Charles Cullen and Amy Loughren: Investigation, Plea, and Aftermath

Charles Cullen and Amy Loughren were coworkers at Somerset Medical Center in New Jersey whose friendship ended one of the longest killing sprees in American medical history. Cullen, a registered nurse, murdered at least 29 patients across hospitals in New Jersey and Pennsylvania over 16 years. Loughren, his close friend on the night shift, agreed to work with detectives in 2003, wore a wire, and used their bond to draw out the confession that put him in prison for life.¹

How Cullen Killed and Why It Went On So Long

Cullen worked at roughly nine hospitals and one nursing home between 1987 and 2003.² He killed patients by injecting lethal doses of medication into IV bags or directly into IV lines, primarily using digoxin, a heart drug that can trigger cardiac arrest, and insulin, which can cause fatal diabetic shock. He also volunteered for “code teams” that responded to cardiac arrests, appearing as a devoted nurse rushing to help with the very emergencies he had caused.³

To hide his drug use, Cullen exploited the Pyxis MedStation, a computerized dispensing system. He would place a medication order and immediately cancel it, which unlocked the drawer without creating a clean record of what he took. He later refined the trick by ordering acetaminophen, which shared a drawer with digoxin, so the system logged only the harmless drug.⁴

Hospitals repeatedly noticed something was wrong and pushed Cullen out quietly. He was reprimanded at St. Barnabas for contaminating an IV bag with insulin, fired from Morristown Hospital, investigated at Warren Hospital after a suspicious death, fired from Liberty Nursing Center for administering medication without authorization, and suspended from St. Luke’s in Pennsylvania for stockpiling lethal drugs. No former employer passed on a negative reference; hospitals cited fear of lawsuits for their silence. New Jersey law at the time did not require hospitals to report suspicious nurse terminations to the state nursing board.⁵

The Friendship at Somerset Medical Center

Cullen began working at Somerset Medical Center in Somerville, New Jersey, in 2002. He would murder 13 patients there before he was stopped.⁵

Loughren was an experienced trauma, ICU, and ER nurse working night shifts at the hospital.⁶ She and Cullen worked the same overnight hours and developed what author Charles Graeber later described as a “work spouse” dynamic, built on gallows humor and the grind of night nursing.²

Loughren had cardiomyopathy, a serious heart condition that caused episodes of severe breathlessness at work. Cullen covered her duties during those episodes, helped with her children, and became her confidante.⁷ She stayed at Somerset despite her worsening health because she needed a full year of employment to qualify for insurance that would cover a life-saving heart surgery.⁶

Meanwhile, Somerset’s own internal reviews had already flagged “medically alarming” digoxin orders and suspicious deaths. In July 2003, Dr. Steven Marcus of the New Jersey Poison Control Center called hospital medical director William Cors and urged him to contact police about the possibility that an employee was killing patients. In a recorded call, Cors weighed the risk of “throwing the whole institution into chaos” against the “responsibility to protect patients from further harm.”⁸ The hospital waited more than three months before contacting law enforcement. Cullen killed five more patients during that gap.⁹

What Loughren Did With Detectives

In 2003, Detective Sergeant Timothy Braun and Detective Daniel Baldwin of the Somerset County Prosecutor’s Office were assigned to the case. Analyzing hospital data, they found that 67 percent of deaths in the Critical Care units occurred on the midnight shift when Cullen was on duty, and Pyxis records confirmed he had been pulling unauthorized digoxin at an alarming rate.¹⁰

Getting to that data took work. When detectives asked for Pyxis records, Somerset administrators told them the system erased data every two months. Detectives called the manufacturer and learned the records were actually stored indefinitely. Lead detective Tim Braun later told 60 Minutes that when asked whether the hospital had obstructed the investigation, his answer was: “They didn’t try to help it, that’s for sure.”⁹

The detectives approached Loughren at the hospital and asked her to help. Despite her fragile health and the weight of learning her closest friend at work was a murder suspect, she agreed. She described Cullen’s habits to detectives, including how he routinely opened medical charts for patients who were not under his care shortly before those patients died.¹¹ A confidential informant at the hospital, also a nurse, helped detectives replicate the acetaminophen-and-digoxin drawer trick that had hidden Cullen’s drug pulls.⁴

Loughren then agreed to wear a wire and meet Cullen. Over dinner, he showed her newspaper clippings about the investigation and appeared, in her words, “very proud” of them. She confronted him directly, knowing by then that he was harming patients.¹

Cullen was arrested in December 2003 in Somerset County. He refused to talk, and authorities were close to releasing him. Loughren then let detectives suggest to Cullen that she might be implicated. Still casting himself as her protector, he confessed to shield her, telling investigators he had killed more than 40 patients.¹²¹ Loughren later said their friendship was “what really put him behind bars.”

Plea, Sentences, and Where He Is Now

Cullen entered a plea agreement with prosecutors in all seven New Jersey and Pennsylvania counties where he had worked. They agreed not to seek the death penalty in exchange for his cooperation in identifying victims.¹³ He pleaded guilty to murdering 29 patients and attempting to murder six others.¹⁴

On March 2, 2006, Superior Court Judge Paul W. Armstrong sentenced Cullen in New Jersey to 11 consecutive life terms totaling 397 years without possibility of parole, for 22 murders and three attempted murders.¹⁴¹⁵¹⁶

He is incarcerated at New Jersey State Prison in Trenton.¹⁴ Although he was convicted of 29 murders, experts have said the real toll could be far higher, potentially in the hundreds, because many of his earlier crimes predate electronic medication tracking and the records are incomplete or lost.³

The Law That Came Out of the Case

In July 2005, New Jersey enacted the Health Care Professional Responsibility and Reporting Enhancement Act, commonly called the Cullen Act, a direct response to the systemic failures that let Cullen keep moving between hospitals.¹⁷¹⁸

Amy Loughren Today

Loughren eventually underwent experimental heart surgery that saved her life and has said she is doing well. She has spoken publicly about the emotional cost of the case, including the guilt of missing her friendship with Cullen and her reluctance to accept that he was not a “mercy killer” but a “cold-blooded murderer.” As she put it, “I literally risked everything to make sure he was behind bars.”⁷

After leaving hospital nursing, she trained as a Reiki master, hypnotherapist, and integrative energy healer, among other practices.⁶ She has become an advocate for nurse well-being and mental health, speaking at professional conferences and on podcasts about nurses supporting one another and speaking up when something is wrong. She lives in Florida, near her two daughters and grandchildren.¹⁹

The Book and Screen Adaptations

Journalist Charles Graeber spent years investigating the case and interviewed Cullen in prison through letters and visits. His 2013 book, The Good Nurse: A True Story of Medicine, Madness, and Murder, became a New York Times bestseller and was the basis for both a dramatized film and a documentary.²

The Netflix film The Good Nurse, released on October 26, 2022, stars Jessica Chastain as Loughren and Eddie Redmayne as Cullen. Loughren consulted with Redmayne over Zoom during production, describing Cullen’s mannerisms in detail. She later said she was left “shaking” by how accurately Redmayne captured the shift in Cullen from a gentle, “Mr. Rogers type” personality to the cold emptiness she witnessed on two occasions: at the restaurant where she wore the wire, and later in the interrogation room.²⁰

A companion documentary, Capturing the Killer Nurse, was released on November 11, 2022. It features Loughren, the investigating detectives, former colleagues, and the poison control employee who first flagged the threat, along with audio of Cullen from Graeber’s prison interviews in which Cullen described his killings as “ending their suffering.”²¹

1
BBC. How I Found Out My Friend Charlie Was a Serial Killer
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Netflix. Charles Graeber Interview
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NPR. NPR Transcript on Charles Cullen
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Wired. Charles Cullen Hospital Hack
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CBS News. Did Hospitals See No Evil
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Newsweek. What Happened to Amy Loughren
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BBC. Amy Loughren Story
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CBS News. Detectives on Catching Serial Killer Charles Cullen
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NJ.com. Detective Tells 60 Minutes Somerset Medical Center Lied
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National Law Enforcement Officers Memorial Fund. Officers of the Month – July 2004
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Oxygen. What Happened to Charles Cullen’s Coworker Amy Loughren
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Lehigh Valley Live. When Killer Nurse Charles Cullen Admitted ‘I Killed 40 People’
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NBC News. Charles Cullen Sentencing
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MyCentralJersey. Remember When NJ Killer Nurse Charles Cullen Murdered 22 Patients
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The Morning Call. DA Says Cullen Asked Too Late to Avoid Court
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The New York Times. Charles Cullen
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NJ Activity Professionals. Professional Legislation
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NJ Consumer Affairs. Health Care Reporting
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Nurse.com. The Good Nurse Advocates for Nurses’ Well-Being
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Newsweek. Amy Loughren Interview on Eddie Redmayne Transformation
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Variety. Capturing the Killer Nurse Review