If, like most, you spent your weekend watching Netflix’s latest drama, The Good Nurse, you’d likely be familiar with the chilling story of serial killer Charles Cullen. Though the film arrived somewhat quietly on the platform, despite the star power of Eddie Redmayne and Jessica Chastain, audiences watching around the world have been transfixed by the gripping story, and shocked that such crimes escaped the scrutiny of the healthcare system. For 16 years, American nurse Cullen murdered patients and, perhaps most shockingly of all, he did so with no motive. While rumours surrounding Cullen and his practice plagued his career, it was only after he was caught and arrested in 2003 that he admitted to detectives that he had killed as many as 40 people, with some experts believing that number could actually be in the hundreds.
It’s a harrowing story that captures not only the terror of Cullen’s crimes and the fact he got away with murder so easily, but also the flaws in the legal system and the pressures surrounding the healthcare system which meant few hospitals were willing to turn Cullen away. The subject of Cullen’s crimes were documented in Charles Graeber’s 2013 book, “The Good Nurse: A True Story of Medicine, Madness and Murder.” Now, the book has received the Hollywood treatment, serving as the basis for Netflix’s latest film, The Good Nurse, written by Krysty Wilson-Cairns and directed by Tobias Lindholm.
The film not only follows the story of Cullen, but is instead largely told through the eyes of Amy Loughren, a fellow nurse who helped bring Cullen to justice. As Wilson-Cairns tells Los Angeles Times, “I’d never heard about Charles Cullen, I didn’t know he was America’s most prolific serial killer. I didn’t know it happened in my lifetime. And I’m a weird, twisted person who stays on Google until four in the morning reading about terrible people, so I would know it.”
Speaking about the American healthcare system that swept Cullen’s actions under the rug for so long, Wilson-Cairns says: “When you put profits ahead of patients, you jeopardise care and you jeopardise the system in which people can be held to account. So [my interest] was the trifecta of the fact that I’ve never heard of it, the system that I thought is profoundly broken and this single mum superhero. What more can you ask for as a writer in a story you want to tell.”
As with any film though, entertainment is a key detail and naturally, there are some fictionalised elements that crept into The Good Nurse. Here, we separate the fact from fiction to see just how the onscreen version stacks up to the true story.
Who is Charles Cullen and what were his crimes?
As mentioned, Cullen is one of America’s most prolific serial killers and worked as a nurse for 16 years during which time it’s believed he may have murdered hundreds of patients. Though it’s believed he adapted his methods of murder over the course of his career, the film depicts how he would pollute IV bags before they went out on the floor, dosing them with dangerous medicines in the storeroom before they went out to patients.
Who is Amy Loughren?
In the film, Jessica Chastain plays Amy, a single mum with a heart condition who works nights as a nurse in the ICU and comes to befriend Cullen. The character is actually based closely on the real Amy, who was also involved in the making of the film. Due to the fact she doesn’t have health insurance, Amy tries to keep her heart condition a secret, and the recently hired Charlie becomes a friend to her, helping her conceal it as he helps with her patients. It isn’t until Amy discovers Cullen is spiking IV bags with drugs like insulin and digoxin that cause patients to die suddenly that she becomes alert to Cullen’s danger. Ultimately, it’s thanks to Amy that the two detectives, Danny Baldwin (Nnamdi Asomugha) and Tim Braun (Noah Emmerich) investigate him. It’s Amy who is key to Cullen’s confession and helped bring him to justice.
Though the film showed Cullen as being something of a family man by helping Amy at home and with her two daughters, this is a fictionalised element as though he knew where she lived, the true story is that Charlie would never have met Amy’s children. Even so, the real-life Amy did have severe heart issues and also confronted Charlie in a diner while wearing a wire prior to his arrest. It’s also true that Cullen only confessed to the crimes because Amy persuaded him at the police station to come clean.
Was Amy the first to raise alarms about Cullen?
Though the film shows Amy becoming curious about Cullen’s practice after being shown a police report on the drugs he ordered from the dispensary, the fact is that several nurses at hospitals where Cullen worked had actually tried to alert the authorities. Seven nurses at St Luke’s Hospital in Pennsylvania persuaded the State Police in August of 2002 to come to the hospital after Cullen had taken up an offer to resign, later telling the district attorney’s office that they suspected a former colleague had been found mishandling medication and might have even been involved in the deaths of several patients. Despite the alarm, the case was dropped after eight months due to lack of evidence.
It wasn’t just nurses who raised the alarm bells though, with the relatives of three of Cullen’s victims also suspecting someone was at fault and asking the police to investigate further. Despite this, they faced stonewalling on the part of the hospitals and the investigations were less than thorough when it came to examining the evidence and building a case against Cullen.
In 2008, five hospitals settled wrongful-deaths lawsuits with the families of 22 victims in a negation that took four years. The suits alleged that hospital administrators had done nothing to stop Cullen from using stolen medications to kill patients and failed to notify authorities about such suspicions.
What was Cullen’s motive?
After confessing to the crime to Amy, the film ends with something of an anti-climax. As audiences, we are left wondering what Cullen’s motive was and what it was that led him to become one of America’s most prolific serial killers. Instead, we’re only left with more questions. In the opening of the film, we see a young Cullen being pushed to the side as a medical team administers defibrillation to a family member, learning later in a conversation with Amy that his mother died in the hospital and her body was lost and left to lie naked. The most we get in terms of a motive here is that Cullen may have sought revenge on hospitals.
The reality however, is that Cullen’s motive remains a mystery. We know for a fact that he wasn’t present when his mother died and that she was killed in a car accident when he was 17, something made all the more devastating as the hospital delayed notifying him of her death and instead cremated her body without asking him.
Cullen gave a 2003 confession in which he presented himself as a compassionate nurse, believing that he acted instead to end his patients’ suffering and was performing community service by preventing hospital personnel from dehumanising them. In a 60 Minutes interview, he explained: “I thought that people weren’t suffering anymore. So, in a sense, I thought I was helping. You know, what I did, there is no justification. I just think that the only thing I can say is that I felt overwhelmed at the time.”
He added, “I don’t know if I would have stopped.”
What was Cullen’s punishment?
After his arrest, Cullen worked out a plea deal with prosecutors in which he would help investigators identify victims in order to avoid the death penalty. He later pleaded guilty in 2004. He was sentenced in March 2006, with the relatives of victims calling him “a demon, a coward, a monster, a waste of life,” and “Satan’s son.”
At the trials, Cullen sat in silence and showed little remorse. It wasn’t until a later sentencing in Lehigh Country court that he accused the judge of bias for granting a newspaper interview and repeated the phrase, “Your honour needs to step down” more than 500 times, leading him to be gagged with a cloth and several pieces of duct tape. He never apologised to victims’ family members or explained his motive, and also kept his eyes closed while they read victim impact statements.
Cullen pleaded guilty to 22 counts of murder in New Jersey and seven in Pennsylvania, as well as six counts of attempted murder. He is currently serving 11 consecutive life sentences, meaning he won’t be eligible for parole until long after his death.