Murder Gave Killer Nurse Charles Cullen ‘a Sense of Power’

Nurse and convicted serial killer Charles Cullen, whose crimes have inspired movies, serves time at New Jersey State Prison for murdering 29 victims and attempting to murder five others. But a journalist who met him believes there’s more to Cullen than his notorious actions.

Cullen’s wrongdoings between 1987 and 2003 led journalist Charles Graeber, the only writer the nurse allowed to interview him for years, to publish the book The Good Nurse: A True Story of Medicine Madness, and Murder, which led to the making of a film by a similar name starring Eddie Redmayne. When apprehended, Cullen admitted to the killings, but a recent cold case opened unsuccessfully in 2022, leads Graeber to question the potential findings of other possibly related cases.  

Cullen worked as a nurse for approximately 16 years in at least nine hospitals in Pennsylvania and New Jersey before arriving in Somerset County, N.J. He was terminated from Sacred Heart Hospital in Allentown, Pa., just before coming to Somerset Medical Center about one year before authorities were made aware of the concerns surrounding him.

Former Somerset County prosecutor Wayne J. Forrest tells A&E Crime + Investigation he remembers “working in my office late on a Friday night” in October 2003 when potential misconduct at Cullen’s hospital first came on his radar via a call from a former assistant prosecutor in Essex County, at the time working in private practice. Although it was late, the former assistant prosecutor felt it was urgent to contact Forrest as they reviewed the situation because of the deaths involved.

“He was called in to review some concerns that the hospital, the State Department of Health and Dr. Steven Marcus of the State Poison Control Center had,” Forrest says.

Forrest adds that the concern developed as the Department of Health, the state poison control and the hospital were reviewing what they believed to be “inappropriate conduct” by one of their staff.

"Well, probably more than that, ‘intentional misconduct,’” Forrest says. “Dr. Marcus, who was extremely concerned, believed that there was intentional administration of medications inappropriately that resulted in the death of multiple people, probably about a dozen at that time.”

A criminal investigation in Somerset County began that night, and Cullen was arrested two months later.

Authorities talked to a friend and colleague of Cullen’s, Amy Loughren, who provided them with information and went to dinner with Cullen on the night of his arrest. Loughren spoke with Cullen while wearing a wire, and he confessed to killing 30 to 40 people. Most of the cases involved lethal doses of digoxin, but also insulin and other medications that were inappropriate for the victims’ medical conditions.

“He was injecting them at random with insulin, which could cause a deadly spike in blood sugar or a lack of blood sugar,” Graeber says.

Cullen pled guilty to charges in multiple counties across New Jersey and Pennsylvania, totaling 29 counts of first-degree murder and five counts of attempted murder.

Forrest says Cullen was not charged for other deaths because of the difficulty in identifying the victims. “I don’t believe he ever had a specific recollection of somebody’s name,” Forrest continues. “He would be able to describe to us a time frame, their medical diagnosis—he’s obviously a trained nurse—or other identifying information.”

Detectives reviewed hospital systems, including records from pyxis machines—automated medication dispensing machines used in medical facilities—and pieced together information to make a case for court.

Somerset, N.J., public defender Johnnie Mask served as Cullen’s lawyer when the nurse faced consecutive life sentences in both states. Mask ordered a mental evaluation for Cullen to determine if he was competent to stand trial. They never considered an insanity plea because Cullen understood his charges, showed competency and was able to participate in the defense when he pled guilty.

According to Mask, prosecutors were interested in naming the victims Cullen might have been responsible for killing. Mask says this is how Cullen avoided the death penalty, by helping to identify as many victims as he could. “Any time you can avoid the death penalty, you consider that a win,” Mask emphasizes.

Families wanted to know if Cullen was responsible for the death of their loved one. “Some of the individuals were looking for evidence to have a civil suit against hospitals that hired him,” Mask explains.

Per Mask, the medicine dispensary machine led investigators to Cullen, which helped Cullen identify the patients he murdered. Cullen admitted to the killing of Judge John Yengo Sr., who might have been his first killing in 1988.

The 2006 sentencing in New Jersey was determined by statute, with a first-degree murder charge is a life sentence, a minimum of 64 years. Cullen was handed 11 life sentences. The New Jersey Department of Corrections lists the current parole eligibility date for Cullen as June 10, 2388, though he would still have to serve his life sentence in Pennsylvania.

Mask says Cullen, known as “The Angel of Death,” did not feel he was committing deliberate crimes of malice at the time. He adds that Cullen did not agree with the hospital’s treatment of patients.

“He thought he was alleviating undue pain and suffering, that the patients were basically treated inhumanely, given unnecessary treatment that prolonged life knowing that they would not have a quality lifestyle,” Mask explains.

Graeber, the only journalist Cullen allowed to interview him aside from 60 Minutes, believes Cullen killed “as a response to other things in his life.” Cullen lost both parents at an early age and felt the hospital where his mother went after a car accident deprived him of seeing her before her burial. Cullen also attempted to die by suicide as a preteen, and Graeber notes in his book that Cullen made at least 20 more suicide attempts over the course of his life.

“It somehow affirmed him as being in control when he felt out of control in his life, gave him a sense of power,” Graeber says.

Graeber believes the number of Cullen’s victims could total over 400 people based on his conversations with multiple sources. He wants the hospitals to be held accountable for their role in how Cullen moved from job to job with ease.

"There are family members of victims still out there, and there is still an evidence trail,” he says.

Essex County Prosecutor Theodore Stephens II tells A&E Crime + Investigation that “we were exploring some new leads” from 2022 to 2023 "based on tips that we received, but they all fizzled out.” Stephens reveals “there is nothing active at this time” in regards to Cullen’s case.

"There are other families who believe he murdered their loved ones,” Forrest says, “but there wasn't enough evidence where we or another jurisdiction was able to charge that.”