Charles Cullen, an American nurse, murdered several hundred patients by the administration in overdose of restricted drugs. Hospitals should be safe places but they are actually rather dangerous: mistakes are made, accidents happen, medics may be careless or just exhausted. But although many patients die when they should have recovered, very few die at the hands of a psychopathic serial killer — so far as we know. The trouble is, we often don’t know. There could be a Cullen working and murdering in a hospital near you. Look up ‘Healthcare professionals convicted of murdering patients’ on the internet and you find 39, and note the ‘convicted’. Many have merely been suspected but escaped conviction because of lack of evidence.

Alarmist? This is an alarming book and not far into it the reader realises that it was not only the murderer people had to fear but the hospitals in which he continued working despite warnings, dismissals on suspicion and even full investigations. Cullen managed to escape partly because he was cunning and clever, as such serial killers often are, partly through luck, but also, terrifyingly, because of hospital incompetence and deception. When several managers discussed reports about Cullen their priority was not to have the buck stop on their premises. So they gave him extended leave, paid him off and issued warnings.

One CEO even telephoned the other nearby hospitals, warning them not to employ him, but the message was not passed further and Cullen hopped over the state line to a new area. He frequently worked nights, took on all the extra shifts he could get, did emergency cover, moved from one ward and hospital to another and back again. He seemed a good nurse, hard-working and supportive of colleagues, but the signs were all there. He was an oddball who loved answering the emergency blue call and attending to the bodies. The death rate on his watch soared and when he left a hospital it dropped back again. The quantities of dangerous drugs — digoxin and insulin, for example — that he ordered were many times the norm. People noticed, but nothing was done, though once a note was written on his report when he was dismissed for ‘medication issues’.

With hindsight, Cullen’s miserable life is revelatory but no one joined up the dots until far too late. He was an abused child, his mother died in a car crash and he blamed the hospital to which she was taken. He had a record of depression and of suicide attempts, he killed small animals, he had a chaotic love and marital life and was very controlling of wives and children. Psychopaths usually are, and murder is the ultimate form of control over another person.

There is nothing unusual here to the student of serial killers, from Cullen’s friendly demeanour to the ‘weird blankness in his eyes’. Reading about him will not warn anyone in time to stop the next one in his — and occasionally her — tracks. It is dull diligence that may finally make such hospital killings impossible, meticulous record-keeping, triple-checking, taking up of references, regular reviewing and tightening up of systems. And no cover-ups. We have learned here lately just how those have allowed hospital malpractice to flourish.

The final account of how Cullen was eventually cornered and caught is a
great cop story, mainly of persistence and single-minded determination. The detectives Tim Braun and Danny Baldwin were rightly rewarded for their work with medals and citations, but the nurse friend of Cullen’s who helped them trap him at great personal risk is the true heroine.

Cullen is serving life, of course — pleading guilty saved him from the electric chair. You think it could never happen again? Have you been in hospital lately?