Liability Ruling in Litigation Involving Somerset and Saint Luke’s

The liability ruling in litigation involving Somerset Medical Center and Saint Luke’s Hospital turned a dispute over Cullen’s employment history into a question of institutional responsibility. Judge Garruto sided with Somerset without deciding the merits of the individual victim-family cases, but regarded Saint Luke’s communications with other hospitals as a major reason it could be held responsible for lawsuits arising from harm at Somerset.

Background: A trail of unresolved warnings

The ruling came against the background of patient deaths and unresolved questions about how hospitals handled warning signs connected to Cullen. At Somerset, administrators initially described a series of abnormal, life-threatening patient incidents without declaring them homicides. The hospital said it had conducted an internal investigation for five months, yet had not identified their source before notifying the prosecutor after the sixth incident. That cautious framing contrasted with the urgency of Poison Control director Steven Marcus, whose assessment was that patients might continue to suffer while the hospital delayed acknowledging the evidence.

The investigation also encountered institutional and evidentiary gaps. Detectives were told that Somerset’s internal inquiry had produced only four pieces of paper and no answers; they lacked Pyxis drug records, interviews, and physical evidence, and the patient incidents were not yet confirmed as homicides. The problem was not simply whether Cullen had worked at a hospital before or after Somerset, but how information about him had been recognized, retained, and passed across institutional boundaries.

The competing claims

After the victims’ families brought lawsuits, hospitals alleged that responsibility lay with whichever earlier employer had hired Cullen and then allowed him to move on. The suits named Saint Barnabas Hospital as the place where the serial killer had been formed. In one of the larger disputes, Somerset’s lawyers argued that Saint Luke’s should bear responsibility for lawsuits brought by families of victims at Somerset.

That argument made the hospitals’ communications about Cullen consequential in a new way. Saint Luke’s administrators had called other hospitals; they had advised some against hiring him but had not alerted others. The calls therefore showed that Saint Luke’s had acted on concerns about Cullen’s risk, while the unevenness of its warnings became relevant to whether it could be held responsible for later harm.

Judge Garruto’s decision

Judge Garruto of the New Jersey Superior Court sided with Somerset on the allocation of responsibility. The decision did not resolve whether the claims in the underlying cases were factually or legally meritorious: the judge expressly did not weigh the specific merits of those cases. Instead, the fact that Saint Luke’s administrators had contacted other hospitals was among the principal contributors to the ruling against Saint Luke’s.

The book presents the court’s conclusion in stark terms: by deciding which hospitals to warn and which not to alert, Saint Luke’s had effectively “decided who would live and who would die.” The phrase captures the moral weight attached to the calls, while the ruling itself remained narrower than a final judgment on the families’ individual claims. It treated the act of communicating—or withholding—risk as a basis for responsibility without adjudicating the underlying cases.

Significance and limits

The ruling shifted attention from Cullen’s actions alone to the decisions made by the institutions that employed him and exchanged information about him. Earlier in the investigation, Bruce Ruck repeatedly insisted that suspected patient poisoning was “a police matter,” while Somerset’s lawyer carefully avoided calling the incidents homicides. Those exchanges reflect how responsibility could be divided among medical staff, hospital leadership, investigators, and regulators; the later ruling addressed a related but distinct question of what one hospital owed in light of its knowledge and warnings to others.

Its significance lies in that distinction. Judge Garruto did not establish the merits of every victim-family lawsuit, nor did the ruling itself determine the full responsibility of every hospital named in the broader litigation. It did, however, make Saint Luke’s selective calls central to the allocation dispute and frame communication about Cullen not as incidental background, but as conduct with consequences for the people who might later become his patients.