Steven Marcus

Steven Marcus is the director of the New Jersey Poison Control Center whose urgent response to unexplained patient poisonings at Somerset Medical Center turns a hospital’s internal concern into a matter for police and state authorities. He recognizes that the danger lies not only in the possibility that patients are being deliberately harmed, but also in the time lost when a hospital treats suspected poisoning as a problem to solve privately before reporting it. His insistence that the case be referred outside the institution makes him one of the book’s clearest advocates for prompt, independent investigation.

Position and Recognition of the Pattern

Marcus oversees the New Jersey Poison Control Center and is Bruce Ruck’s boss. When Ruck brings him news of the Somerset cases, Marcus cuts through the preliminary account: his instinct is that someone at the hospital is deliberately killing patients, and that further delay could expose more people to harm. His certainty is not presented as proof of a culprit. It is an experienced warning that the pattern is serious enough to require action before the hospital has resolved every uncertainty.

That judgment draws on Marcus’s familiarity with cases in which hospital staff poisoned patients, including incidents he had encountered through the literature and cases in which he had personally participated in investigations. He knows the recurring danger of allowing abnormal medical events to remain framed solely as a clinical puzzle. Doctors may try to explain a cluster as a disease, while administrators and lawyers may focus on institutional liability; meanwhile, a suspected perpetrator can move on and become harder to trace. Marcus’s experience makes delay itself part of the threat.

Confrontation with Somerset Medical Center

The disagreement becomes explicit during a conference call arranged for nine o’clock on July 8, 2003, after increasingly forceful calls from Poison Control. Marcus tells the Somerset administrators that if someone is intentionally harming patients, the hospital has a legal obligation to report the possibility. William Cors, speaking for the hospital, explains that Somerset has been investigating and sought expert advice before reaching a judgment. Marcus rejects the idea that the institution should wait for its own inquiry to settle the question: suspected poisoning requires a police investigation, not only a medical or administrative review.

Marcus’s argument is forceful but not indifferent to the hospital’s patients. He says that he is concerned with protecting them, while also warning that the institutions involved could be left looking incompetent if the facts emerge after preventable delay. When Cors suggests ending the call to consult counsel, Marcus agrees that the hospital should involve its lawyers but urges it not to waste time. His position is not that legal advice or internal fact-finding is irrelevant; it is that neither should postpone notifying the authorities.

The recorded call also captures a conflict over professional responsibility. Somerset’s administrators are trying to gather more information before making a report, whereas Marcus treats uncertainty as compatible with an immediate referral. He argues that physicians are poorly equipped to conduct forensic investigations and that the longer a suspected offender remains unreported, the more difficult it may be to track that person. His repeated effort to define the matter as a police case challenges the hospital’s control over how the incidents are classified and when they leave its internal process.

Reporting Beyond the Hospital

The pressure continues after the first confrontation. In a subsequent conference call, Marcus again tells Somerset that suspected incidents must be reported to the state within twenty-four hours and that the hospital is already outside that requirement. He warns that he will report the matter to the New Jersey Department of Health and Senior Services if Somerset does not act. By then, however, he has already contacted state officials himself. He calls the state epidemiologist and assistant commissioner, describing a cluster of illnesses that may have resulted from a criminal act, and emails the assistant commissioner of health with a summary of four troubling events and Somerset’s stated intention to wait until its investigation was complete.

The sequence matters: Marcus’s state-level report precedes Somerset’s own notification. After he tells the administrators that the conversations have been recorded, Mary Lund contacts the department later that day. Somerset reports four patient incidents, involving suspected digoxin poisoning in Reverend Florian Gall and Jin Kyung Han and insulin-related incidents in two other patients. The hospital describes steps it has taken to rule out alternative explanations, including checking for recalls and drug interactions, examining equipment, and repeating laboratory tests. It also tightens controls on digoxin, following similar controls on insulin. Those precautions address access to the drugs, but they do not resolve Marcus’s central concern about reporting suspected intentional harm.

Marcus’s intervention does not produce an immediate, uncomplicated state response. A state health commissioner considers foul play premature and declines a proposed referral to the attorney general, while a state investigator reviewing the records cannot identify a specific explanation for the abnormal results. The book thus distinguishes Marcus’s timely warning from the slower, contested process that follows it: reporting brings the incidents into view, but it does not automatically align the agencies responsible for investigating them.

Record and Narrative Significance

The later documentary record confirms the importance of Marcus’s actions. Police investigation materials include the calls and the records of his state contacts. In December, an assistant commissioner writes that Marcus’s call was the grain of sand that brought the situation to light and credits his ability to recognize the trend with focusing the hospital on the issue. Two years later, the state epidemiologist points out that Somerset’s claim to have notified the department on its own initiative obscures the fact that the hospital reported only after Marcus warned that he would do so.

Marcus’s role is therefore defined less by solving the poisonings than by refusing to let institutional uncertainty become a reason for silence. The evidence does not establish him as the investigator who identifies the perpetrator, and his warnings do not by themselves overcome every administrative delay. Instead, he recognizes the stakes early, argues that forensic authority belongs with the police, and acts directly when the hospital does not report promptly. His calls and emails expose the practical consequence of a divided system: a suspected pattern can be visible to one agency while remaining stalled within another.