The Good Nurse: A True Story of Medicine, Madness, and Murder (49 page)

8
According to DOH records, Amie Thornton e-mailed Dr. Marcus again in December 2003:

I’ve been meaning to contact you all, but things have been a zoo here (as you can imagine). Your call to Eddy and me in June seems to be the grain of sand in the oyster that brought this situation to light. [Your] ability to spot the trend and get the hospital focused on pursuing this issue proved quite valuable. Clearly your instincts were right on target! Thanks.

Dr. Bresnitz e-mailed Dr. Marcus two years later regarding the calls, telling him, “Ironic that Somerset portrays themselves as doing the right thing by notifying us when clearly it was in response to your informing them that if they wouldn’t do it, you would.”

9
At 4:23 p.m. on July 10, 2003, several hours after Dr. Marcus had called and e-mailed the DOH.

10
Those patients were Joseph P. Lehman, who suffered unexplained hypoglycemia on May 28, 2003, and Francis Kane, who had a similar incident on June 4, 2003.

11
They’d hired an RN from an inspection agency, who spent two days interviewing leadership and checking the machines before submitting a report.

12
According to documents from the police investigation, an internal memo on the interview (written July 25, 2003, and included in police investigative reports), by Fleming, indicates conflicting impulses and information, including that he had not interviewed any nurses other than Cullen, that he had some suspicion that the unexplained overdose incidents at Somerset were both connected, and that such incidents might not yet be finished:

Ms. Lund and I discussed a variety of issues and planned some further investigation,” Fleming wrote. “Some of the blood taken from patients in the CCE/ICU in recent days is going to be tested and the ICU/CCU blood taken from patients now and in the immediate future is being saved. In addition, we are going to speak to the nurses caring for Reverend Gall on the 27th and 28th of June. The billing records are going to be checked to see if Digoxin was billed to any of these three patients, even though the record doesn’t show that it was given. Lastly, Ms. Lund is going to send me the Han medical chart and the Maurer medical chart. (Maurer was another, unknown patient who was also apparently within the scope of Fleming’s investigation.)

The penultimate paragraph suggests that while police involvement was not warranted, Lund and Fleming already suspected Cullen as a subject to be watched: “We agreed that there was nothing so overtly suspicious at this point in time (either from the records or Mr. Cullen’s demeanor itself) that would necessitate a call to the authorities. However all the patients in ICU/CCU are being carefully monitored and red flags are going up for any Digoxin orders of medication administration…. Incidentally, the records also show a number of viles [
sic
] of Digoxin not being accounted for last month.”

1
Pasquale Napolitano, killed on July 13.

2
Dr. Max Fink, the head of the insulin coma unit at the Hillside Hospital in Glen Oaks, Queens, New York, from 1952 to 1958, described some of the effects of insulin for PBS’s
The American Experience
:

Stages of Coma

0630–0715: Pre-comatose.

Patient went gradually to sleep and then to coma. Two forms of coma were recognized, a “wet” and a “dry.” In the “wet” form, sweating was profuse and was accompanied by “goose-bumps” in the skin. Salivation increased, so much so that nurses sopped it up with gauze sponges. In the “dry” form, the skin was hot and dry, muscles twitched, in a sequence that began in the face, arms, and then in the legs. These were often small twitches, but from time to time, patients would move and jerk an arm or a leg. Occasionally, a grand mal seizure supervened.

3
Götz Aly et al.,
Cleansing the Fatherland
(Baltimore: Johns Hopkins University Press, 1994). The Eichberg Station was designed to accommodate experiments with intentional IV overdoses; see Henry Friedland,
The Origins of Nazi Genocide
(Chapel Hill: University of North Carolina Press, 1995), 131.

1
Details of this horrifying incident, and all patient deaths, are drawn from police investigation documents.

2
September 23, 2003.

1
Tim got the call that he’d made the grade in Essex the same day that he got the call that his father had passed away. He didn’t know if that was what changed it for him, but something shifted in the way he saw his role in life.

2
Fifteen years later, in January 2010, Essex County investigators finally made their knowledge of Duryea’s killer’s gun public. The Newark
Star-Ledger
would report “Robert Reeves, 44, used the same .32-caliber revolver involved in the Duryea slaying to fire five bullets into a Newark minister. When asked about Reeves, Anthony Ambrose, the prosecutor’s chief of investigators, [confirmed] in an interview that Reeves is ‘a person of interest’ in the Duryea case.” Philip Read, “More Details Emerge in the Killing of Glen Ridge Grandmothers,”
Star-Ledger
, January 10, 2010,
http://www.nj.com/news/index.ssf/2010/01/new_details_emerge_in_1995_kil.html
.

1
Dennis Miller at Somerset Medical Center contacted the office of Prosecutor Wayne Forrest on this date.

2
Details of the detectives’ actions and interactions with the individuals at the hospitals are drawn from the police investigative reports and detailed by personal interviews.

3
In fact, the Department of Health and Senior Services had reached out to the New Jersey Attorney General’s office before Somerset Medical Center administrators contacted the Somerset Prosecutor’s Office.

The full story of how these incidents were reported is a bit more complicated, and suggests that the process of reporting, investigating, and ultimately acting upon the incidents at Somerset Medical Center in a timely manner had been stalled or sidetracked at several junctures, both within Somerset Medical Center and at the highest level of the DOH itself.

The DOH sent an investigator named Edward Harbet, an RN and a complaints Investigator from Health Care Systems Analysis. He visited SMC on July 11 and 14, reviewing the medical records of the patients involved and the summary of the SMC internal investigation, and interviewing several administrators. Harbet was unable to identify any specific findings that would explain the relevant lab values in the patient incidents. He told SMC administrators that the charts would be reviewed by others in his department.

The sitting commissioner of Health and Senior Services at the time was Cliff Lacey. According to e-mails from the senior assistant commissioner, Marilyn Dahl, the incidents at Somerset Medical Center had been discussed with Commissioner Lacey following the reporting of both Steven Marcus and then Somerset Medical Center administrators. “Based on his experience with the drugs in question, and as the senior medical officer of a large hospital,
the commissioner thought it was extremely premature to start suspecting foul play. I had, at that time, raised the issue of a referral to the AG, and the commissioner declined
,” Dahl wrote. “He was able to hypothesize several likely scenarios not involving foul play that could have resulted in the outcomes reported.” (Emphasis mine.)

Then, on September 26, 2003, some members of the DOH became increasingly concerned about what was unfolding at Somerset.

A senior DOH staffer named Maureen F. Miller sent an e-mail to Marilyn Dahl. “While the Dept was aware that three unexplained incidents had occurred and was working with Somerset’s administration who was investigating the incidents,” Miller wrote, “Somerset reported to us today that a fourth incident occurred one month ago,” despite being explicitly warned of the necessity of reporting any additional patients.

Dahl was deeply concerned. She reported that she had met with Alison Gibson, director of Inspections, Compliance and Complaints at the DOH, and Amie Thornton, assistant commissioner of Health Care Facility Quality:

We all agreed that there may be sufficient reason to suspect foul play.
The disturbing part of this picture is that Somerset had made us aware of the 3 previous occurrences, yet chose to wait an entire month before reporting the 4th. We believe that this was irresponsible at best,
and would like permission to seek counsel’s opinion from OLRA [the DOH office for Legal and Regulatory Affairs] for referral to the AG’s [Attorney General’s] office. [Emphasis mine.]

That day, the Department of Health reached out to the Attorney General’s office regarding the issue at Somerset. Amie Thornton wrote Ms. Miller and others at the DOH later on September 26 to report that “I believe at this point the hospital actually suspects foul play as they have retained private investigators/attorneys to investigate this situation.” Seven days later, Somerset Medical Center contacted the Somerset County Prosecutor’s Office (SCPO).

1
Sachs, Maitlin, Fleming, Greene, Marotte and Mullen.

2
This conversation is reconstructed from SCPO investigation documents detailing the meeting and the information Lund provided, aided by extensive interviews with Detective Baldwin.

3
Somerset hadn’t called the police for a half-dozen patients who
had
been poisoned—then, months later, called to report the death of a man who hadn’t.

1
This call was part of an investigation at Easton Hospital, just underway at this time but already stalled.

1
The info to this date (October 8, 2003) comes from various databases and contacted agencies, including the South Carolina State Police, the Summerville (South Carolina) Police Department, the Palmer Township (Pennsylvania) Police Department, the Phillipsburg (New Jersey) Police Department, and the New Jersey Board of Nursing.

1
Those investigations were closed in late December 1991, with no conclusion. Charles Cullen was fired the first week of January 1992, and the insulin spikes stopped. Saint Barnabas has since maintained that these facts are unrelated, and that the administration did not have reason at that time to believe Charles Cullen was a risk to patients.

2
Fragments of this investigation would later be recovered after Cullen’s arrest.

3
Several incident reports described the MO of the crimes almost exactly. For example, Charlie had been written up for checking the insulin levels of a patient repeatedly and at inexplicable and inappropriate intervals, and for leaving an unprescribed and unlabeled IV hanging for a patient after his shift, rather than the prescribed KCL solution. Afterward, when his supervisor contacted him at home by phone, Cullen seemed apathetic, and he claimed that if it was hanging there, it must have been the prescribed KCL. It wasn’t, but exactly what was in the bag, and whether this was one of the saline IVs which Cullen would later admit to having randomly spiked with insulin, would never be known.

4
Cullen had signed up with MCHCS halfway through his years at Saint Barnabas in order to have more flexibility in the hours and units in which he worked. This was the reason that Cullen’s Saint Barnabas file covered only the final two years of his five-year tenure; technically, a different corporate entity had hired him.

5
In fact, what was meant by “dual medication error” is somewhat more damning of the nurse. What was referred to here is a situation in which Cullen had (1) withheld medication the patient was prescribed; (2) in its place hung an unlabeled bag that, strangely, he had (3) pinched off so that the next nurse would be the one to start the drip. It is, in fact, a triple error; exponentially less likely, and rather more troubling than a single dosage error, as it cannot so easily be written off as a simple mistake. The supervisor’s reaction reflects this.

Ostensibly the IV bag in question contained only saline, though we cannot know for sure, as Cullen’s practice at the time was to use such bags, spiked with insulin, to sicken patients; and he often covered his tracks by ensuring that the spiked bags were infused by other nurses when he was not present.