Welcome to episode seventeen of the Ausmed Handover podcast. Nurses have always been good at self-regulation, and when someone’s performance is identified as being sub-optimal, they are quick to raise their concerns with management. But what happens when management ignores these concerns? In this episode I’ll be telling a true crime story, and how the failure of several hospitals to act on the concerns of their nurses led to one man becoming the worst serial killer the world has ever known.
Hello and welcome to the Ausmed Handover podcast. My name is Darren Wake, and in this episode, I’m going to tell a true crime story.
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In 1961 the philosopher Hannah Arendt attended the trial of the Nazi war criminal Adolf Eichmann. Eichmann, who had been hunted down and brought to justice by the Israeli secret service, was directly responsible for organising the deaths of around 1.5 million Jews in concentration camps such as Auschwitz during World War 2.
What struck Arendt was how plain Eichmann looked. Rather than being the personification of evil, he had the aura of a very dull office clerk, and sounded much the same. Writing about her experience, she coined the phrase “the banality of evil” to describe his dullness, and this has been used repeatedly over the years by journalists and historians to describe a trait of appearance and demeanour common to those who commit the very worst of atrocities against the human race; describing the cruellest war criminals, spree shooters and serial killers as looking not like something readily identifiable as a person to be feared, but rather looking just like the average schmuck waiting in line in front of you at Woolworths, the guy buying a lotto ticket at your local agency, your next door neighbour, or perhaps the nurse working in the bedside beside you.
Which is exactly what Charles Cullen was.
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Charles Edmund Cullen was born in February 1960 in West Orange, New Jersey, and had a fairly desperate upbringing. His father died before he was even a year old, and his mother followed when he was 17. Devastated by her death, he enlisted in the US Navy to try and reinstate some order into the chaos that was his life. He duly finished his basic training and was assigned to the submarine service and became part of a team that managed the ship’s Poseidon missiles.
Rather disturbingly for the submarine’s captain, Cullen started to show signs of mental instability during undersea missions – which is not a good thing when you’re in control of an intercontinental missile system – so he was booted topside to the safer environment of a supply ship, where he subsequently tried to commit suicide seven times over the next couple of years.
But this self-harm was nothing new for Cullen: his first attempt at killing himself was when he was just seven, when he downed the contents of his chemistry set. Self-loathing and his routinely failed suicide attempts would almost come to define his life. That is, if it wasn’t for the outstanding opportunities offered by a profession he happened to stumble across soon after his naval career came to an end.
The navy, in a very wise move, decided that after suicide attempt number 7 it was time for Cullen to seek greener pastures, and he was given an honourable medical discharge.
But being hospitalised so many times during his naval career must have given Cullen a taste for what nursing was like, and it appealed to him. Soon after being discharged, he applied for and was accepted into a nursing course at the Mountainside Hospital School of Nursing.
Over the next three years, probably much to his own surprise, he was a successful and diligent student, even being elected to president of his class. He graduated in 1987 a registered nurse, and also a married man with two children.
Being a good student, if not a bit odd, Cullen had no problem obtaining a graduate post, and his first job was on a burns unit at the St Barnabas Medical Centre in New Jersey.
On his first day there, he realised that he had literally walked into a playground for his rather twisted little mind.
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Newly graduated, Cullen was relatively free of the scrutiny and supervision normally reserved for undergraduates, and for him, a burns unit presented a world of opportunity.
But not the kind of opportunity you or I would see in a new job or a new career. For Charles Cullen, being a registered nurse was a perfect storm of means, motive and opportunity.
All that self-loathing, that inwardly directed and destructive hatred could now be directed elsewhere. If he wasn’t able to kill himself successfully, then right in front of him, every working day, was literally going to be an endless procession of weak, extremely vulnerable individuals, and make no mistake, they were going to bear the brunt of his rage.
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One would think that Cullen would have spent months, if not years planning his first kill, but from what we know from the man himself, it came in the form of a sudden and overwhelming desire to ‘end someone’s suffering’.
You see, Cullen was already learning to clothe his homicidal intent in the language of the caring profession. A kind of poor man’s justification.
And on the 11th of June, 1988, Cullen circled like a shark around his first victim.
John Yengo senior, a retired judge, had been admitted to the burns unit following a severe photo-allergic reaction to an anticoagulant he had been prescribed. Cullen, ever the opportunist and highly impulsive, found Yengo on his bed with no other staff present. Cullen quickly drew up a syringe full of lignocaine – a drug normally reserved for the treatment of heart arrhythmias or used as a local anaesthetic, and lethal in the wrong hands – and injected it into Yengo’s drip and he was dead within seconds.
Cullen’s taste was piqued: from this very first murder he discovered so many useful tips that could be formed into a modus operandi.
First, he found he was often alone and unsupervised with many of the patients he cared for.
Second, they were often extremely weak at the time he came across them, and had no fight in them, so they could be easily overpowered if need be.
And third and most importantly, there was a whole pharmacopeia of drugs at his fingertips, many of which could be used to kill.
This third point was important for Cullen, and Yengo was something of a test case. The drugs often used by Cullen to kill were often exactly the same drugs that would be found in a patient’s body on autopsy after attempts to resuscitate them when they were found dead, and no-one would suspect Cullen was the one actually bringing about that death.
Cullen had immediately developed taste for his new metier; this was something that really satisfied him, and he could do it well.
So he decided to up the ante, and began tampering with bags intravenous fluids, a tactic that put even more safe distance between himself and his victims, and had the potential to significantly increase his death toll. By tampering, I mean injecting them with potentially fatal and easy to source additives.
However, some of the nurses on the burns unit began to notice that there was something not right about these saline bags: often, deaths were occurring soon after an IV bag was changed for relatively well patients, for instance, and alarm bells were raised.
A discrete internal investigation led the hospital administration to conclude that, on the basis of all circumstantial evidence, Cullen was probably both killing off his patients and was the person tampering with the intravenous fluids.
However, before he could be confronted with the results of the investigation, Cullen resigned and took a job at the Warren Hospital in New Jersey. And with this move we saw the beginning of a distinct pattern of actions that would accompany every change of job for the entire length of Cullen’s career as both a nurse and a serial killer.
Fearful of being sued by Cullen, and because their case against him was mostly circumstantial, Warren did not report Cullen to the state licensing board, nor inform his new employer of their investigation, and in fact, they even gave him a good reference.
But there in the background the ranks were mobilising. Nurses who had worked with Cullen began what would also become a regular event in his career; since the hospital managers were essentially effete, nurses independently made anonymous phone calls to Cullen’s new employer, to the nurses that would be working with him, and to his new ward managers, warning them to watch him closely, and to be extremely wary of his practices.
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So, Cullen moved on to his next job, with glowing references accompanying him. But although he had extricated himself from one professional catastrophe with a lot of luck and decisive action, his home life had deteriorated to rock bottom. Whilst in his first job, the failed suicide attempts had continued with a degree of near monotonous regularity, his wife and children had finally left him, he had restraining orders taken out against him, and he was forced by the courts to pay substantial child support.
So, who better to bear the brunt of his rage than his patients?
Within a year of starting at Warren, he had already killed three elderly women by injecting them with digoxin. He had attempted to kill a fourth whilst she was sleeping, but she woke and he was scared off. The woman and her relatives reported that “a sneaky male nurse” had attempted to put something in her drip during the night to the other ward staff, but these accusations were largely dismissed by management and Cullen, once again with a lot of luck and by the skin of his teeth, evaded being caught.
And during this time he continued his slow and steady decline into madness. He was found guilty of stalking a co-worker and put on probation, he attempted suicide several more times and was treated as an in-patient at a psychiatric facility twice.
Cullen left his job at Warren in 1993, and took a night shift job on the intensive care unit of the Hunterdon Medical centre, and, if we are to believe Cullen, the first two years in this position were distinguished by the fact he took no lives. But the now well-established impulses returned, and in a seven-month period, in 1996, he killed 5 intensive care patients with overdoses of digoxin.
As per his modus operandi of leaving a position as soon as questions of his performance were raised, Cullen left Hunterdon in 1997 and moved to another hospital, which had the good sense to fire him for poor work practices almost immediately, although, in line with the established pattern, they also provided him with a good reference for his next job.
That was at Liberty Hospital, and by this time, Cullen had become incredibly bold and started to become careless; he was seen giving his patients medications at unprescribed times (something that earned him a reprimand and drew the attention of hospital administration), and was ultimately fired when he attempted to inject a patient with an unknown liquid. The patient, sensing something was wrong, attempted to fight Cullen off and had their arm broken in the ensuing fight. No-one bothered to determine just what Cullen was trying to inject into the patient, but it’s safe to assume it wasn’t going to be good.
Cullen got the boot, and yep, the hospital, fearful of being sued for giving a bad reference, supported his application with another employer, and once again, the nurses he had worked with mounted a covert campaign of anonymous phone calls to the staff and management of his next employer to warn them that he was a dangerous man.
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Cullen moved on. To Easton hospital, where he killed a patient with an overdose of digoxin. The death was ruled suspicious by the coroner, but somehow, and yet again, Cullen again managed to walk away unscathed, and of course with a good reference.
And after this he moved to Lehigh Valley hospital, where he took another life and to St Luke’s hospital where he killed two more and, rather surprisingly, was caught.
But being the lucky SOB that he was, and hospital management being so ineffective, being caught simply didn’t have the same consequences faced by most serial killers.
It seems that one of Cullen’s colleagues had found a number of hidden vials of medication – some of which had been used, some of which had not, and these were medications that had no ‘street value’, but could be fatal in the wrong hands, so their theft and concealment seemed suspicious.
In the ensuing investigation, it was determined that Cullen was the thief, but despite the mounting suspicions that he was using these drugs to kill those he was supposed to be caring for, the hospital administration offered him a deal: he would resign and they would give him a reference for his next job, or they would fire him.
Now I imagine that isn’t the kind of deal normally offered to your average serial killer, so of course Cullen took the deal and walked away again from another job unscathed and with decent references in hand.
These references were literally a licence to kill.
But the nurses, who all along, and with every employer, had raised red flags about Cullen’s performance with their managers, and were once again ignored. But this time they took some direct and serious action. A group of seven nurses took their stories about Cullen to the state’s district attorney – that’s the equivalent of a public prosecutor – who looked into the case. But looked only as far as Cullen’s St Luke job, as all his references from employers prior to that job were glowing and the hospitals made no mention of performance issues or any suspicions, as none had ever been recorded on his personnel files… anywhere, ever.
Alas, it seemed the evidence was circumstantial and not enough to prosecute Cullen and once again, he walked. Of course and again, with that golden ticket of a good reference in hand.
In 2002, Cullen began work at Somerset Medical Centre on the intensive care unit and over the next 12 months, he killed another 8 patients using insulin, digoxin and epinephrine, but a failed attempt to kill a 9th drew the attention of Cullen’s co-workers, who reported him to management who, in a complete reversal of the previous hospital’s attitude, took notice of them and began an investigation.
The hospital administration began a secret audit of Cullen’s activities, and a whole swathe of suspicious red flags were uncovered.
Cullen was found to have been accessing the medical records of patients to which he was not assigned, was often reported to be ‘hovering’ around the bedspaces of patients he was not caring for, and most worrying of all, was found to have booked out several dangerous and unprescribed medications from the intensive care unit’s automated drug dispensing system.
But the hospital was slow – by the time the investigation was over and a formal notice had been given to the hospital executive that Cullen was probably killing his patients with a stunning regularity, Cullen had already killed off another five patients, and when he failed in an attempt to kill another, the hospital finally alerted the authorities. But, and this is amazing, after the inescapable conclusions were drawn that Cullen was a serial killer, and the hospital decided to sack him and hand the investigation over to the district attorney, they asked him to work one extra shift before they fired him as they were short staffed, something Cullen found highly amusing in his interview with 60 minutes after his imprisonment.
At the same time as all this was slowly unfolding, one of Cullen’s colleagues – a nurse – notified the police about her suspicions and handed over the evidence she had collected, and on December 12th 2003, Cullen’s career as a serial killer came to an end when he was finally arrested whilst having dinner at a local restaurant.
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With Cullen’s arrest and subsequent confession, some startling facts came to light. Despite almost countless suicide attempts, criminal convictions, treatment as an in-patient at a psychiatric institution, being sacked for incompetence, being investigated for murder at every hospital he had ever worked at since graduation, Cullen’s records at his state licensing board and his personnel files at each hospital were clean as a whistle and in fact, all his references prior to his final job indicated nothing but him being an exemplary employee.
However, Cullen confessed to 40 murders, and freely gave details about the when, where, and how’s of each murder, which led police to investigate his past in detail.
What the investigators found was almost far too horrifying to comprehend.
Analysing the numbers of patient deaths at each hospital Cullen had worked in, investigators found spikes in mortality at every hospital he had worked at for the time he had been employed there. The numbers of deaths had increased dramatically from the norm from the date he started work, and fell back to the norm the day after he left.
Looking even closer, they found that the dates of the individual deaths contained within these spikes correlated with the days Cullen was working, and the deaths often occurred on the ward where he worked, and from this, by subtracting the baseline norm from the spiked numbers, experts have drawn the conclusion that Charles Cullen was probably responsible for the deaths of around 400 people in his care.
The magnitude of his crimes meant that it was both logistically and financially impossible to investigate every one of these deaths, but on March the 10th 2006, Cullen was convicted. Curiously, despite the scores of failed suicide attempts throughout his life and the prospect of spending the rest of his life being somebody’s twink in jail, Cullen opted to avoid the death sentence by entering into a plea bargain with the public prosecutor. He plead guilty to 40 deaths in exchange for a life sentence instead of the death penalty.
Ironically, if Cullen had been sentenced to death, it would have been by lethal injection.
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Currently, Cullen is imprisoned for several life terms with no possibility of parole.
Although Charles Cullen was convicted for only 40 murders, he probably killed over 400 patients in his care, making him by far the worst serial killer in the history of the world, let alone the United States.
Throughout his career, nurses from the very first job onwards alerted both management and authorities to their concerns about his practices, and when they were ignored, they covertly warned his next employer as he moved from job to job to job, building up his kill count.
Despite clear evidence that Cullen was regularly killing patients in his final job, hospital management was slow to act, and his ultimate arrest was made solely because one nurse bypassed the management hierarchy and went directly to the police with her concerns.
If the managers of all of the hospitals Cullen had worked at had listened to their nurses, nearly 400 people would probably still be alive today.
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This is the Ausmed Handover podcast, my name is Darren Wake, and thank you for listening.
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