A Bethlehem critical care nurse told investigators he killed 30 to 40 patients over the past 16 years and firmly confessed Monday to two charges in a Somerset County courtroom, ignoring a judge's repeated requests to remain silent.
Charles Cullen, 43, who worked at almost every hospital in the Lehigh Valley, was charged with one count of first-degree murder and one count of first-degree attempted homicide in the deaths of two Somerset Medical Center patients earlier this year.
Authorities said their investigation is just starting, but it could become one of the biggest homicide cases ever in New Jersey.
Cullen tried to plead guilty numerous times Monday, but New Jersey Superior Court Judge Paul Armstrong said he was not prepared to accept a plea at an arraignment hearing and repeatedly advised Cullen to remain silent. He urged Cullen to find an attorney or accept a public defender before making further statements.
Cullen, a slim, fit-looking man dressed in prison garb, spoke clearly and lucidly as he told Armstrong he didn't want a trial.
"I don't want to contest the charges. I plead guilty," Cullen said in a courtroom full of reporters from New York to Philadelphia. "I don't want to be represented. I don't intend to fight this."
Cullen, of Fernwood Street, told investigators over the weekend that he committed the crimes by improperly medicating the victims to ease their pain and suffering, according to documents released by Somerset County Prosecutor Wayne Forrest.
"As you can imagine, this is by far the biggest homicide investigation undertaken by the Somerset County prosecutor's office, and maybe by any law enforcement agency in New Jersey," Forrest said at a news conference.
Forrest said charges in a third case are pending autopsy results, but added that Cullen has told investigators he was responsible for 12 to 15 deaths at the medical center during a 13-month period.
Lehigh County District Attorney James Martin called on Pennsylvania State Police to reopen a 2002 probe related to several suspicious deaths while Cullen worked at St. Luke's Hospital in Fountain Hill.
Northampton County District Attorney John Morganelli is looking into a suspicious death at Easton Hospital while Cullen worked there.
Cullen also worked in the burn unit at Lehigh Valley Hospital, Salisbury Township, and Liberty Nursing Home in Allentown. LVH officials said they are re-examining the records of patients who died while Cullen was there but so far have found no problems.
Liberty officials, in a prepared statement, said Cullen was fired for failure to follow company procedures.
Sacred Heart Hospital in Allentown said Cullen worked there for 18 days in July 2002 and was fired for having "interpersonal problems" with other employees. Hospital spokesman Chris Sodl said Cullen was in an orientation period when he was let go, and had no unsupervised contact with patients.
Forrest said Cullen was arrested without incident Friday night after he dined with a companion at a restaurant on Route 22 in Bridgewater. He was alone when arrested, said the prosecutor.
Forrest said his investigation is still in the early stages, and he declined to predict how long it would take to finish. He said investigators are looking at possible accomplices, but downplayed the possibility that Cullen had help.
Cullen, a divorced father of two, graduated from West Orange High School in 1978 and served in the Navy for six years before attending Mountainside Hospital School of Nursing in Montclair, N.J. He graduated from Mountainside in 1987 and worked at St. Barnabas Medical Center in Livingston, N.J., from June 1987 to January 1992.
Cullen went to Warren Hospital in Phillipsburg in February 1992 and was the subject of an inconclusive investigation there related to patient deaths before leaving in December 1993.
The charges in Somerset County come after abnormal blood tests revealed the presence of unusual medication amounts in at least a half-dozen patients who have since died. The tests revealed unusually high levels of the prescription heart medicine digoxin and unusually low blood sugar levels in the patients, Somerset Medical Center officials said last week.
Cullen was charged with the June 28 death of the Rev. Florian Gall, 68, a Roman Catholic priest from Whitehouse Station who had lethal levels of digoxin in his blood. He was admitted June 13 with what was described as various serious medical conditions and heart disease.
Cullen also is accused of administering lethal doses to an unidentified cancer patient to cause her death. Admitted June 12, the Basking Ridge woman was described as very ill with cancer and heart problems. She was found to have a potentially deadly level of digoxin on June 16, but recovered after an antidote was administered.
She was discharged June 29, but was later readmitted and died Sept. 5 at the hospital.
Forrest said Cullen would access the drugs through a computerized disbursement system, then access the patient's computerized medical records. After receiving the drugs from a motorized dispensing cart, he would then cancel the order through the computer to hide the acts.
"[Cullen] accessed the medication dispensing system for digoxin at an abnormally high rate during his employment, according to a review of the records," Somerset County Detective Daniel Baldwin stated in the probable cause affidavit. "There was no medical reason or authorization for the high number of entries."
Somerset Medical Center changed its access procedures to make medicines more difficult to obtain after the incidents with Gall and the Basking Ridge woman, according to the affidavit.
Martin confirmed that Cullen was the subject of a Pennsylvania State Police investigation of improperly medicated patients at St. Luke's Hospital, where Cullen worked from June 2000 to June 2002.
"There were suspicions and yes, the patient files we reviewed involved patients who died over a seven-month period," Martin said.
The probe ended with insufficient evidence for prosecution, Martin said.
"These people were very sick to begin with. They were being treated in the cardiac care unit. The deaths were not completely unexpected," Martin said. "It was a very difficult task, especially without the benefit of any autopsies, to determine from the records whether the deaths were suspicious."
Martin said the case was brought to his office through a nurse concerned with actions she had seen while Cullen was there.
St. Luke's officials conducted their own investigation after others found needle disposal boxes full of unopened drug packets. One was called procainamide, and is used to treat arrhythmia. The other was sodium nitroprusside, used to regulate blood pressure, according to spokeswoman Susan Schantz.
"There is no reason in the world unopened medications would be there," Schantz said. The medications themselves are very common, especially in a coronary care ward, she said. The box was emptied and more unused medications were found in the box the morning of June 3, 2002.
St. Luke's began its investigation and on June 7, Cullen resigned under pressure after he refused to answer questions about the unused medications. He was suspected because other nurses had seen him in the medication room and around a needle disposal box, and he was suspended from duty on June 3, said Dr. Charles Saunders, senior vice president and president of medical and academic affairs.
The medications found are used to treat acutely, critically ill cardiac patients and were normal cardiac medications, Saunders said. Administered in small amounts over a long period of time, they would not be lethal. "Any drug given a high enough dose could be lethal," he said.
Martin said Cullen's previous Lehigh County employment experience was known to investigators at the time, but they found no reason to pursue activities at LVH or Liberty.
In 1998, one of Cullen's patients at Liberty died of a suspected insulin overdose, according to a lawsuit filed in Lehigh County Court.
Cullen had treated the unnamed patient the night of the overdose, but another nurse also treating the patient was fired for the death. That nurse, Kimberly A. Pepe, later won a settlement from the home when she alleged that her firing was unfair and that the home had failed to investigate the real killer, Cullen.
Liberty officials said they conducted an internal investigation and alerted the state Department of Health, but they believed no actual harm came to any patients during his employment.
Northampton County's Morganelli is investigating Cullen's activities at Easton Hospital. Morganelli said he began an investigation two months ago of a suspicious death that occurred while Cullen worked there in late 1998 and early 1999.
"While he admits to causing the deaths of patients at other hospitals, it is my understanding that he is not admitting to the death at Easton Hospital," Morganelli said. "If there is sufficient evidence to file homicide charges, we will pursue that, but right now we don't know if that's going to be the case."
Easton Hospital spokeswoman Debbie Borse said Cullen was hired through a temporary agency.
In 1993, Warren County prosecutors investigated Cullen in connection with the suspicious death of a 90-year old woman who was a patient at Warren Hospital. The woman was treated at Warren Hospital and moved to a nearby nursing home, where she died a few days later, said Kay Shea, vice president of public relations for the hospital.
The woman's family asked for an autopsy and that led Warren County to investigate. The case was closed within a few months, and Cullen resigned from Warren Hospital shortly afterward.
"We didn't have enough evidence to file charges back then," said acting Warren County Prosecutor Frank Busci. "But in light of recent events, we will be reopening that case."
Hunterdon County First Assistant Prosecutor Steven Lember said his office also is investigating Cullen's activities during his time at the Hunterdon Medical Center in Flemington, N.J., from April 1994 to October 1996.
The revelations left some hospital administrators in shock.
"It's a frightening, sad story for anyone in the health care business," said Shea. "It's very difficult for us to understand how someone could take another person's life. It's very sobering."
Dr. Terry Theman, a longtime cardiac surgeon at St. Luke's, doesn't remember working with Cullen, but that didn't dull the impact on him.
"Who made him God?" Theman said. "Enough bad things happen without him expediting the process."
Reporters Matt Assad, Garrett Therolf, Genevieve Marshall and the Associated Press contributed to this story.Copyright © 2014, Los Angeles Times