Confessed killer's actions result in call for tougher background checks.

A string of killings in Pennsylvania and New Jersey by a former nursing home nurse may lead to reform in the way background checks are carried out in the states' medical facilities.

Bethlehem, Pa. resident Charles Cullen has confessed to killing as many as 40 terminally ill patients during his 16-year nursing career to "alleviate [their] pain and misery," according to the Somerset County Prosecutor's Office in Somerville, N.J.

So far, Cullen has been charged with the first-degree murder of one patient and the first-degree attempted murder of another at Somerset Medical Center in Somerville. Both victims received overdoses of the heart drug digoxin, according to the prosecutor's office.

Authorities from seven counties in New Jersey and Pennsylvania have since joined forces to investigate as many as 40 mysterious deaths at Cullen's other workplaces.

In his confession, Cullen said that he killed 12 to 15 patients at Somerset, where he worked from Sept. 2002 until Oct. 2003. Somerset Medical Center was one of 10 facilities--nine hospitals and one nursing home--that Cullen worked at during a career that began in 1987.

That career includes being fired from six jobs--including from Somerset--and abruptly quitting three others, according to investigators. In most cases his termination was due to "interpersonal problems"

Cullen's checkered past has resulted in several legal actions by parties wondering why so many facilities continued to hire him.

One civil action filed in Northampton County Court, Pa. names five of Cullen's former employers--including Somerset and Allentown, Pa.-based Liberty Nursing Homes and Rehabilitation Center--in connection with a patient's near-death at St. Luke's Hospital in Fountain Hill, Pa. in 2002. The filing contends that all five facilities could be liable for not stopping Cullen in some fashion, according to Allentown lawyer Peter Karoty.

In a separate action, Kelly Rambo, of the Cohen and Feeley law firm in Easton, Pa., has filed a claim on behalf of a 41-year-old Pennsylvania woman who died at St. Luke's while Cullen was working.

Meanwhile, Easton, Pa.-based Two Rivers Hospital Corp. has filed a summons against the staffing firm that supplied Cullen as an employee for one of TRHC's hospitals in 1998. According to TRHC legal counsel David Auten, Two Rivers has been named in a wrongful death lawsuit in connection with Cullen's employment at Easton Hospital in Easton, Pa.

"Why wasn't all this information passed on about [Cullen]? What kind of screening process were the hospitals going through and what kind of references did they give to each other about Cullen?" Rambo said.

Labor attorneys note that many health care facilities afraid of being sued for defamation are reluctant to give past employees bad references and will only give information concerning start and finish dates of employment.

Some employers may not check references as thoroughly as they should because of the nursing shortage, said Debbie Portola, administrator of Casa Coloma, a 140-bed nursing home in Rancho Cordova, Calif.

"A lot of people are so desperate for nurses that when they check references they're really hoping they don't find anything that would prevent them from hiring them," Portela said.

In California, recent legislation requires nursing homes to call every reference a potential employee lists, Portela said. There's also a nurse's registry Web site where one can put in a license number to see if someone has restrictions on their license or if it's been suspended.

New Jersey has a registry for malpractice by physicians but not for nurses, according to David Wald, communications director for Sen. Jon S. Corzine, D-N.J.

Wald said Corzine and other legislators are exploring ways create a better health provider network that would protect health care facilities from liability issues and create a national health registry to track nurses with histories of disciplinary action.

"When (employers) call hospitals for references, they're never any clues about whether someone left under suspicious circumstances or if they left because of the quality of their work," Wald said. "We would like to change that and make more meaningful information available."

New Jersey law prohibits the public release of an individual's consolidated criminal history, according to John Hagerty, spokesman for the New Jersey Division of Criminal Justice. This means that it is virtually impossible for a health facility to do any kind of a criminal background check on a potential employee.

The Pennsylvania Senate's Consumer Protection and Professional Licensure Committee will meet in Bethlehem, Pa., in early February to seek ways to help medical facilities avoid hiring potentially dangerous employees.

Committee chairperson Sen. Lisa Boscola, D-Northampton, said the legislature will explore various options, including a possible statewide clearinghouse to share information.