Some people go to work to do a bad job
When cases like these are brought up in patient safety discussions with health care professionals, they dismiss them one way or the other - another reason health care professionals never will make patients safe. Patients need to stop trying to get health care professionals to make them safe and and fix this themselves (see Agency), as the case of Cullen shows.
Cullen was a nurse who is yet another case of a health care professional who murdered lots of patients without anyone in medicine even filing a report with the state medical board. There is nothing unusual about that. Health care professionals don't report problems and do not know that they don't. In fact, they get angry at the suggestion that they don't.
Nurse Cullen last worked at Warren Hospital in Phillipsburg, N.J. Another hospital at which he worked before that without anyone reporting him was St. Luke's in Bethlehem, Pennsylvania. When that hospital combed through the records of 69 patients who had died while Mr. Cullen was around them, they refused to answer why. Prosecutors and police who looked into it were left with nothing to go on.
Same old, same old.
Dr. William Cors, chief medical officer at Somerset Medical Center in Somerville, N.J. said, "...we're prevented from telling one another what we know out of fear, quite frankly, of being sued."
Medicine uses the threat of lawsuits as a scapegoat. In the USA you have the right to report to a legitimate authority and cannot be sued for doing so. Anyone could have reported Cullen to the police or to a state medical board without fear of getting sued. It is the other repercussions for reporting in medicine, most brought by the medical community against its own members, that silence them.
A system that lacks a way
According to the New York Times (12/17/03, pg.C23) the hospitals and public agencies that were concerned about him say they were defeated by a system that lacks a way to spread the word about medical professionals suspected of misdeeds.
Don't they have telephones? Or email? Or lunch breaks? Could they not take someone to lunch and say, "I hear Nurse Charles Cullen is working for you now. How is that going?"
Their system uses those ways and more to spread the word about patients who might be a problem for caregivers (see blacklisting). But when the problem is a health care professional, and the problem only is, say, murdering patients, theu can't think of anyway they could have notified anybody.
Time after time one thing that is clear is that medicine routinely makes up self-serving statements that are complete popycock and then not only chooses to believe them itself, but expects everyone else to as well.
The individual health care professionals as well as the institutions, the hospitals and public agencies, that were concerned about Cullen, chose to believe that there just was no way to spread the word.
There are more ways than I have mentioned, but medicine is more worried about its own interests than it is about the very lives of its patients. Health professionals can accumulate criminal records without the state medical board finding out because neither they nor anyone else gives a rat's ass. Sorry for the vernacular, but good grief (see Schramm). School janitors have to meet higher standards than that.
They say they also were defeated by hospitals and government agencies that are unwilling to spread the word. A serial killer is murdering patients and the hospitals and government agencies are unwilling to spread the word? Who works for them? Any injured patients on their boards?
Could there be a more clear statement about whose interest all current agencies and boards serve? Is there a more clear statement showing whose side they are on? Do you think that if there were a state PATIENTS board, whose first priority really were the well-being of patients, that they would have been unwilling to spread the word about a nurse who was murdering patients?
Blaming it on the lack of a system deflects responsibility in a way that falls in line with the myth that the problem only is a systems one, as though it has nothing to do with the people in that system.
The people are the problem
No new system and no new agency run by yet more health care professionals can overcome the fact that they are more worried about repercussions for themselves than they are about stopping a serial killer who is murdering their patients.
Fortunately a writer came along who cared enough to look deeper than merely repeating the self-serving view that health care providers give when asked about these things.
The Good Nurse: A True Story of Medicine, Madness, and Murder, by Charles Graeber (links to Amazon).
The New York Times says it reveals how the hospitals' systemic and ethical failings protected Nurse Cullen. They write ". . . the eagerness of ambitious hospital administrators to cover up his misdeed . . . hospital efforts to know as little as possible about Mr. Cullen's activities. At the risk of their patients' lives, they did not want their institutional reputations damaged. . . the paucity of records about Mr. Cullen and the eagerness of hospital lawyers to deflect [the investigators] . . . The investigators were lied to . . . told by a hospital "risk manager" that the Pyxis didn't keep long-term records, so there would be no point in checking on Mr. Cullen's history." But the Pyxis does keep long-term records. It was just more lying and more covering up of that which would save the lives of future patients.
It is the same throughout medicine. They do the same thing in response to most of the problems in medicine - graft, abuse, incompetence, negligence, and even mere errors. It is a rare problem that gets in any record at any level let alone has anything done about it (see Medical Reporting).
If you want an individual example of why things are this way, you could read about the nurse who worked with a serial killer without reporting him and, when I didn't understand that, wrote angry emails to me explaining why. See Orville Lynn Majors on this site.
If you need thoughts on why she, and the hospital, should have, here is this from the Florida Supreme Court in Insigna v. LaBella, articulating what of dozens of other jurisdictions already had articulated:
"The hospital is in a superior position to supervise and monitor physician performance and is, consequently, the only entity that can realistically provide quality control."
Unfortunately, it is not in their own interest to do that, so no number of laws or lawsuits will result in their doing the job as well as it could be done if they were not the only entity monitoring performance (see Community Patient Agency). The patient community needs objective information, not ignorant faith in health care professionals to be the saints they imagine themselves to be.