52 Lock Up: Angel of Death Charles Cullen

A patient’s trust in their healthcare provider(s) are vital to their healthcare, whether it is the doctor, nurse, emt and even the dietary aide. Trust is vital due to healthcare providers are with people during an extremely vulnerable moment; and there is an expectation of healthcare providers to work as a team to improve the quality of life and health for them.

“I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witness, that, according to my ability and judgment, I will keep this oath and this contract…I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them..However, should I transgress this Oath and violate it, may the opposite be my fate.” (Hippocrates). Unfortunately, there have been individuals who would breach the fragile trust patients have, the loved ones of the patients, colleagues and healthcare facilities.

Charles Edmund Cullen was born on February 22nd 1960 in West Orange, New Jersey. He was born to his father Edmond and Florence. His father died when he was 7 months old. His father’s death impacted the family of 8 children and Florence. By the age of 9 Charles reportedly attempted to commit suicide by swallowing chemicals from a chemistry set. His mother would later be killed in a car accident on December 6th 1977; he would 17 years old at this time. This would become a defining moment for Charles, which he describes to be devastating; due to him not being immediately informed his mother passed by Montclair New Jersey hospital. His mother’s body was immediately cremated instead of the body being returned to the family.

Due to Charles’ mother’s death, he dropped out of high school and joined the Navy instead; where he would later receive a medical discharge in 1984 after another suicide attempt and psychological evaluation. Upon returning from discharge in 1985 Charles enrolled at Mountainside Hospital nursing school in Montclair, New Jersey. He naturally had a gift to nursing and this where in life he finally began to excel. He would later graduate in 1986 and was even president of his class. He wed Adrianne Baum whom he met in Roy Rogers in 1987. They would have 2 daughters of his own with his first born Shauna in 1988. He began to work at a burn unit of Saint Barnabas Medical Center in Livingston, New Jersey.

Unfortunately, the burn unit would be where Charles would utilize his gifts to begin killing. Later, Charles would admit to administering a lethal overdose intravenously to a patient; one of his patients included an AIDS patient whom was given an overdose of insulin. The body naturally produces insulin in the pancreas to maintain blood glucose levels. “In HIV untreated, patients there is severe insulin resistance with increased LPS and cytokines that involves liver, hypothalamus, muscles, vessels, and adipose tissue. After cArt treatment, the insulin resistance is mild/moderate, with reduced LPS and cytokines that probably spares adipose tissue.” (Pedro et al., Insulin resistance in HIV-patients: Causes and consequences 2018). This means the patient with AIDS may have been at a level of struggle with their body’s insulin levels. By Charles overstimulating the body with insulin, the cells in the body begin to absorb too much glucose (sugar) from the blood. Th hypoglycemia. Glucose is essential for the brain, central nervous system and red blood cells to function properly.

By January of 1992, Charles, strange behavior did not go unnoticed due to excessive coding (a term coined by medical staff indicating patients who are going into cardiac arrest). Saint Barnabas hospital begin to investigate their IV bags and realized the bags were contaminated by being spiked with insulin. Charles would resign from the burn unit and told his wife that he was being targeted for speaking out against someone. During this time, his wife was the primary care giver and it was stated that her suspicions of her husband truly began once when he was drinking more and more; and one time when he was supposed to be taking care of their daughter his wife found that she was given cough syrup to sleep while he walked out of the house with the door left completely ajar. Later on, a neighbor’s dog would be found dead under their porch poisoned.

At the burn unit Charles would be developing his weapon of choice with his patients. His common choice at the hospital would be to use insulin against patients. The pancreas secretes insulin and it is a hormone that allows glucose to be absorbed by muscles and to get to the body where it is needed. Insulin is a necessity for everyone especially diabetics. C-peptides are connecting peptides (amino acids) in the body that are produced alongside with insulin; the number of insulin and c-peptide will generally be equal. C-peptide levels are expected to be equal except in cases of diabetes types 1 where the c-peptide levels would be below the expected range of 0.2 nmol/L and this would indicate how much insulin the body is truly producing. C-peptides are the reason why testing can provide information of if insulin was externally provided or made internally. If a patient has a much higher level of insulin than c-peptide levels; this indicates they were given additional insulin. If a person receives additional insulin that is not supposed to be there it places a patient into the dangers of hypoglycemia; the brain is dependent on more than just water. The body needs glucose, sodium and additional electrolytes. Without sugar, the patient can experience symptoms of seizures, nausea, altered mental status, sweating, tremors, hunger, frequent urination and tachycardia; which would result in stored glucose in the body being released into the body as well as ketones.

An investigation would later determine that Charles was more than likely the responsible party to the contaminating IV bags with excess insulin. Charles later would admit to killing at least 11 patients directly; but this does not include the additional bags that were not found and the patient would have died under excessive insulin. Charles would resign from Saint Barnabas hospital in 1992.

Charles would continue his nursing career two weeks later at St. Luke’s Warren Hospital in Phillipsburg, New Jersey in the cardiac and intensive care units. During his tenure there, in 1992 his wife would leave him and take the kids with her due to his excessive drinking and cruelty towards the dogs. After his wife Adrianne would leave him, Charles became close with a coworker and began to obsess over. The coworker would begin to pull back from Charles which would led him to choose to follow her around the hospital, leave her gifts everywhere she went, followed her home, drive around her house in the middle of the night; and eventually breaking into her house while she slept with her children. He was arrested for the harassment but would be released due to another act of attempted suicide; this would land him in Greystone Psychiatric Hospital. Charles would medicated at the hospital and described his time their as a moment he was truly happy. St. Luke’s Warren Hospital was incredibly short staffed and reached out to see if Charles would be cleared by a doctor there to be able to return to work; and he returned to work. His last known victim at that hospital would be Helen Dean.

In August 1993, Charles would be accused of killing the 91 year old breast cancer patient Helen. The patient’s son was in the room when Charles administered a medication to her and then she would die within a day of heart failure. The patient was recovering very well, and then suddenly their condition rapidly declined after the injection. It is believed that Charles used digoxin, which is a cardiac glycoside inotropic medication and this in turn squeezes the heart harder. This medication is frequently used for heart failure, cardiogenic shock, as well as other heart conditions. It is only administered when the heart is having trouble pumping and emptying correctly. Toxicity of this drug can cause hypokalemia, hypomagnesemia, hypercalcemia, and in the elderly, renal and liver function decrease. Unfortunately, the medical examiner did not check for digoxin; and nothing appeared in the medical examiners notes. Police would interrogate Charles as well as provide a lie detector test which he would pass, and combination of the lack of results from the medical examiner notes and a lie detector test; no action was taken. He would resign in September 1993 due to the medical examiner not checking for a drug toxicity with digoxin. Another notable sign of Charles is that hospitals did not have as many coding in their units after him leaving.

Charles would leave New Jersey to work in Pennsylvania and the first hospital he worked at was Liberty Nursing & Rehabilitation Center. A resident named Frances J Henry’s health deteriorated rapidly due to his blood sugar levels descending too quickly resulting in his death May 8th 1998. This patient was under the care of Charles and his supervisor became suspicious of Charles intentionally administering excess insulin. The supervisor would be reprimanded and fired for speaking out and Charles would remain at Liberty a few more months longer; before resigning by early 1999.

By March 1999, Charles would begin working at another burn unit of Allentown’s Lehigh Valley Hospital-Cedar crest and after killing one patient and attempting another; a month later he would resign from the hospital. After his resignation from Lehigh Valley Hospital, he would begin working in the cardiac care unit at St. Luke’s Hospital in Bethlehem, Pennsylvania. He maintained his job for three years and would murder at least five patients.

By January 11, 2000 Charles would attempt suicide again by lighting a charcoal grill in his bathtub in hopes to kill himself with carbon monoxide poisoning. His neighbors had smell the smoke and call the fire department. Charles will be taken to a psychiatric facility again, but would be returned home the following day to return to work.

It seems no one was suspicious of Charles murdering the patient at St. Luke’s until a coworker had found medication vials in a disposal bin. The drugs were not valuable outside of the hospital, were not administered to anyone through documentation, and they were often not used as recreational drugs. The theft was considered to be extremely unusual. An investigation proved that Charles had taken the medication and was considered to be stealing medication. He was offered a deal from the hospital to resign and be given a neutral recommendation, or he would be fired for stealing medication. Charles chose to resign and was escorted from the building in June 2002. Several of his coworkers from St. Luke’s with later alert Lehigh county district attorney about those suspicions of Charles, using the drugs to kill the patient. Unfortunately investigators did not look into Charles’ past and the charges would be dropped nine months later, due to lack of evidence.

During Charles Cullen, nursing career over a span of 15 years, he would work at nine hospitals/nursing homes. He returned to New Jersey to work at New Jersey Somerset Medical Center in September 2002. He would become close friends with another nurse he was interested in named Amy Loughren. Amy was nurse who was new and did not have medical coverage yet; but had a heart condition. Charles had discovered Amy crouched down in pain at work and realized she needed help; he would sneak her drugs that she needed at this time. He would log into Pyxis and cancel the order to get the draw to open and take the drugs he needed. When he gave her the drug she stated she did not question how he got the drugs for her but was incredibly grateful to his help. He would begin to spend time her and her kids and home.

Reverend Florian Gall was admitted for an arrhythmia during the spring of 2003; the patient recovered so well that he was being discharged. Rev Florian Gall abruptly died of a heart attack without warning. An autopsy showed the patient had dangerous toxic levels of digoxin in his body. Investigations showed that Charles was the nurse caring for the patient and was the nurse who had taken digoxin from the pharmacy. He was forced to resign with another neutral letter of employment. Two detectives named Tim Braun and Dan Baldwin had begun an investigation on Charles but many of the hospitals were not cooperating enough to be able to stick charges to Charles. After Reverend Gall’s passing, Detective Braun and Detective Baldwin were interviewing the nurses but only under the supervision of the hospitals head administrator physically present; they would be left alone for a few minutes with Amy Loughren who was able to read the charts and noticed the discrepancies in the patient’s charting.

The nurses were not permitted to work with law enforcement as per the hospital and were told it was for their protections as a nurse; Amy trusted her gut feeling and worked with the detectives quietly. Slowly, she began to realize that Charles was killing the patients and spiking the IV bags. Her cooperation with law enforcement is the reason Charles was finally arrested; a documentary was recently released on Netflix called The Good Nurse. Amy would wear a wire and ask him questions and learned he would be taking a new job at another hospital soon. In the interrogation room, Amy was brought in to talk to him and he began to tell everything and spoke to Amy as if nothing had happened.

Over the 15 years, employers did not have communication with previous workplaces and lacking in reporting protocols of misconduct; seems to have permitted the career of nursing and killing. Studies have shown that victims are predominantly, elderly, patients, or patients, who are very sick; where their death would not be considered a surprise. He would be sentenced to 11 consecutive life terms with no hope for parole in 2004. Charles’ reign of being an Angel of death under the guise as a nurse would finally come to an end. He admitted to 40 killings but only 29 patients were to be confirmed; it is suspected he may have killed as many as 400 patients due to multiple IV bags being spiked and unknowing nurses giving a bag to their patients at every hospital he worked at.

Charles became the inspiration behind the New Jersey law that requires healthcare professionals to sound an alarm to stay consumer affairs and licensing board if they suspect workers pose a danger to patience; it is now referred to as the Cullen Law. The Patient Safety Act of 2004 “Patient Safety and Quality Improvement Act of 2004 - Amends the Public Health Service Act to designate patient safety data as privileged and not subject to: (1) a subpoena, discovery, disclosure, or admission as evidence in any Federal, State, or local civil, criminal, or administrative proceeding; (2) disclosure pursuant to a Freedom of Information Act request; or (3) use in a disciplinary proceeding against a provider. Defines "patient safety data" as any data, reports, records, memoranda, analyses, or statements that could result in improved patient safety, health care quality, or health care outcomes.” (Congress.gov, S.720 - 108th Congress (2003-2004): Patient safety and quality ... 2003).

“The Patient Safety and Quality Improvement Act of 2005 (PSQIA) establishes a voluntary reporting system designed to enhance the data available to assess and resolve patient safety and health care quality issues.” ((OCR), Patient Safety and Quality Improvement Act of 2005 Statute & Rule 2022) This will help prevent or stop any new nurses who become Angels of death and the hospitals are obligated by law to cooperate and report those findings; instead of setting up resignations and providing a neutral letter of recommendation.

Healthcare killers have been coined as “angel of death” often have noticeable personality or psychiatric problems that are missed because healthcare administrators are desperate for more nurses at their facilities. California State University, nursing Professor, Beatrice Yorker stated “ employers, too often have simply fired workers with troubling patient, death records rather than warning, other institutions”.

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