatric Hospital in mid-April.

  CHAPTER 12

  1 There are other vital signs telemetry can monitor—blood pressure, blood oxygen level, temperature—but the electrocardiogram is the most common.

  2 In Cullen’s accounting, the judge who had ordered him to pay for this was responsible for forcing him back into nursing. Given a free hand, Cullen maintains, he would have quit.

  3 Cullen would later characterize the relationship as romantic but not sexual.

  CHAPTER 13

  1 Statements by Larry Dean and police investigative records.

  2 Larry Dean would die in 2001, still attempting to prove his contention that his mother had been murdered. After his death, his late mother’s blood and tissue samples would be found in his home freezer.

  3 Cullen had given Helen Dean an intramuscular injection that should have taken maximum effect in three to four hours. But Mrs. Dean died the next day, nearly twenty-four hours later and shortly after her release from the hospital.

  4 Det. Richard Clayton and Lt. G. Dundon.

  5 The results of the autopsy of Helen Dean, as written by Dr. M. L. Cowen, Warren County medical examiner: “The injection site was examined for chemicals and toxic substances… the chemistry evaluation was negative… The male nurse suspected of injecting an unknown substance into Mrs. Dean’s anterior left thigh successfully passed a polygraph test indicating that he was truthfully stating that he did not inject Mrs. Dean with a needle.”

  CHAPTER 14

  1 Fair Oaks Hospital (formerly Summit Hospital), Summit, New Jersey.

  2 Police investigative report.

  3 It appears that the Saint Barnabas Human Resources department was never reached by anyone at Hunterdon, but several Warren Hospital employees vouched for him, including Charlie’s nurse supervisor, and the ICU nursing manager. Both gave Cullen positive remarks, his ICU manager adding only that Cullen had left their hospital for “personal reasons.”

  4 Charles Cullen has changed his accounting many times. After his initial confession, he would go back and decide that in terms of actual deaths, he probably was responsible for at least one patient in January. Also, definitely one in April, and yes, another about a week later, then two weeks after that, then two weeks after that—not able to really keep the details, knowing only that all of them would have been injections while he was working in the ICU.

  5 Police investigative records and witness statements, in addition to Cullen’s personnel file.

  6 One patient was later discovered in a room strewn with bloody cloths and empty bottles, naked and oxygen-starved and staring at the ceiling. Physicians contended that these factors contributed to, if they were not responsible for, the patient later suffering a stroke.

  7 The spellings and spacings herein are from the original letter.

  CHAPTER 15

  1 Carco Research.

  2 Police investigation records. The Hunterdon and Warren HR departments both confirmed that Cullen had been employed by them; Medical Center Health Care Services, the staffing agency owned by Saint Barnabas Health Care Corporation, indicated that they could vouch for Cullen being employed there from 1990, but Saint Barnabas itself could not locate a file for Charles Cullen.

  3 From Cullen’s Morristown personnel file and documents from court records.

  4 A short-acting sedative, usually used to initiate anesthesia.

  5 This was Cullen’s recollection, as stated to detectives on December 14, 2003. Cullen believed “there could have been one or two at Morristown,” and that while he “didn’t remember specifics,” he “could have been involved in something there.” Cullen did not provide any further details at that time, and during the subsequent investigation he failed to identify victims among the Morristown Memorial Hospital patient records.

  6 April 7, 1997: “Tammy, I really don’t want to write this, but for the patient’s sake and safety, as well as for
the unit’s reputation. This is just one of many patients who verbalized the same thing. Call me.” This was but one of the handwritten notes, presumably from Cullen’s supervisor or colleagues, found jotted on paperwork relating to Cullen’s employment at Morristown.

  7 This and all subsequent details taken from police investigation report.

  8 $500, according to Cullen’s testimony in police investigation.

  9 This was to be a serious review, and lawyers for Morristown Memorial and the American Arbitration Association exchanged letters in preparation.

  CHAPTER 16

  1 A company called Medical Staffing Network took over for the Health Force staffing agency in 2000, at which point all old employee records were purged from their system.

  2 It is impossible to say exactly when the problems started at Liberty, but Mr. Henry was the earliest Liberty patient with whom Charles Cullen would admit to having “intervened.”

  3 Police investigative records and Pennsylvania State Nursing Board investigative reports.

  4 According to the brief filed by Kimberly Pepe in her lawsuit against Liberty, Henry was taken to nearby Lehigh Valley Hospital after he began having respiratory problems that morning. Hospital officials discovered the insulin overdose. Henry was later returned to Liberty, placed on a morphine drip, and subsequently died. Liberty’s records don’t say if his death was a result of the insulin overdose. Charles Cullen would ultimately confess to being responsible for Henry’s overdose.

  5 Pepe’s suit alleged that administrators at Liberty “intentionally chose to ignore and overlook any evidence pointing to the fact that Cullen may have been the nurse who administered insulin” despite the fact that Charles Cullen’s repeated medication issues had put him under “a cloud of suspicion.” Charles Cullen was not Henry’s nurse that night, but he was in and out of the room frequently for another patient. Pepe also filed a complaint with the Equal Employment Opportunity Commission.

  6 According to a February 29, 2004, New York Times article (“Death on the Night Shift: 16 Years, Dozens of Bodies; Through Gaps in System, Nurse Left Trail of Grief,” by Richard Pérez-Peña, David Kocieniewski, and Jason George), Julie Beckert, spokeswoman for HCR Manor Care (which owns Liberty), would not discuss Mr. Henry’s case, but she denied that Mr. Cullen had been under investigation for stealing drugs. Liberty settled Ms. Pepe’s lawsuit on terms that both sides have kept secret.

  7 Four years later, in January 2002, the Pennsylvania State Nursing Board would initiate a background investigation into Charles Cullen in response to complaints from another incident. At that time, Liberty Nursing and Rehabilitation Center nursing director Dawn Costello was interviewed and asked whether “any drugs or unexplained deaths had occurred during his [Cullen’s] employment.” Ms. Costello replied “No.”

  8 Liberty admitted their investigation into the patient’s death was inconclusive, according to Pepe’s 1998 lawsuit.

  9 A Liberty spokesman stated that Charles Cullen’s infractions were reported to the Pennsylvania Department of Health, which oversees hospitals but not nursing personnel.

  10 Internally, Liberty listed the reason for dismissal as “failure to follow drug protocol.” In 2003, the Express-Times of Easton, Pennsylvania, quoted Liberty spokeswoman Julie Beckert as saying that Cullen was fired in 1998 after he was accused of giving patients drugs at unscheduled times. Beckert said there was no evidence that Cullen, who worked at the center for eight months, had given patients medications they had not been prescribed.

  While giving patients drugs in violation of a prescribed delivery schedule can cause serious harm, Beckert said Liberty was not aware of any cases in which a patient became ill. Liberty said it reported Cullen’s actions to the Pennsylvania Department of Health, which regulates nursing homes but does not have the power to discipline individual nurses.

  According to a story in the December 18, 2003, New York Times,

  the year after Ms. Pepe was fired, she sued the nursing home and filed a complaint with the federal Equal Employment Opportunity Commission. She and the hospital settled her claims in 2001, and the terms of the deal were sealed. Yesterday, through her lawyer, Donald Russo, Ms. Pepe declined to be interviewed, and Mr. Russo said he could not say much about the case.

  But Ms. Pepe’s account is laid out in detail in her original suit and in a statement she gave the employment commission.

  On May 8, 1998, she said, after Mr. Henry was taken to Lehigh Valley Hospital, staff members there called her three times to ask if she had given him insulin, and said his blood-sugar level had dropped to 25—so low that a patient is likely to lose consciousness and may suffer brain damage. Except in rare circumstances, a person’s blood sugar does not drop below 70 on its own. But insulin, a hormone used by diabetics to combat high blood sugar, could force such a drop, with the effect peaking one to two hours after injection. Ms. Pepe said Mr. Henry was not diabetic.

  Ms. Pepe said that when she was asked about the incident days later, a nursing supervisor told her “they were not suspecting me at that time; they were, in not so many words, looking at my co-worker, Charles Cullen.”

  In a statement yesterday, Liberty’s parent company, HCR Manor Care, said, “To the best of our knowledge and according to our employee records, Charles Cullen was not under investigation by the center or outside pharmacy in May of 1998.”

  11 Charles Cullen was employed through Health Force, an agency Easton Hospital used for its staffing.

  12 Details of this incident are corroborated with police witness statements and police investigative records.

  13 Ottomar Schramm had been taken from his nursing home by ambulance with aspirated food in his lungs.

  14 These conversations are reconstructed as recorded from Easton Police interviews with Kristina Toth.

  CHAPTER 17

  1 Northampton County coroner Zachary Lysek didn’t see how Schramm could have been accidentally given a dose of the deadly drugs in his system, and undertook a rigorous eight-month investigation of the death, interviewing dozens of staffers who had been involved with Schramm’s care, both in the nursing home from which he was transferred and at the hospital where he overdosed and died. He was aware from Toth of the mention of a man who seemed to be a nurse, but was unaware of that nurse’s identity. The forensic pathologist found that Mr. Schramm had died of pneumonia with digoxin overdose as a contributing factor, and, as a result, reported that Schramm’s “manner of death will be listed as accidental.” Lysek was still suspicious, but despite his personal opinion, had no evidence to take it further.

  According to court documents and police investigation reports, Lysek was contacted three years later by an unnamed source, who told him that the mystery male nurse Toth had mentioned was named Charles Cullen, and that Cullen might have had some involvement in Mr. Schramm’s death. At this point, Lysek contacted the state police.

  According to Mr. Lysek, he also called Easton to inquire about Charles Cullen’s records there. The Easton administrator looked up employee records and reported that they had no record of having employed a Charles Cullen. While of little help to Lysek, this was in fact technically true; while Mr. Cullen had worked at Easton Hospital, his employment had come through a personnel agency called Health Med One of Harrisburg, Pennsylvania. This was a familiar problem in the tracking of Charles Cullen throughout his career; and it taught Lysek the importance of forensic investigators in the future being sure to ask the right questions when compiling complete and accurate lists of all medical staff who might have had contact with a potential victim.

  2 OxyContin entered the market in 1996.

  3 This perception of the situation has been drawn from interviews, both by myself and by police detectives, with Charles Cullen; the facts surrounding his subsequent actions and the hospital’s reaction come directly from police investigative documents and witness statements to police.

  4 Although Cullen recalled having killed four or five patients at Lehigh Valley, investigator
s were only able to definitively identify two of the victims: twenty-two-year old Matthew Mattern (August 31, 1999) and seventy-three-year old Stella Danielczyk (February 26, 2000); she had granny burns over 60 percent of her body, a death sentence by the rule of 9s.

  5 The surgeons flapped out muscle to lay down a vascular grid over the bone to which they might eventually graft skin. The drugs in his system kept his body from fighting the transplant tissue, even as it prevented him from effectively fighting off infection. Each infection sent Mattern back to the OR.

  6 This account comes from interviews and copies of Duddy’s police incident report. The dialogue has been taken from these sources and framed into quotes by the author.

  7 Charlie was examined and sent home. There was nothing wrong with him physically, and he appeared quite sane.

  CHAPTER 18

  1 In April 2000, Cullen used the unit’s computer to send an e-mail to two nurses who had recently been fired by the hospital, expressing sympathy and solidarity. Cullen was leaving the Burn Unit too, he explained—he’d already put in for a transfer to the Cardiac Floor. He was one of them, he said, aligned against the “Senior Service”—the fifteen-year veterans of the ward. Charlie called them “the SS,” for short, and continued on with the Nazi references—at the time, he didn’t realize that his e-mail would be sent not only to the two fired nurses, but to everyone on the Burn Unit staff, including the “Senior Service” members themselves. After that, life on the Burn Unit was utterly unbearable, and the Cardiac Unit no longer had any room for his transfer.