Cullen Begins a New Series of Patient Poisonings at Somerset

Charles Cullen’s new series of patient poisonings at Somerset Medical Center took shape during Amy Loughren’s absence from overnight work and exploited the ordinary routines of nursing: preparing medications, helping colleagues, and taking charge during emergencies. Its significance lies in the collision between those routines and the concealed acts within them. Cullen’s reputation for competence could grow at the same time that patients were being harmed, while the means of obtaining drugs extended beyond the system investigators initially scrutinized.

The Series Begins

Cullen later could not say how many patients he had poisoned at Somerset. He placed the beginning around the time Amy became ill, and described the acts as continuing once they started. In February, Amy’s cardiomyopathy went unchecked until she collapsed at work and was taken to the emergency room. She needed a pacemaker and a leave of absence; Cullen was left alone on the overnight shift. The account links that change in the unit’s working life with his return to compulsive poisoning, without claiming that Amy’s illness explains or excuses his actions.

The cases the narrative singles out begin around mid-January with Elanor Stoecker, a sixty-year-old housewife, and digoxin. About two weeks later, on the night of Cullen’s forty-third birthday, he used Pavulon, a powerful paralytic. He had combined it with other drugs, and by the end of the shift could not say with confidence which of his actions had caused the deaths of Joyce Mangini and Giacomino Toto, or precisely what had killed them. The uncertainty is part of the record: the cases are connected to Cullen’s conduct, but the narrative does not turn every suspected cause into a settled finding.

By March 11, Cullen was certain that norepinephrine had caused John Shanagher’s heart to fail. As Shanagher deteriorated, Cullen’s apparent command of the drugs that might reverse the crisis seemed almost prescient to the other nurses. Residents stepped aside and let him lead. In May, when Dorthea Hoagland’s heart began hammering and the code was called, Cullen again seemed to know what to do. His reputation as a code expert rose within the same series of events in which his interventions were putting patients at risk.

Concealment in Routine Care

An earlier scene at Saint Luke’s shows the methodical quality of Cullen’s approach. With an elderly patient alone in a private room, he injected clear digoxin into the piggyback port of her IV, using a route that nurses ordinarily used to flush a line. The act could pass for legitimate care if someone entered. Afterward he discarded the vial and needle in a sharps container, returned to the nurses’ station, and occupied himself with chairs and other routine tasks. When the patient’s code came, he was present as its leader. This episode is not itself part of the Somerset series, but it reveals a method that makes the later pattern legible: familiar clinical actions and visible helpfulness could mask the concealed intervention.

On June 1, 2002, also at Saint Luke’s, Cullen arrived early for a night shift and began with his customary rearrangement of chairs. He watched the patient monitors, then carried the pharmacy runner’s medicines to the supply room, entered his code, and shut the door. There, alone, he prepared syringes and altered IV bags, placing the finished medications in named patient trays. The account emphasizes how little concealment the procedure seemed to require: colleagues could read the medication stocking and later help with IV lines as ordinary assistance, without connecting the separate actions. When he noticed that Pronestyl had been restocked, he treated its return as another opportunity.

At Somerset, the outward pattern of usefulness likewise obscured access. Amy later remembered Cullen stationed near the doors at the end of the CCU’s L-shaped hallway, away from the nursing station. He routinely wheeled a portable Cerner computer down the hall, a habit she had understood as a preference for quiet. From that position, however, he could see the pharmacy runner first and often alone. Cullen would relieve the runner of the medication tote, appearing to save him a trip and stock the unit. Amy recognized that this route could give Cullen access to drugs without his using the Pyxis system at all. The detail changed the meaning of a seemingly considerate habit and exposed a gap between recorded dispensing and actual access.

Patients, Codes, and Uncertainty

Michael Strenko’s death sharpened the contrast between the visible care of a code and the hidden possibility of interference. Strenko, a twenty-one-year-old Seton Hall computer science student with a genetic autoimmune disease, was young for the unit and believed by his parents to be improving. Amy, back at work after pacemaker surgery and bed rest, feared he would not survive; Cullen was sure he would die. The narrative says that digoxin, epinephrine, or some combination may have pushed Strenko past the edge, and describes how little might be needed to tip a patient already precariously ill. It does not identify one certain drug as the cause.

After a second code, Cullen went to the waiting room and gave Strenko’s mother a graphic, technically accurate account of her son’s condition and the measures being used to save him. She told him to leave. At about two in the morning on May 15, she waved away the last shock paddle, and Strenko died. The scene places Cullen’s knowledge and apparent candor beside the unresolved question of what had caused the collapse: his clinical explanation was persuasive, but the events surrounding the codes could not be read as ordinary deterioration alone.

The narrative also describes unusually volatile medication access at Somerset through an insulin-accountability change. Nurses were asked to sign an electronic form estimating how much insulin remained in a vial, after insulin had previously been kept in a small refrigerator without that procedure. Amy objected that the estimate was unreliable and refused to sign. Her supervisor would not explain what had prompted the change. The form was not proof of Cullen’s actions, but it signaled that something had made insulin control a concern on the unit, a concern the institution did not explain to Amy.

Amy’s Recognition and the Cost of Knowing

As police interviews spread anxiety through the unit, nurses began whispering, taking sides, and fearing for their jobs. Amy was known as Cullen’s friend and as the nurse who had challenged the insulin form. She worried that her own medication or an undocumented mistake might have implicated her; she checked that her nursing license had not expired and avoided detectives’ appointments until her manager sent her to meet them. The investigation therefore reached her first as a threat to her professional standing and to the trust she had placed in a colleague.

That changed when Danny Baldwin showed her Cullen’s Pyxis printout from the night Reverend Florian Gall died. Amy recognized the record and could imagine, for the first time, that Cullen had done something terrible on those shifts. But the paper did not make her friendship with him disappear; she struggled to reconcile the evidence with the person she believed she knew. Her reaction matters to the investigation’s course: recognizing a clue was not the same as accepting its implications about a trusted friend.

Amy eventually weighed the risks of cooperating against the possibility that the detectives were mistaken or manipulating her. She feared losing her job, lying to Cullen and her employer, and betraying the friend she had defended. Yet as she reviewed her memories, she connected his position by the hallway doors with the pharmacy runner’s deliveries and saw how he might bypass Pyxis. She shared Cerner-record information with investigators and brought them paperwork, even as she felt exposed and alone between her nursing role and her confidential cooperation. The Somerset series thus became not only a pattern of concealed access and patient harm, but also the beginning of Amy’s difficult shift from protecting Cullen to helping investigators understand how his ordinary-looking routines could evade notice.