The Rev. Florian Gall was getting better. The Roman Catholic priest had been admitted to Somerset Medical Center in Somerville, New Jersey, in 2003 with pneumonia, and he was recovering when his heart gave out. The autopsy found digoxin in his blood, a heart drug he had never been prescribed, in a quantity that could only kill. By then the New Jersey Poison Control Center had noticed that several patients on the same critical care unit had come in with digoxin overdoses or insulin levels that made no medical sense, and it told the police.
The case went to two detectives in the Somerset County prosecutor's office, Tim Braun and Danny Baldwin. The hospital, as Braun later told 60 Minutes, cooperated mainly when served with court-ordered subpoenas. The records they did get, including the logs of the Pyxis machines that dispensed drugs on the unit, pointed to one nurse, Charles Cullen, who had joined the staff in September 2002. When they looked at where he had worked before, they found nine other hospitals and a nursing home, and at several of them, suspicion that had never gone any further than a resignation.
What the detectives needed was someone he trusted. Amy Loughren was a nurse on the same unit and, possibly, the closest thing Cullen had to a friend. She had noticed on her own that his charting was muddled and hasty. After talking it over with her eleven-year-old daughter, she agreed to help. She took records out of the hospital for the detectives and met Cullen while they listened. He never confessed on the recordings, but what he said, and did not say, when she confronted him about the deaths convinced them. By then Somerset had fired him, officially for lying on his job application. He was arrested on December 12, 2003, outside a restaurant in Bridgewater, and charged with Gall's murder and the attempted murder of another patient, Jin Kyung Han.
Two days later he told Braun and Baldwin what he had done, and then kept telling them. Over the following months he sat with them going through thousands of pages of medical records, trying to pick out the patients he had killed. He said it was as many as forty, over sixteen years. He said he could not remember them all. He had put digoxin, insulin, epinephrine and other drugs into intravenous bags, sometimes into bags stocked in supply rooms that would go to whichever patient needed one next, so that he did not always know who would die.
At Somerset alone, in about thirteen months, he killed thirteen patients. Michael Strenko, twenty-one, had been admitted for surgery on his spleen that he should have recovered from easily; Cullen gave him a high dose of norepinephrine. Matthew Mattern was twenty-two. Most were older and very sick, which made their deaths easy to accept. Among them over the years were Helen Dean, ninety-one; Lucy Mugavero, ninety; Mary Natoli, eighty-five; Jesse Eichlin, eighty-one; Irene Krapf, seventy-nine; Ottomar Schramm, seventy-eight; Earl Young, seventy-six; LeRoy Sinn, seventy-one; Frank Mazzacco, sixty-six; and Catherine Dext, forty-nine. The first he could remember was John W. Yengo Sr., a judge, seventy-two, who had been admitted to the burn unit at Saint Barnabas Medical Center in Livingston after a reaction to a blood thinner, in the late 1980s, in Cullen's first hospital job.
He was born Charles Edmund Cullen in West Orange, New Jersey, on February 22, 1960, the youngest of eight children. His father, Edmond, a bus driver, died on September 17, 1960, when the boy was seven months old. His mother, Florence, an English war bride, was killed in a car crash on December 6, 1977, when he was seventeen and a junior in high school, and he said later that the hospital cremated her before the family was told. He first tried to kill himself at about nine, by drinking chemicals from a chemistry set, and tried many times after. He graduated from West Orange High School in 1978 and enlisted in the Navy, where he served on the submarine USS Woodrow Wilson as a petty officer second class on the crew that operated its Poseidon missiles. A year in, his leading petty officer found him at the missile controls wearing a surgical gown, mask and gloves. He was moved to the supply ship USS Canopus, attempted suicide, was committed to the Navy's psychiatric ward several times for depression, and was discharged in 1984. He went to nursing school at Mountainside Hospital in Montclair, graduated in 1987, married, and had two children.
He started in the burn unit at Saint Barnabas Medical Center in Livingston, and the first murder he later admitted, on June 11, 1988, was committed there; he also admitted killing an AIDS patient there with insulin. He left in January 1992, as the hospital investigated contaminated IV bags, and a month later joined the coronary care unit at Warren Hospital in Phillipsburg. In August 1993 a ninety-one-year-old cancer patient told her son that Cullen, who was not her nurse, had come into her room and injected her with a needle; she died the next day. He and several other nurses took lie-detector tests and passed, and he later pleaded guilty to killing her with digoxin. At home he drank and abused the family dogs. His wife filed for divorce in January 1993 and obtained a restraining order that spring, after he had been treated at two psychiatric institutions, and the divorce became final in December 1994. In March 1993 he broke into the home of a co-worker as she and her young son slept, then stalked her; he pleaded guilty to trespassing and was given a year's probation.
He spent three years in the intensive care unit at Hunterdon Medical Center in Flemington, where he won an employee award and, he admitted, killed five patients with digoxin between January and September 1996. Morristown Memorial Hospital fired him for poor performance. In February 1998 he went to the Liberty Nursing and Rehabilitation Center in Allentown, Pennsylvania. That May, Francis Henry, eighty-three, was sent to Lehigh Valley Hospital with a toxic dose of insulin; his nurse, Kimberly Pepe, was fired, and in a lawsuit she later settled she said Liberty had never looked at Cullen, who was on duty that night. Liberty dismissed him later that year after he was found in the room of a patient he was not assigned to, holding syringes, and the patient's arm was broken. At Easton Hospital, where he worked through an agency from November 1998 to March 1999, John Sakala, eighty-six, died with an abnormally high level of insulin, and Ottomar Schramm, seventy-eight, tested positive for digoxin he had never been prescribed and died on December 31, 1998. The Northampton County coroner, Zachary Lysek, suspected an angel of death, but closed his inquiry as inconclusive in 2000 when the hospital told him its own review had found no suspect. At Lehigh Valley's burn unit in 1999 Cullen killed one patient and tried to kill another. At St. Luke's Hospital in Bethlehem he killed at least five and tried to kill two more over three years, and on January 11, 2000, he tried to kill himself with a charcoal grill lit in his bathtub. When Sacred Heart Hospital in Allentown hired him in June 2001, nurses who had heard about him threatened to quit together, and he was let go at once.
St. Luke's caught him taking drugs that had no street value. It offered him a choice between being fired and resigning with a neutral reference, and in June 2002 he resigned and was escorted out. Seven of his co-workers there went to the Lehigh County district attorney with their suspicions; the inquiry never looked into his past and was dropped nine months later. That September he started at Somerset. The case was also a story of missed chances outside the hospitals: more than a decade before his arrest, a medical examiner failed to run a test that could have exposed him, and another coroner believed a death was not an accident and never told the police or a prosecutor. At Somerset the drug cabinets logged him requesting medications his patients had not been prescribed, often ordering and canceling within minutes, and in July 2003 the director of the New Jersey Poison Information and Education System warned the hospital that at least four suspicious overdoses pointed to an employee. The state later faulted Somerset for failing to report a nonfatal insulin overdose he gave in August. When a patient died of low blood sugar in October, the hospital called the state police, and on October 31 it fired him, officially for lying on his application. He was arrested at a restaurant on December 12, 2003, charged with one murder and one attempted murder, and on December 14 he told Braun and Baldwin that he had killed Father Gall and tried to kill another patient, Jin Kyung Han.
In exchange for his help identifying victims, prosecutors in both states agreed not to seek his death. In April 2004, before Judge Paul W. Armstrong, he pleaded guilty in New Jersey to killing thirteen patients and attempting to kill two more. A month later he pleaded guilty to three more murders, and in November, in Allentown, to six murders and three attempts, repeatedly interrupting with the chant "Your Honor, you need to step down" until he was restrained and gagged. By 2006 the total was twenty-nine murders and a number of attempted murders. On March 2, 2006, he was sentenced in New Jersey; the New York Times reported eleven life terms that day, and other accounts give eighteen consecutive life sentences, with no parole before June 10, 2403. On March 10, before Lehigh County Judge William H. Platt, he repeated the same chant for half an hour until the judge had him gagged with cloth and duct tape, and he was given six more life sentences, which in Pennsylvania carry no parole. He is held at the New Jersey State Prison in Trenton. In August 2006, over the objections of prosecutors and victims' families and under a judge's conditions, surgeons removed one of his kidneys for Ernie Peckham, the brother of a former girlfriend, who had been on dialysis.
Twenty-nine is the number the courts could prove. He said forty. The journalist Charles Graeber, whose book The Good Nurse became a film, believes the real number may be closer to four hundred. More than 150 families of patients who died at Somerset contacted investigators after his arrest. In 2008 the families of twenty-two patients settled wrongful-death suits with Somerset, Hunterdon and Warren hospitals, which admitted no wrongdoing, and St. Luke's fought its cases for years before settling five in 2012. New Jersey, Pennsylvania and thirty-five other states changed their laws to encourage honest references and protect reports of medical errors, New Jersey with its 2004 Patient Safety Act and a 2005 law requiring hospitals to report details of disciplined workers and keep patient-care complaints for seven years. Asked on 60 Minutes whether he had known what he was doing was wrong, Cullen said that he had, and that he was sorry. "But like I said," he added, "I don't know if I would've stopped."