Saint Barnabas Hospital is the setting of an early, unresolved investigation into repeated insulin-related emergencies among its patients, and an important first institutional warning about Charles Cullen. What began with patients suffering unexplained crashes became a suspected pattern of deliberate contamination: an IV bag tested positive for insulin, and its punctures suggested tampering. The investigation narrowed attention to hospital staff and Cullen, but closed without a conclusion. The episodes stopped after his dismissal, a sequence the hospital later said did not establish that he had posed a risk to patients.

The hospital and the emerging pattern

The suspected poisoning came into focus through individual cases rather than a single clear alarm. Fred Belf, a patient receiving heparin, began vomiting and could not keep down orange juice. Doctors ordered intravenous dextrose alongside the heparin. Once the connection between the heparin bags and the patients’ symptoms was made, Belf’s nurses stopped his heparin drip; he quickly began to feel better. They removed the IV bag, sealed it in sterile plastic, and sent it for testing.

The bag tested positive for insulin. Microscopic examination of its exterior found numerous tiny needle marks, including three along the perimeter. The account distinguishes those punctures from the marks that can occur when saline bags are connected to IV equipment: perimeter punctures were not an ordinary part of that process. The finding made intentional, repeated contamination in the hospital’s storage room a possibility. Investigators had two bags as evidence, along with accounts involving Belf and Anna Byers, and turned to patient records to see whether other recent insulin crashes resembled theirs.

The records disclosed a broader, less orderly pattern. Across the intensive-care, critical-care, and cardiac units, patients had been experiencing unexplained emergencies with such frequency that some codes overlapped, requiring nurses to leave one patient to attend another. The episodes were not confined to one unit or one shift, and investigators initially lacked proof that they shared a cause. Laboratory results nevertheless showed exceptional insulin levels in affected patients, much of it foreign insulin not produced by their bodies. The tests established that insulin had been administered; they did not, by themselves, identify who had given it.

From medical error to staff investigation

A medication mistake was the first explanation investigators considered. A nurse might have misunderstood a doctor’s order, or a vial might have been mislabeled. But Thomas Arnold and his colleague found no insulin prescription in the patients’ charts and no nursing notation that the drug had been administered. The absence of documentation left two troubling possibilities: an unrecorded error involving a drug no patient had been prescribed, or intentional administration. Arnold took the findings to Joe Barry, the hospital’s head of security and senior vice president.

Barry brought substantial investigative experience to the inquiry: before working in hospital security, he had been a police veteran and a major with the New Jersey State Police. After investigators ruled out patients’ visitors, Arnold and Barry compared nursing schedules with the times of the patient emergencies. Only three nurses were working at every code they examined; Cullen attracted particular attention among them. The schedule comparison made him a focus of inquiry, not proof that he had caused the incidents.

Arnold had already spoken with hospital staff. Other nurses appeared nervous about their jobs, their reputations, and the patients involved. Cullen, by contrast, seemed unconcerned and defiant. Arnold had difficulty arranging an interview because Cullen worked for a staffing service rather than being directly employed by the hospital, and his shifts varied. When asked to meet, Cullen emphasized his nursing duties; when Arnold and Barry finally brought him into a conference room, he refused to answer questions.

Warning signs and a disputed response

The investigation did not resolve the case. It closed in late December 1991 without a conclusion. Cullen was fired in the first week of January 1992, and the insulin spikes stopped. Saint Barnabas Hospital later maintained that the timing did not connect the dismissal to the end of the episodes and that its administration had not then had reason to believe Cullen was a danger to patients. The sequence is consequential, but the book preserves the distinction between that chronology and a proven finding about responsibility.

Fragments of the investigation were recovered after Cullen’s arrest. Among the incident reports were descriptions of conduct resembling the later-known method of contaminating IV bags. Cullen had been written up for checking a patient’s insulin levels repeatedly at inexplicable and inappropriate intervals. In another report, he left an unprescribed, unlabeled IV hanging for a patient after his shift instead of the prescribed KCL solution. When a supervisor called him at home, Cullen appeared apathetic and said that if the bag was hanging there, it must have been the prescribed solution. Investigators could not establish what the bag contained or whether it was one of the insulin-spiked saline bags Cullen later admitted to using.

The employment arrangement also limited what the hospital’s file could show. Cullen signed on with Medical Center Health Care Services partway through his years at Saint Barnabas Hospital to gain flexibility in his hours and work units. Because a different corporate entity technically employed him, the hospital’s file covered only the final two years of his five-year tenure. The record therefore preserved only part of his employment history and some of the warning signs that would later acquire a more troubling meaning.

Aftermath and significance

The hospital’s insulin sign-out procedure became a point of conflict for Amy Loughren, an intensive-care nurse. Under a new insulin adjustment form, nurses were asked to electronically sign their estimates of how much insulin remained in a vial. Loughren considered the estimate unreliable and refused to sign. She also demanded to know why insulin was being treated like a narcotic, but her supervisor did not explain what had happened. Her resistance shows how a safety procedure could reach frontline staff without bringing with it an account of the danger it was meant to address.

Years later, during the investigation at Somerset Medical Center, Saint Barnabas Hospital’s earlier events returned through records, interviews, and staff recollections. Some nurses remembered Cullen as helpful and were upset when he was accused of tampering with IVs. Those recollections sit uneasily beside the reports of suspicious insulin checks and an unexplained IV bag. The contrast matters: a colleague’s helpfulness could shape how accusations were received, while fragmentary files and divided employment arrangements made an already inconclusive inquiry harder to reconstruct.

As a location in the book, Saint Barnabas Hospital marks the first substantial emergence of a pattern that was initially dispersed across patients, shifts, and units. Its story is not a completed case but an unresolved set of findings and consequences: unusual insulin levels, physical evidence of punctured bags, scrutiny of staff schedules, warning reports, Cullen’s dismissal, and the cessation of the insulin spikes. The hospital’s later insistence that these facts did not establish a patient risk leaves the tension between chronology and institutional interpretation visible rather than settled.