Charles Cullen was hiding in plain sight.
As a registered nurse, the New Jersey native won people's trust the minute he walked into a hospital wearing scrubs.
No matter that, by 2003, Cullen had been investigated four times by police, had been the subject of dozens of complaints and disciplinary actions, spent time in mental institutions and been fired or asked to resign by five of the hospitals that had gainfully employed him at one time or another over the course of 16 years. Reporting for duty with a technically clean record, he apparently made a killer first impression at every new place by dutifully signing up for weekends, holidays and other unpopular shifts.
All the better to ply his real trade with fewer people watching.
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"I thought that people aren't suffering anymore, so in a sense, I thought I was helping," Cullen told 60 Minutes' Steve Kroft in 2013, seven years into multiple life sentences for murdering dozens of patients while working as a nurse.
And, he admitted to Kroft, if he hadn't been caught, "I don't know if I would've stopped."
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Eddie Redmayne and Jessica Chastain play Cullen and Amy Loughren, a close friend and colleague who helped the police close their case, in "The Good Nurse," which premiered at the 2022 Toronto International Film Festival and is now streaming on Netflix.
The real Loughren met with both stars to help them get a handle on what it was like for her to find out that a person she trusted implicitly — the single mom of two daughters suffered from severe heart trouble that she didn't disclose at work, but she confided in Cullen — was living this double life.
"She describes it as dissociative, and so even though I'd read all about his background and his upbringing, which is woven with trauma," Redmayne told AV Club, "hearing this person that was so close to him [explain that Cullen] was two different people was an insight."
Loughren said that she was unsure about being involved at first, not wanting it to look like she was profiting from her association with the case in any way.
"Eventually," she explained to Glamour UK, "I realized it would give me a platform to explain myself and also give a voice to others who have loved dark people or have loved those with serious mental illness that led to dark acts."
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And, Loughren continued, "Eddie and I talked a lot about who the real Charlie was. I didn't know the serial killer, I met that person only a few times. The real Charles Cullen was a different person." Aside from suspecting that he had "a bit of depression," like she did, "I didn't see any outward darkness until I met the murderer. When I did realize he was a killer, there were so many emotions. When I first read the evidence and there was no doubt there was something sinister, I had a moment that you see in movies where my vision went."
The Good Nurse also scrutinizes the system that allowed Cullen, his nursing license up to date in two states and his record unblemished, to keep working at nine hospitals, leaving a trail of bodies behind at every one.
"If he's the most prolific serial killer in the U.S., why do I not know anything about him?" Chastain remarked to the Financial Times. "Probably because they don't want me to know anything about him, because it's a for-profit medical system, and there were a lot of people involved in keeping everything quiet."
Who is Charles Cullen?
Cullen, the youngest of eight siblings, was a dedicated student and — in 1984 — the only guy in his class at the Mountainside Hospital School of Nursing in Montclair, N.J., according to Charles Graeber's 2013 book (and source material for the 2022 film) "The Good Nurse: A True Story of Medicine, Madness and Murder." The Navy veteran was even elected class president.
He met his future wife, Adrianne Baum, working at a Roy Rogers, one of the handful of part-time jobs he maintained to pay his tuition. Cullen proposed six months after their first date and they tied the knot the week after he graduated from nursing school. They cut their honeymoon to Niagara Falls a day short so he could report for work in the burn unit at Saint Barnabas Medical Center in Livingston, N.J., on June 11, 1987.
Cullen and Baum welcomed daughter Shauna in 1988 and, per Graeber's book, he turned his attention entirely to the baby, "as if he couldn't broaden the focus of his affections to cover both." One day Baum came home to find that Cullen had taken scissors and cut out the little boys in the photos she had taken of Shauna with her friends at daycare. A few days later, the neighbors' old Beagle that frequently wandered into their yard was found dead — poisoned, the vet said — in the alley next to their house.
Baum had already told some friends that she was starting to suspect something was "seriously wrong with Charlie."
What were the first signs that Charles Cullen was a killer?
Per Graeber, who pieced the story together with police reports and court documents as well as hundreds of interviews, on Feb. 11, 1991, a pharmacy nurse at St. Barnabas found an IV bag that looked suspiciously full. It turned out that, in addition to the saline and heparin (a blood thinner) it was supposed to hold, it also contained insulin.
Three days later, two patients were hooked up to two more of these tainted bags. A look at patient records found that there had been an unusual number of patients crashing from spiked insulin levels lately, some of whom had died. Three nurses had been working at the time every one of those patients had coded, including Cullen.
And, according to the hospital security officials who questioned him, he was the only one of the three who didn't seem at all concerned that he had done anything wrong.
Pressed to admit he had put something in the IV bags, Cullen replied, per Graeber, "You can't prove anything."
Which was true. So hospital officials consulted law enforcement, and were told there wasn't enough evidence for police to do anything.
The security execs tried to catch Cullen, even putting cameras in the storage room and implementing a new drug sign-out policy to track insulin the same way they tracked morphine. But two more patients ended up with insulin overdoses in October 1991.
Only when St. Barnabas stopped scheduling Cullen for shifts toward the end of 1991 did the problem stop.
He told Baum the hospital fired him because he'd been vocally against a possible nurses strike, and now — out of spite, he claimed — they were blaming this epidemic of tainted IV bags on him.
According to Graeber, Baum wasn't convinced by his story but, having just had their second daughter, Saskia, in December, she was in no position to get to the bottom of it.
How did Charles Cullen keep working as a nurse?
In January 1992, just weeks after St. Barnabas let him go, Cullen was hired at Warren Hospital in Phillipsburg, N.J. Asked by HR why he wanted a change after five years at his previous hospital (which he listed as his "current employer"), he answered, simply, that he wanted a better commute.
Again, Baum, who worked as a computer programmer, really didn't know how her husband got hired again so quickly. He was also drinking heavily — and secretly, hiding his bottles in the basement — and would complain about being vilified and misunderstood, and how even his wife was against him.
Baum filed for divorce in November 1992.
Meanwhile, three elderly patients at Warren Hospital — including a 91-year-old cancer patient, Helen C. Dean, who told her son, Larry Dean, that a male nurse who wasn't one of her usual caretakers came into her room and "stuck [her]"—died of what turned out to be overdoses of the medication digoxin, which is commonly used to regulate heart rhythm.
Larry reported what his mother told him to doctors and nurses—and then to the county prosecutor after his mother died in September 1993, insisting she was murdered. Investigators determined Cullen was the nurse who'd been in her room, but the autopsy didn't turn up digoxin—because it wasn't one of the roughly 100 substances the medical examiner tested for.
Also that year, Cullen started stalking a coworker and on Aug. 10 pleaded guilty to misdemeanor trespassing for breaking into her home. He got probation.
Cullen voluntarily left Warren on Dec. 30, 1993, and went to work in the ICU at Hunterdon Medical Center in Flemington, N.J., where he later admitted to killing five people with digoxin between January and September of 1996.
How did Charles Cullen finally get caught?
After stops at Morristown Memorial Hospital (fired for poor performance); Liberty Nursing and Rehabilitation Center in Allentown, Pa. (fired after entering a resident's room with syringes and the resident ended up with a broken arm); Easton Hospital, also in Pennsylvania (an internal investigation into a suspicious death due to digoxin was inconclusive); Lehigh Valley Hospital–Cedar Crest in Allentown (voluntarily resigned); St. Luke's Hospital in Bethlehem, Pa. (suspected of stealing medications, he was given the chance to resign; a state pathologist was called in to investigate 69 patient deaths but couldn't confirm a pattern); and Sacred Heart in Allentown (fired after 16 days for not getting along with fellow nurses), Cullen landed at Somerset Medical Center in Somerville, N.J., in September 2002.
The following July, an assistant pharmacist contacted the New Jersey Poison Information and Education System after a series of suspicious deaths due, respectively, to digoxin and insulin overdoses, in the same ward. On poison control's recommendation, Somerset officials finally contacted New Jersey State Police in October 2003.
"It got pushed to the forefront, certainly, by an outside entity refusing to allow that internal process to continue to drag on," Graeber told NPR in 2013. "And it's terrifying to speculate as to what would've happened if [Dr. Bruce Ruck and his boss, Dr. Steven Marcus, at poison control] not pushed it."
Adept with technology, Cullen used the computerized Pyxis MedStation, designed to make keeping track of and checking out drugs more streamlined and secure, to his advantage. According to Graeber's book, authorities eventually saw a pattern: Cullen canceled many of his own orders, having realized that if he ordered but quickly canceled, the drawer had opened but there would be no computer record of the drug being removed. Guessing investigators were onto him, he changed his method, instead ordering up a suspicious amount of acetaminophen (Tylenol)—which, his friend and fellow nurse Amy Loughren soon realized, shared a drawer with digoxin.
After interviewing many hospital staffers, authorities enlisted Loughren to help analyze the records of Cullen's drug orders. She too wondered why an ICU nurse was acquiring substances needed more in the cardiac wing, plus the combination of meds he was ordering was suspicious. He had also been accessing the charts of other nurses' patients.
"She came across as a strong-minded, intelligent individual, so I rolled the dice and revealed some of our findings to her," since-retired Det. Daniel Baldwin (played by Nnamdi Asomugha in "The Good Nurse") told People of enlisting Loughren in their investigation. And then they had her wear a wire to a meeting with Cullen outside the hospital. (They hesitated when they saw her scar from having a pacemaker put in, but, she told Glamour UK, she assured them, "I'm a cardiac nurse, I know I'll be OK.")
Confronting him with what she knew, Loughren offered to go with her friend to the police, to confess.
"He sat straight up," she recalled to People. "The color of his eyes changed. He put a smirk on his face and said, 'I'm going to go down fighting.'"
Cullen was fired Oct. 31, 2003, ostensibly while being investigated for altering the blood chemistry of six elderly patients, including four who had died. A hospital official told authorities that five of the six incidents ended up having acceptable explanations.
As for the sixth: Cullen was arrested that December on suspicion of murder in the June 28, 2003, digoxin overdose death of the Very Rev. Florian J. Gall, a 68-year-old priest. He was also charged with attempted murder for trying to administer a fatal amount of digoxin to a 40-year-old woman, who received an antidote in time.
How many people did Charles Cullen kill?
After his arrest, in addition to confessing to the charges, Cullen told a detective he'd killed 12 to 15 patients, explaining that he had administered lethal doses of digoxin to end their pain and suffering.
At his first hearing days later, where bail was set at $1 million, he told the judge, "I am going to plead guilty. I don't plan to fight this." By then he'd told investigators he had caused 30 or 40 deaths in New Jersey and Pennsylvania.
Prosecutor Wayne J. Forrest called the case against Cullen "by far the largest homicide investigation ever in Somerset County,'' and possibly the state. Investigators have said that the number of Cullen's victims could be closer to 400, but without his corroboration, most would be impossible to prove in a court of law.
All told, the case encompassed multiple counties, numerous exhumations of remains and months of testing.
Cullen ultimately pleaded guilty in 2005 to 29 counts of murder committed between 1988 and 2003 in New Jersey and Pennsylvania, as well as six attempted murders. Somerset County Superior Court Judge Paul W. Parker sentenced him in March 2006 to 11 consecutive life sentences for the 22 murders in New Jersey.
"The malicious magnitude of your crime requires the fullest measure of deterrence the law will allow," the judge said. Given the chance to speak, Cullen stated that he had nothing to say. For most of the hearing he reportedly appeared unmoved, his eyes closed much of the time.
Numerous family members of the victims spoke out in court, however, with Rev. Gall's sister, also a nurse, telling Cullen, "We are taught to care for others, and you broke the trust placed in our profession."
The granddaughter of his second victim, Mary Natoli, told him, "I want you to die tomorrow."
Thomas Strenko, whose son Michael was 21 when he died from a fatal injection of norepineprhine while recovering from a splenectomy, said, "For someone to be able to hop from hospital to hospital with these problems for over 15 years defies trust. We are outraged that no one stopped Charles Cullen from murdering my son."
Cullen was subsequently given seven more life sentences in Pennsylvania.
Where is Charles Cullen now?
Cullen, now 62, is serving his time in New Jersey's Trenton Maximum Security Prison.
Talking to 60 Minutes in 2013, he was asked about his reluctance to call what he did murder, though he admitted causing all those deaths.
"I think that I had a lot of trouble accepting that word for a long time," Cullen said. "I accept that that's what it is."
Did he consider himself a serial killer?
"I mean, I guess it depends upon a person's definition," he said. "If it's more than one and it's a pattern, I guess then yes."
Where is Amy Loughren now?
"The person I am today is not the same as the woman you see on screen — I am 20 years wiser and more confident," Loughren, 57, told Glamour UK, comparing her memory of herself to Chastain's portrayal in "The Good Nurse." "I'm a much better version of myself than I was then. Jessica offered a gentleness to that 20-year-old past self that I didn't realize I had and that to me was one of the most beautiful things that she put into play."
She visited Cullen a number of times in jail, she recalled, but he stopped answering her letters once he found out she was cooperating with the prosecution.
"I think I wanted to be in denial that he was a mercy killer, I wanted to make certain that whoever my friend Charlie was that he was no longer there," she said. "I didn't get the answers I wanted, but I was able to see how charismatic he was and how easy it was to be drawn in. It was a process of being able to forgive myself for not seeing it.
"I knew that monster needed to be behind bars, but I was also putting my friend Charlie behind bars."
Seeing the movie, Loughren said, helped her overcome her lingering trauma from the experience once and for all.
"It's just not in my nature to betray one of my friends, but of course I knew I had to," she told People. "What I love about nursing is that I could protect the vulnerable — and I'm a badass nurse."
"The Good Nurse" is streaming on Netflix.