The Good Nurse: A True Story of Medicine, Madness, and Murder (10 page)

16

T
he Pennsylvania border was just a line on the map to most people, but extremely important to a nurse like Charlie. Pennsylvania required a different nursing license—a simple application. It meant a clean start.

His application to Liberty Nursing and Rehabilitation Center of Allentown, Pennsylvania, was made through a staffing agency called Health Force
¹
and required references. Morristown Memorial Hospital, from which Cullen had been fired for incompetence, patient complaints, and grave medication errors, simply confirmed his former employment. Charlie’s reference from Hunterdon Hospital was Marjorie Whelan, who had threatened to terminate Cullen for his multiple medication and patient-care issues. The Liberty HR reference form would record that Charles Cullen was “an excellent nurse, gave good care, was excellent with patients,” and that Whelan would recommend Charles Cullen for employment. Nobody at Liberty questioned why a nurse with ten years of hospital experience would downshift to a nursing home and a $5-an-hour pay cut. They needed the help, and Charlie needed the money.

After months without work, Charlie was $66,888 dollars in debt. The interest on his maxed credit cards grew, as did the money he owed for alimony and child support. If Charlie didn’t pay, he might be characterized as a bad father, which was not acceptable to him. It might seem like he was abusing his kids. His inability to pay would give Adrianne an opportunity to poison his children’s minds, characterize their father as a bad guy—Shauna was already nine, old enough now that she might even get the idea herself. And that wouldn’t help him at all. Each evening he packed into the aging Escort and took his troubles to the Liberty night shift.

F
rancis Henry
²
was an elderly resident who needed extra attention for a broken vertebrae. Doctors had stabilized his neck with a halo device—a Frankenstein-ish rig of shoulder supports supporting a metal ring screwed directly into the skull. Nurse Cullen believed that Mr. Henry should be in a hospital rather than a nursing home.

It was Charlie’s diagnosis, his alone. In this matter, there would be no arbitration board, no letters of rejection. Instead, he simply loaded a syringe with insulin, and injected it directly into Mr. Henry’s IV.
³
It was a whopping dose. During his overnight shift on May 6, 1998, Mr. Henry quickly spiraled into a diabetic shock. The results were almost unimaginably violent; Charlie Cullen had put an elderly man with a broken neck into violent seizures. That night, Francis Henry finally devolved into a coma,
⁴
and by morning, Charlie’s “diagnosis” had been proved correct; Henry did, in fact, need a hospital. Henry was returned to the nursing home the next day, and died soon after. Three days later, on May 13, Charles Cullen filed for bankruptcy.

Mr. Henry’s death was not quiet, and suspicion was inevitable; Charlie knew that this time, he’d pretty much asked for trouble. Liberty initiated an internal investigation and discovered the massive levels of foreign insulin in Mr. Henry’s blood. Insulin appeared nowhere on Mr. Henry’s medical chart—he had not been prescribed insulin at any dose. His charts had no record that any staff member had administered it to him. It was extremely unlikely that an immobilized, elderly patient had overdosed himself, and suspicion quickly fell upon the night shift for what was assumed to be a medication accident. Charles Cullen had already been written up for several nursing issues during his short tenure at Liberty; he was ready for the axe to fall again. Instead, Liberty fired a senior nurse named Kimberly Pepe. Nurse Pepe’s lawyer immediately hit Liberty with a wrongful termination suit, going so far as to suggest Charles Cullen was more likely to be responsible, and that Liberty Nursing Home had suspected as much.
⁵

According to Pepe’s suit, she had first been asked about the incident by her nursing supervisor several days after Mr. Henry’s death. “They were not looking at me at that time,” Pepe claimed in her lawsuit. “They were, in not-so-many words, looking at my coworker, Charles Cullen.” Liberty
would go on to vehemently disagree with Pepe’s accusations
⁶
and deny that they had any suspicion of Charles Cullen.
⁷
Liberty and Pepe later settled her suit out of court.

It’s impossible to say with certainty why Pepe had been targeted; perhaps it was simply a mistake. But
somebody
had poisoned Mr. Henry, and they were either still working at Liberty or had been moved on to another hospital. But there would be no criminal investigation. Liberty and its parent company, HCR Manor Care, maintained they were unaware of this being a criminal matter.
⁸
Pepe and her lawyer were asking for more than $50,000 in damages, but the exact amount of Pepe’s settlement was sealed, along with her nondisclosure agreement.

Whatever Liberty did or didn’t know, they moved Nurse Cullen out of their Intensive Care Unit. Reassigned to work shifts on the psychiatric wing, Charlie quickly discovered that some of the patients were downright feisty. On October 1, Cullen was seen with syringes entering the room of an elderly woman who was not his patient and delivering her drugs that weren’t prescribed.
⁹
A scuffle ensued, and the patient ended up with a broken wrist. Finally, five months after Mr. Henry’s death, his killer
was
fired, for failure to follow drug protocol.
¹⁰
Charlie was only on the couch for two days before a staffing agency
¹¹
found him nursing work. It was always easy to get extra hours during the holidays.

The week between Christmas and New Year’s Day was a stressful time for Charlie, but he was happy to be in uniform. The commute to the new job was only a couple miles down the road from Liberty, at Easton Hospital in Easton, Pennsylvania. He’d be happy with whatever shifts they’d give him, racking hours in whatever ward needed the help. Mostly, that meant working overnights in the familiar confines of the ICU, where death on the night shift was never totally unexpected.

A
t first, Kristina Toth didn’t make much of the strange man with the syringe;
¹²
she wasn’t even certain he was a nurse; all she noticed was that he was male, another uniformed stranger now responsible for keeping her father alive. Ottomar Schramm’s strokes had started a year before, each clot annexing another small quadrant of his body, and though he was now unable to put on his socks or navigate stairs, he was still Dad, even when unconscious in a nest of tubes and wires. Kristina comforted herself knowing
that Ottomar had been a practical man, with savings and a living will and a knowledge of what life brought; he was not surprised that it was his turn to suffer the same pedestrian indignities of old age that had afflicted his friends years before. He was now in the hands of the professionals at Easton.

Kristina remembered the man saying that he needed to take her father out of his room for “some tests.” The syringe, he said, was “in case her father’s heart stopped.” Kristina didn’t believe her father had any issues with his heart, but then, she wasn’t the professional here. At the time, she just accepted it.

The next time Kristina saw her father, during visiting hours the following morning, December 29, 1998, he looked waxy and unwell, far worse than when he’d arrived at Easton Hospital.
¹³
According to the doctors, Mr. Schramm’s deterioration appeared to be unrelated to his stroke. His heart rate wavered, his blood pressure plummeted. Mr. Schramm appeared to be spiraling downward, and Kristina began the mental preparations for her father’s imminent death. It seemed to be some sort of medical miracle when she arrived at the hospital the following morning to learn that her father’s condition had stabilized. In fact, she was told, her father was improving. With each passing day he was more responsive. Her visits were happy events. Otto’s wife and daughter would come nearly daily with cookies and a hot thermos, and he was always pleased to see them, even more for the kiss Kristina planted on his pate before she left for work. She allowed herself to feel the first ticklings of hope. The worst seemed to be over.

On the third afternoon, Kristina Toth received a strange call from her father’s longtime GP, Dr. Robert Silberman. Silberman told Kristina that somebody in the hospital—Silberman didn’t know who or why—had ordered a series of unauthorized blood tests for her father, which had turned up equally mysterious results. Ottomar Schramm’s blood contained digoxin, a drug he had never been prescribed. Silberman described the digoxin levels as being “off the charts.” Dr. Silberman couldn’t explain any of this, but promised to call back with the results of a follow-up test. At 1:25 a.m., Dr. Silberman called again, in shock. The new tests were consistent. And Kristina Toth’s father was dead.

“Please, listen to what I’m about to tell you,” Silberman said. “When you get to the hospital, they will ask you if you want an autopsy performed,” Silberman said. “If I were you, I would say yes.” Kristina didn’t understand. “
Because of the digoxin,
” Silberman said. He didn’t think he should say more.

Kristina’s family arrived back at her father’s Easton hospital room the next morning, finding it empty except for Charles Cullen, still on his night shift. Kristina got the sense that the male nurse had been waiting for her. He led Kristina’s family down the hall to another room. Otto Schramm’s body was there, cleaned, combed, and unhooked from the machines. The sight of him, truly dead, shocked her. “I’ll give you some time,” Charlie said. Something about that rankled Kristina—as if time with her father was a personal gift from this nurse—but she let it pass. Cullen returned a few minutes later. He wanted to know if the family planned to request an autopsy.

Kristina remembered what Dr. Silberman had told her. “I think so,” she said. “We were thinking about it.”

Nurse Cullen didn’t seem to like the answer. “Why would you want an autopsy?” he said. Cullen reminded her that Mr. Schramm had a living will which had specified against the use of extraordinary measures such as life support. An autopsy would be even more intrusive than life support—didn’t she see that she was violating the spirit of her father’s wishes?

Kristina didn’t bother answering. She simply told Nurse Cullen to leave the room.

Another nurse entered only minutes later, a woman this time. She too asked Kristina whether the family would request an autopsy.

Kristina didn’t understand. Was she being tag-teamed, or were the nurses not communicating? Hadn’t she already told her father’s nurse everything necessary? “We’re not sure,” Kristina said. The nurse nodded and left the room, and Kristina returned to her family.

A few minutes later, a third nurse arrived, and again asked whether they’d be requesting an autopsy. This time, she’d had enough. “Yes, we want an autopsy!” Kristina said. “Of course we do—somebody here gave my father an overdose and—”

“I wouldn’t say anything more,” the nurse said.
¹⁴

17

T
here had been an internal investigation after Ottomar Schramm’s death, and when the presence of a potentially lethal level of unprescribed digoxin was discovered in Schramm’s system, his autopsy was turned over to the county coroner.
¹
It would be ruled an accidental death, though Charlie didn’t really know about the outcome, and it didn’t much affect him. He’d never intended to stay long at Easton, anyway. It didn’t suit him. By the time questions began to circulate in March 1999, Charlie already had a full-time position down the road in the burn unit at Lehigh Valley Hospital.