Charles Graeber: I have to be very fair in saying that it's beyond the imagination, or at least requires a great deal of imagination for any administrator, let alone anyone else, to ever think that their nurses are killing their patients. That's not the first thought that comes to mind, certainly not that it's intentional, certainly not that you're dealing with a serial killer.
The other larger point, though, is that hospitals are businesses. They have a tendency to become worlds in themselves, shut off from the outside trying to deal with their problems internally, and largely for fear of—were it to ever go external—liability. And liability is a real concern.
Carlson: “60 Minutes” had a feature on this story recently, and they were able to interview Cullen as well, and I was struck by some of his words. Cullen said, “I think you can say I was caught at St. Barnabas and I was caught at St. Luke's. There's no reason that I should have been a practicing nurse at that point.” Yet he left St. Luke's without even so much as a bad job reference and went on to kill more than a dozen other people. Is it fear of negative publicity, or is it this fear of litigation?
Graeber: That's part of what took so long researching this book—really trying to lay those facts out cleanly, so that the reader could decide, the public could finally understand what that process was. When I started meeting with Charlie Cullen a little more than six years ago, he was very upfront about the fact that he had been caught before, particularly at those hospitals. There were several other instances.
Sixteen years and nine hospitals, a lot happened to him and he was killing throughout. But the St. Luke's example is, I think, a particularly onerous one. That was more than a failure of imagination, I think. He was caught stashing empty bottles of dangerous drugs at night. They knew that it was him that had been doing it repeatedly. The other nurses were very concerned about the mortality rates. The administration has since denied that aspect. They confronted him, allowed him to leave that same night with neutral references and didn't report it.
Carlson: “A lot has been made of the fact that the hospitals didn't seem to warn one another about Cullen during the job screening process because of legal repercussions for giving out bad references. Isn't there any legal risk in not telling another hospital that their job candidate was let go for reasons like suspected harm to patients or even just misuse of medications?
Graeber: The neutral reference is a standard corporate policy throughout many industries, and the reason is fear of being sued for libel. And the flipside of that is you don't want to be blackballed because of some interpersonal issues that have nothing to do with true job performance. It's a matter of trying to shift the power, or keep the power, from being entirely in the hands of either side, particularly in a small community. Having said that, they are completely abused here, and there is a liability in not informing a hospital if you suspect someone's been harming your patients.
The hospitals maintain that they did not have reason to believe that Charles Cullen was harming any of their patients. St. Luke's Hospital did report eventually to the nursing board that they couldn't say for sure what he had been doing with these diverted medications.
Carlson: “It seems like that might be a conflict of interest, though, to expect a hospital to do a thorough internal investigation to dig out information that could eventually be used to harm its reputation.
Graeber: Absolutely. It's a horrific situation all around for all involved. You don't want the killer to be there. You don't want anyone to have been harmed. You don't want to harm the reputation of a fine hospital or endanger the jobs of the fine men and women who work there and work hard there every day saving lives, or to wrongly accuse somebody.