In 2003, police in Somerset County, N.J., arrested a hospital nurse named Charlie Cullen who was suspected of injecting patients with lethal doses of a variety of medications. Cullen would turn out to be one of the nation's most prolific serial killers, murdering dozens, perhaps hundreds of people in nine hospitals over a 16-year period.
Journalist Charles Graeber spent six years investigating the Cullen case, and is the only reporter to have spoken with Cullen in prison. In his new book, The Good Nurse, Graeber pieces together the elements of Cullen's story.
"We'll never know how many people Charlie Cullen ultimately killed," Graeber tells Fresh Air's Dave Davies. "Charlie Cullen doesn't know how many people he killed. He initially could recall 40 and also said there was a large part of his life that was a fog during which he would have no ability to recall. But during that fog — those fogs lasted years — he said there were probably multiples a week."
Graeber — who has written for Wired, GQ and New York Magazine, among other publications — focuses not only on Cullen's tortured life and crimes, but on why Cullen wasn't stopped for so long, despite plenty of evidence he was harming patients. In case after case, Graeber writes, hospital staff believed Cullen was harming patients and pressured him to leave, but failed to alert state regulators or take other steps that might have ended his killing spree. Graeber has his suspicions of why the hospitals failed to report Cullen to the police, but stops short of directly pointing fingers.
He says that in writing the book he has tried "[to lay] it out so that a reader can see the facts laid side by side and decide for themselves the culpability of the hospitals, what they knew, when they knew, what they should have done; and certainly laws have changed in the wake of this."
One of the reasons that Cullen's crimes were so difficult to pinpoint is that human error and death are simply part of the hospital experience.
"Other incidents such as medication errors that are more routine, he had a lot of those as well," says Graeber, "and it's again difficult to sort out which ones were legitimate mistakes and which were simply the M.O. of murder. And more of those should have been reported; very few were, and the question time after time is, 'Should more have been reported?' Yes, absolutely. And you have to go hospital-by-hospital, case-by-case and really look at which incidents should have been reported."
On the actions of the hospitals
"The first actions you see time and time again at these hospitals is a legal action rather than an effective investigative reaction. And oftentimes, you'll find that what becomes — certainly in retrospect — to be a real burden of evidence against one guy ... when it starts to really look like this guy is dirty, that's the time he gets moved on one way or the other. He's pushed out or pressured out. So do the hospitals know? That's a question a reader needs to ask, and I think I provide enough evidence that they'll be able to draw that conclusion. But certainly he should have been stopped before he was, and because he wasn't, he killed a lot more people."
On Cullen's troubled childhood, possible sexual abuse and his first attempt at murder
"When asked directly about abuse of that sort in the house he gets very angry. He has gotten very angry with family members, with ex-wives, when they've tried to get him to seek counseling, when they've tried to take him aside, because the pattern — it certainly seems to fit the pattern. He won't say, but he felt unsafe. There were strange men in and out of that house. He had a brother-in-law that came to live with one of his sisters when his sister was pregnant. There was a lot of domestic abuse surrounding that. Exactly what happened to the child is not clear. Eventually the sister ran away, but the brother-in-law stayed, and he and Charlie had a tortured relationship that Charlie had reported to at least one — if not two — of his later lovers that he'd tried to poison that brother's drink. He'd put lighter fluid in the vodka, which is sort of an early example of what would become his pattern for life: a way of passively dealing with things."
On Cullen's narcissism
"His thinking is circular, narcissistic and then the question is how far does that narcissism go? Is it sociopathic? And the answer to that lies somewhere in, well, you have to ask yourself, 'What sort of a person can kill someone and be there as they die and not have it seem to really affect their day at all, or in fact affect their future behavior in any negative fashion for 16 years?'"
On Cullen's hero complex
"Sometimes that's what worked for him. He knew what was wrong with a patient when no one else did. He could be the first to go in there. The other residents remember him jumping on the chest of a patient in just — the sort of — the most dramatic fashion. They appreciated his enthusiasm and his passion, but it seemed a little over the top. But the truth was he did what others could not do, and he did receive praise for that. It did elevate his status, and so there was absolutely an element of ego in the murders."