The Good Nurse: A True Story of Medicine, Madness, and Murder (50 page)

6
According to the DOH investigation and police investigation documents, SMC’s legal counsel prepared a time line in “anticipation of potential litigation,” in which “DBR, Paul G Nittoly, (PGN), [was] asked to participate in investigation of abnormal lab values with help of private Investigator, Rocco E. Fushetto (REF).”

7
This conversation is drawn from the notes and recollections of Detectives Braun and Baldwin and detailed in police investigation documents. The only liberty taken with the statements reported by the police investigation documents is the use of quotes to create the scene.

1
Bruchak, Egan, and their commander, Cpl. Gerald Walsh, all participated in the briefing, but Egan was Detective Baldwin’s main point of contact.

2
The details of this case could constitute a book in themselves. The following details were provided in the course of the civil suits brought by five families of former patients against Saint Luke’s Hospital. Saint Luke’s argued that the cases should be thrown out because they were older than the two-year statue of limitations; Lehigh County Judge Edward D. Reibman ruled that they were still relevant. Ultimately, Saint Luke’s settled with the families out of court. While the specifics of the settlements are sealed, some details may be gleaned from court records (Case law: Superior Court of Pennsylvania,
Krapf v. St. Luke Hospital
, Lehigh County Judge Edward D. Reibman, Nos. 2958 EDA 2009, 2959 ED 2009, 2960 EDA 2009, 2961 EDA 2009, 2962 EDA 2009. Before: Gantman, Shogan, and Mundy, J. J.): much of the issue facing the court was whether Saint Luke’s had reason to believe that Cullen had been involved in patient deaths.

Attorney Paul Laughlin recalled that he suggested patient charts be reviewed to ascertain whether the diverted vecuronium bromide had been improperly administered, thereby resulting in patient harm (Pl.Ex. VVV at 40–44); however, the question of what precisely Attorney Laughlin learned during, and concluded from, his investigation is not clear. And in that respect, the deposition testimony of the various witnesses diverges considerably. Laughlin indicated that particularized suspicion of Cullen harming patients was never brought to his attention. (See ibid. at 127–135.) However, notes from his interviews in combination with testimony of Nurse Patricia Medellin leave it within the purview of the finder of fact to draw a different inference.

Specifically, Nurse Medellin stated she met with Attorney Laughlin on the night he confronted Cullen and that he had instructed her to call him if she “had any additional thoughts.” (Pl.Ex. III, at 72.) After learning that opened containers of vecuronium bromide had been found in the receptacles and that other nurses had concerns that patients may have been harmed, she telephoned Laughlin on or about June 7, 2002. (Pl.Ex., at 76–78.) She informed him that the unauthorized administration of vecuronium would be consistent with unexplained slowing down of patient heart rates, leading to codes when their hearts stopped. (Ibid. at 79.) She also told Laughlin that no one in the CCU at that time should have been receiving vecuronium. (Ibid.)

In response Attorney Laughlin informed Nurse Medellin that “the investigation was closed” and that he was “confident that Cullen was not in any way harming patients.” (Ibid. at 80.) Medellin pressed Laughlin about how he could be so sure, especially when Laughlin had admitted to her that he had not compared the medications sent from the pharmacy versus those actually used on patients and had not compared the number of patient codes on day versus night shifts when Cullen was on duty. (Ibid. at 81–82.) Laughlin allegedly responded that based on his experience as a prosecutor in Philadelphia for eight years, he was confident in his investigation and was “certain” that Cullen “was not hurting anyone.” (Ibid.) He then informed her once again that the investigation was “closed and not open [[001]] for further review.” (Ibid. at 82.)

Nurse Medellin also testified at deposition that she voiced her concerns to her supervisors, but that she was met with an equally inhospitable response. (Ibid. at 96.) In particular, she stated that after Attorney Laughlin dismissed her concerns, she spoke to Thelma Moyer, the clinical coordinator at Saint Luke’s, and Ellen Amedeo, the CCU nurse manager at the hospital, both of whom dismissed her concerns and informed her that the investigation was closed. (Ibid.) She also testified that after speaking with Attorney Laughlin, she compiled a list of the patients who died in the CCU, compared it to Cullen’s shifts, and determined that a disproportionate number of patients died while he was on duty. (Ibid. at 91–93.) However, because of the lack of receptivity and “almost anger” expressed by Clinical Coordinator Moyer and CCU Nurse Manager Amedeo to her previous entreaties, Nurse Medellin did not present the list she compiled for fear of “repercussions.” (Ibid. at 97.) After he returned from leave in July 2002, the hospital’s general counsel, Seymour Traub, directed Attorney Laughlin to prepare a report and ordered additional chart reviews to be performed by Saint Luke’s staff. (See Pl.Ex. BBBB at 30.) Risk Manager Rader and Nursing Manager Supervisor Koller were charged with reviewing charts of all of the patients who had died over the course of the weekend in which the diverted medications were found. (See Pl.Ex. UUU at 21.) However, Nursing Supervisor Koller testified at deposition that she had never before performed any similar such chart review and, in fact, was not even aware of the purpose of her review when Risk Manager Rader asked her to review the patient charts. (Pl.Ex. AAAA at 46–50.) For her part, Rader testified at deposition that Attorney Laughlin indicated to her at that point that he could not find “a scintilla of evidence that there was any foul play involved.” (Pl.Ex. UUU at 114.) Risk Manager Rader and Nursing Supervisor Koller identified neither any suspicious administration of vecuronium nor any suspicious deaths. (Pl.Ex. UUU at 138.) Accordingly, the additional inquiries ordered by General Counsel Sy Traub failed to unearth Cullen’s involvement in patient deaths; afterward, the hospital’s chief executive officer concluded this part of the investigation by referring Cullen to the State Board of Nursing for follow-up as it saw fit. (Pl.Ex. III.)

After notification by the district attorney that the matter had been referred to law enforcement, the hospital undertook further investigations, including patient-chart review by an outside physician; however, this, too, failed to lead Saint Luke’s to conclude Cullen had harmed any patients. (See Pl.Ex. NNN at 51–55, 125–127.) Cullen ultimately confessed to killing, among others, the five decedents at Saint Luke’s at issue in these cases. (See Pl.Ex. B; Ex. C.) In total, seven patients have been specifically identified as having been killed by Cullen at Saint Luke’s.

3
From police investigation documents and Lehigh County district attorney James B. Martin’s memo of September 9, 2002.

4
Also present were coroners Zachary Lysek and Scott Grim, and Easton County Police captain John Mazzeo, the acquaintance to whom Medellin had first taken her suspicions about Cullen.

5
Only several weeks later (September 6), Saint Luke’s Hospital president and chief executive officer Richard A. Anderson wrote to the State Nursing Board, notifying them of the incident with the sharps box and that Cullen’s employment had been terminated on July 7 of that year.

6
While the Saint Luke’s administration had contended that Cullen had not harmed patients and their investigation had closed, they acted rather differently following Nurse Medellin’s actions and the attentions of the DA. Several weeks later (September 6), two months after Cullen’s removal from Saint Luke’s, Saint Luke’s Hospital president and chief executive officer Richard A. Anderson finally wrote to the State Nursing Board, notifying them of the incident with the sharps box, the discovery of numerous empty vials of dangerous drugs, and that Cullen’s employment had been terminated following the discovery.

7
In all, eighteen Saint Luke’s staffers were interviewed.

8
According to police investigation records, Tester had noticed the death trend early, going so far as to quantify the statistical increase in the death rate in the CCU.

9
Tester told the Pennsylvania State Police that she had brought her observation of this troubling trend to ‘people on the CCU Unit’ to her supervisors, but nobody had any answers.

10
According to documents supplied to the police investigation at Saint Luke’s, the hospital had supplied extensive investigations of its own in support of its assertions that administrators had no reason to believe Cullen had harmed anyone at their hospital, and that the death rate was within the statistical norm.

11
From witness statements in police investigation documents. Other nurses, including Judy Glessner and Darla Beers, also testified to their concerns that Cullen had harmed patients. (See Pl.Ex. RR at 72–77; Ex. PPP at 72–73; see also Ex. U at 2 [police report summarizing statement given by Nurse Gerry Kimble about his belief Cullen had harmed patients with diverted medications].) Assistant Pharmacy Director Susan Reed testified that she recalled expressing to Laughlin that the nature of the empty medications found, including vecuronium, raised a concern about potential patient harm. (See Pl.Ex. VV at 128–130.) And notes Attorney Laughlin apparently took during his conversation with Nurse Medellin contain abbreviated descriptions that could be understood as references to patients being harmed by Cullen and “cod[ing] fast.” (See Pl.Ex. CCCC.) Testimony from the hospital’s vice president of risk management, Gary Guidetti, indicates, however, that Laughlin never apprised him of concerns about patient harm or otherwise passed those concerns on to upper management. (See Pl.Ex. FFFF at 36–39.)

12
Retired Saint Luke’s CCU nurse Susan Bartos, quoted in the
Morning Call
, February 15, 2004 (“Nurses’ Warnings Unable to Stop Trail of Death,” by Ann Wlazelek and Matt Assad;
http://www.mcall.com/news/all-5nursesfeb15,0,4417146.story
).

13
On May 18, 2003.

14
Working with the Pennsylvania State Police, the district attorney retained a forensic pathologist, Dr. Isidore Mihalakis, who reviewed seventeen patient charts selected by Saint Luke’s. (Pl.Ex. MMMM at 18–35.) However, Dr. Mihalakis was not provided with a written list of the diverted medications and apparently had no contact with any of the nurses or their statements regarding suspicions about Cullen. (Ibid.) Dr. Mihalakis was unable to conclude that Cullen had harmed anyone. (Ibid. at 50–55.)

15
Cullen killed Pasquale Napolitano on July 13—though at the time he didn’t know the patient’s name.

1
According to the Somerset Medical Center executive report given to the board of directors on July 17, 2003, the DOH review at SMC took place on July 11 and 14. named Edward Harbet, RN, the Health Care Systems Analysis complaints investigator, visited SMC and extensively reviewed the medical records of the four patients reported, as well as the summary of the SMC internal investigation to date, and pertinent policy and staffing assignment documents. Harbet also met with administrators. He was unable to identify any specific finding that would explain the relevant lab values, but he was comfortable with the level of attention being paid to these events by SMC, and he did not advise any additional external agency report. He said copies of the charts and his report would be reviewed by his department.

On July 14, two clinical laboratory evaluators from the DOH reviewed SMC lab services, focusing on the testing procedures and facilities in validating the abnormal results reported. No deficiencies in the lab process were identified. The SMC executive report says that investigators were “satisfied that all appropriate steps had been and were being taken to identify the cause of the unexplained events.”

2
The DOH files would eventually be made available by a police subpoena, but would shed little light on the incidents at Somerset Medical Center, and they were of minimal use to the SCPO during their own initial investigation.

1
The pieces of this recording are abridged from the original transcript, but context has been carefully maintained.

2
A standard homicide term referring to a body newly murdered and thus potentially still bearing the greatest cache of evidence and trace, as distinct from a body discovered much later and disturbed by time and environment.

1
He was still in his thirties at this time.

2
Details of Detective Baldwin’s meeting and conversation with Lucille Gall were taken from police investigation documents.

1
Dr. Smith found that the cases of patients Lehman and Crews could possibly be medically explained without exogenous influence, and were thus not as suspicious as the other four.