Charles Cullen: Healthcare Serial Killer

Dr. Gregory Moffatt

Dr. Gregory Moffatt, a therapist and expert in risk assessment, discusses the more general phenomenon, in Blind-Sided, of murders that occur where they are not expected. That is, many murders are committed by people who seem nonviolent. Moffatt argues that there are certain predictors of a predisposition toward violence that are generally overlooked by people acquainted with the killer. There is a way to identify the person who may become violent, and he offers a list of warnings to take seriously. While he does not directly address the population of nurses and physicians who may become killers, his warning signs are nevertheless applicable.

Among the signals for potential violence are:

A past history of violence

• Threats
• Social isolation
• Substance abuse
• Job instability
• Poor self-image
• Anger/depression
• Poverty
• Severe situational stress
• Feelings of being wronged
• Weak support system

Cullen fit a number of these, although his social isolation made it difficult for people around him to know what he might have been going through. It should have been clear that he had issues with anger and depression, and that he had little money and few (if any) friends. But he was a quiet, reclusive man who did not let others know him. Nevertheless, some coworkers did suspect him, and they were correct.

Among those warning signs that Moffatt does not include that are more specific to healthcare serial killers are the fact that Cullen would often predict who was going to die, he was often seen coming from rooms where patients soon died, and he jumped from one institution to another, often being fired or leaving under suspicion.

People acquainted with someone with the potential to kill, says Moffatt, should:

• Take threats or statements of intent seriously
• Seek assistance or resist violence when it occurs
• Have a plan in place before violence occurs
• Call for help immediately
• Don't panic

With Cullen, some of the patients were certain that he had done something to them that ought not to have happened, such as giving them an injection. Had they demanded to know what he was doing, or been more assertive about reporting him, the chances are better that he'd have been caught and more thoroughly investigated.

Perhaps the wake-up call from this case and the new legislation will deter some potential angels of death of killing. It remains to be seen. We know that more HCSKs have been convicted in the past fifteen years than in decades before, so it's clear that we're either catching more of them or more of them are developing. In either case, hospitals must acknowledge their existence and train their personnel to spot them, document their movements, and take action. All of us who will become patients depend on this.