Autopsy results released Friday show someone at Easton Hospital delivered a fatal dose of the drug digoxin to 78-year-old Ottomar Schramm between 8 a.m. Dec. 29 and 6 a.m. Dec. 30, 1998.
While they are not ready to file charges, investigators suspect that critical care nurse Charles Cullen, who worked at the hospital at the time, injected the medication, Northampton County Coroner Zachary Lysek said.
Schramm, who was from Nazareth, died at 1:25 a.m. Dec. 31.
Investigators say Cullen, 43, of Bethlehem, told them he has killed as many as 40 patients while working at a succession of hospitals over the past 16 years in the Lehigh Valley and New Jersey.
After saying Thursday he would not release the autopsy report, Lysek released the details Friday at county District Attorney John Morganelli's direction.
Lysek said hospital officials informed him on the date of Schramm's death that digoxin had been detected in the patient's blood and had not been prescribed by a doctor.
But there was no way to know how or when it got there. Lysek said he and county attorneys were initially concerned that the medication may have been injected while Schramm was a patient at Gracedale, the county nursing home in Upper Nazareth Township.
"There was no information to suggest it was a deliberate act at that time," Lysek said.
Lysek said he immediately confiscated all blood taken from Schramm while he was at the hospital for testing. Lysek said he ordered toxicology testing and informed the hospital that he was concerned about the death.
Toxicology results cleared up the timing question eight months later, providing a key piece of evidence in the current Cullen investigation.
The autopsy report shows that based on the blood draws, Schramm arrived at the hospital on Dec. 28 with no digoxin in his blood. At 8 a.m. on Dec. 29, there was still no digoxin. It first showed up in blood drawn in the hospital at 6 a.m. on Dec. 30 at a level of 9.1 nanograms per milliliter.
After that, it gradually dissipated.
The autopsy report, written by Dr. Saralee Funke of Forensic Pathology Associates in Allentown, says digoxin's therapeutic concentration is 0.3 nanograms to 3 nanograms.
Funke's autopsy lists "aspiration pneumonia due to seizures" as the cause of death, with digoxin a contributing factor. It calls the death accidental, Lysek said, because there was no way to know whether the digoxin was injected intentionally.
But Lysek said he listed the cause of death as undetermined on Schramm's death certificate and left the investigation open.
Hospital officials, Lysek said, told him sometime in 1999 that their internal investigation failed to determine who injected the digoxin into Schramm or why it was injected.
Lysek said he informed Morganelli of the suspicious nature of the death soon after it occurred and later briefed him on the details, although he couldn't remember the exact time frame.
The investigation remained open, Lysek said, but despite knowing when digoxin was injected, he had no way to determine how the drug got in Schramm's system.
At some point, Lysek said he learned someone who had worked at hospitals in Lehigh County was under investigation for similar actions and used that information in furthering his own investigation.
Lysek was not sure exactly when he learned of the Lehigh County investigation, or how long ago investigators began to suspect Cullen in Schramm's death.
Lysek officially declared Schramm's death a homicide Thursday at a news conference with Morganelli, citing Cullen's admission to investigators that he had killed as many as 40 people at various hospitals.
Schramm's widow, Lorraine, filed a wrongful death lawsuit against the hospital and group of doctors in October 2001.
Sue Ross, an Easton Hospital spokeswoman, said the hospital's current ownership -- Community Health Systems Inc. of Brentwood, Tenn. -- was not running the facility at the time of Schramm's death and has assumed no liability for any lawsuits arising out of it.
"I know that the lawsuit from the Schramm family was against the old ownership, and the liability was assumed by the [Two Rivers Health and Wellness Foundation]," said Ross.
The foundation is all that is left of the nonprofit corporation that ran the hospital at the time of Schramm's death. Two Rivers President Paul Brunswick said Friday it is liable for anything that happened while it was in control of the hospital.
He could not comment on how the hospital investigated Schramm's death.
Reporter Tom Coombe contributed to this story.Copyright © 2015, Los Angeles Times