Case of the killer nurse reveals new-hire obstacles

A nurse who admitted to authorities that he killed 30-40 severely ill patients is putting the spotlight on the difficulty of investigating the backgrounds of those applying for patient care positions in health care, says the CEO of the hospital where many of the deaths are thought to have occurred.

The president and CEO of Somerset Medical Center in Somerville, NJ, is campaigning now for more openness in background checks. Dennis Miller, FACHE, says his hospital did everything possible to check the background of the man who admits killing patients, but that previous employers did not reveal the man had a history of leaving hospitals under questionable circumstances.

Hospital spokeswoman Vicki Allen tells Healthcare Risk Management that Somerset performed a customary background check before hiring the nurse, including verifying his credentials and checking with previous employers. "But we really didn’t get any information other than the dates of his employment. That’s one of the things our CEO wants to change," she says. "Had we gotten more information about investigations that took place at other hospitals, we might have taken precautions in hiring him."

Somerset County Prosecutor Wayne Forrest, JD, reports that Charles Cullen, 43, told investigators he killed between 30 and 40 severely ill patients at several hospitals and nursing homes in Pennsylvania and New Jersey, starting in 1987. All of the victims were killed with drug injections, Forrest reports.

If Cullen’s admissions prove true, he would be one of the most prolific "angel of death" killers in the country’s history. Somerset County authorities charged him with one count each of murder and attempted murder, but are considering more charges as they investigate his employment history at 10 health care facilities. The current charges stem from the deaths of a Roman Catholic clergyman and a 40-year-old woman, both at Somerset Medical Center. Both had elevated levels of digoxin, a heart medication, in their bodies.

During a recent court appearance, Cullen told the judge he was going to plead guilty and did not want a lawyer, according to local media reports. He was held on $1 million bail.

Somerset Medical Center apparently was only the latest in a string of hospitals where Cullen is thought to have killed patients, but it is under fire for hiring him after he left other facilities under questionable circumstances. Somerset claims that it checked Cullen’s background as well as it could under restrictions that made full disclosure of his past impossible, and Allen says the hospital aggressively investigated the suspicious deaths at its own hospital.

Suspicious deaths prompt concern

Between June and August 2003, Somerset Medical Center documented six abnormal results in routine laboratory tests, he says. No patient deaths were related to these abnormal lab results in five of the six cases. In the sixth case, a death occurred, but the cause of death was inconclusive.

"In June, after the first three abnormal lab values came to light, we launched an internal investigation," according to a statement released by the hospital. "After ruling out a range of possible explanations — faulty equipment, human error, other medical conditions in the patients — we then moved quickly to ask the New Jersey Department of Health to conduct its own investigation. The Department of Health spent several days reviewing patient medical records and our policies and procedures."

When these Department of Health investigations identified no fault with the hospital’s internal systems, the hospital expanded its internal investigation to include external investigative experts. That investigation was ongoing when a decision was made to contact the Somerset County Prosecutor’s Office, the hospital reports.

"We contacted the Prosecutor’s Office and have worked closely with them over the past two months in their investigation," the statement says. "As a result of this investigation, we identified a nurse who we suspected was involved with the abnormal laboratory test results and terminated this individual on Oct. 31, [2003]. We terminated the nurse in question and reported him to the appropriate state authorities."

Other investigations come to light

Allen says it was only after firing Cullen that Somerset became aware that he had previously worked at three other hospitals in New Jersey and two hospitals in Pennsylvania where similar investigations may have been conducted. Information about potential investigations apparently was never reported to either state or criminal authorities, she says.

"We are outraged that some hospitals who have hired this nurse and who may have conducted an investigation did not share the information with us or the appropriate authorities," the hospital statement says. "These incidents have illustrated that Somerset Medical Center is committed to patient safety. To our knowledge, we were the only hospital to report this nurse to the New Jersey Board of Nursing. We were contacted by another New Jersey hospital that was considering hiring this nurse. At this point, we contacted the Board of Nursing to prevent any future concern of patient safety in another hospital."

Allen says Somerset Medical Center is cooperating fully with the investigation of Cullen and is happy to do so. The hospital has turned over a total of eight patient medical files to the Somerset County Prosecutor’s Office.

Legislators address problem

New Jersey assemblyman Jerry Green (D-Plainfield) announced recently that he will introduce a bill that would close loopholes in New Jersey law regarding information that hospitals and other health care facilities can share about their staff. State Sen. Joseph Vitale (D-Woodbridge) reported that the Health, Human Services, and Senior Citizens Committee would convene hearings on patient safety reform.

Green’s bill is intended to close the loopholes that allowed Cullen’s alleged actions to go unnoticed as health care providers repeatedly hired him. It would require a provider to report to the state any questionable conduct by nurses, home health aides, and other health care professionals. Reportable conduct would include voluntary resignation during an investigation and termination because of misconduct.