Charles Cullen's work history should have raised a flag to any nurse manager. So many changes of employment often within several months of each other. Hospitals also should have noticed he was browsing around pt records that weren't his, not once but often.
Patients before their deaths stated that "the sneaky male nurse" had given them injections but family, the hospital and others either didn't believe them or dismissed their observations.
There is also the fact of the declining autopsy rates in this country, even when a death is unexpected. Coroner's inquests are rare for patients who die in hospital unless there are strong compelling reasons or the family insists.
As noted above facilities rather than risk *former nurse* Cullen threatening them with lawsuits simply walked him to the door when strange things happened, but gave references (even if only confirming dates of hire and discharge) when called upon to do so and sometimes gave positive reviews. http://www.mycentraljersey.com/artic...al-killer-case
The world may never know the exact number of persons sent to their deaths by Mr. Cullen. Most experts in the case agree far more than the 40 or whatever number Cullen gave as his victims. It could range as high as 400 patient deaths over his career as a nurse but again we shall never know. The expense of tracing, exhuming then testing potential victim's bodies would be dear and whatever evidence may have been destroyed during the embalming process and or simply gone after long period under ground. Then of course there would be the problem of finding what patient/nursing records exsisted.