Charles Cullen: Healthcare Serial Killer

On December 12, 2003, Cullen was arrested as he left a restaurant and soon charged with the murder of Reverend Florian Gall and the attempted murder of Jin Kyung Han, saved from the June overdose but who had died that September from unrelated causes. With both cases, Cullen was suspected of injecting a lethal dose of digoxin, which he had procured via deceptive computer manipulation from hospital supplies. But he'd been ignorant about computer tracking: canceling the order doesn't delete the transaction. He'd left a record.

Cullen did not resist arrest. In court at his arraignment, he pled guilty to the charges and said he had no intention of fighting. "I don't intend to contest the charges," he uttered in a quiet voice. "I plan to plead guilty."

Charles Cullen in court

The judge did not want him to enter a plea at that time. Cullen's response was to rescind his request for a public defender. "I don't plan to fight this," he reiterated. His bail was set at $1 million and he was taken to Somerset County jail.

But he had already dropped a bombshell to detectives a few days earlier that went well beyond the current charges and would open up the largest murder investigation in that county's history. Many more charges would follow, in this and six other counties, covering two states.

Over the past 16 years in ten different institutions, Cullen had admitted, he'd intentionally overdosed 30, possibly 40 patients. He didn't have an exact count, but he was clearly a serial killer of major proportions. To that date among healthcare killers, only Donald Harvey, another male nurse, had come close to a number like that.

Donald Harvey

In 1987, Harvey pled guilty in Indiana, Kentucky and Ohio to 37 counts of murder and several counts of attempted murder, mostly by poisoning or smothering. A psychiatrist who examined him said that he was a compulsive killer, murdering to relieve tension. When all was said and done, he had the most confirmed victims of any healthcare serial killer in America, and he'd actually confessed to more than twice this number.

Cullen now stood to pass the record. Hepp was on the story before anyone else, and he quickly learned about the phenomenon of healthcare serial killers, or HCSKs. Just a month before Cullen's revelations, Kelly Pyrek had organized the data in Forensic Nurse magazine, and had quoted some shocking statistics from Beatrice Yorker, Director of the School of Nursing at San Francisco State University: male nurses are disproportionately represented among caretakers who harm patients. While there are many more actual cases of females who indulge in this behavior, the 146,000 male registered nurses represent 5-7% of nurses but are responsible for about 1/3 of the healthcare serial murder cases in the U.S.

Harold Shipman

National papers and television programs jumped into the fray to learn more about both Cullen and HCSKs. Nurses who kill, it seemed, perceive how to exploit the atmosphere of trust in the hospital community and to hasten deaths that may go unnoticed. In the past 30 years, the Philadelphia Inquirer reported, there had been at least three dozen such cases in civilized societies, but it turned out they had underestimated by nearly half.

Yorker indicated that, worldwide, there had actually been 72 such cases since 1970, with escalations from one decade to the next, but Paula Lampe in the Netherlands had counted 81 (and 31 were male). Among them, they had over 2,000 fatalities (and that was before the final inquiry in England had decided that physician Harold Shipman had killed as many as 250 patients.)

Some had entered the profession as "angels of death," while others transformed into killers on the job. "Many experts speculate," says Pyrek, "that healthcare has contributed more serial killers than all other professions combined and that the field attracts a disproportionately high number of people with a pathological interest in life and death."

People watched to see what Cullen would say next. For a long time, it seemed, he'd been hiding in plain sight, but now he was exposed.