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This Could Be You: Cullen Law Under Scrutiny

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A law that is the namesake of former registered nurse and convicted serial killer Charles Cullen is good in its intent but harmful in its execution. This is the opinion of two nurse attorneys representing nurses impacted by the law. Kathleen Gialanella, RN, JD, LLM, and JoAnn Pietro, RN, JD, say the law often targets the wrong people and ruins the careers of healthcare professionals -- overwhelmingly most often nurses -- some of whom never should have been reported to the N.J. Division of Consumer Affairs (the Division) or its licensing boards. 

About the Law The Health Care Professional Responsibility and Reporting Enhancement Act (the Cullen Law) was signed into law in May 2005, and it requires healthcare professionals or entities to notify the Division when they have information regarding incompetence, impairment, or professional misconduct which relates adversely to patient care. It also mandates criminal background checks of healthcare professionals seeking licensure in New Jersey. The law was intended to prevent other cases like that of Cullen, who kept getting hired at different hospitals during his 16-year career, despite a questionable employment record. He claims to have killed at least 40 patients but was convicted of killing 29 and is currently serving 11 consecutive life sentences. Some experts estimate he killed closer to 400 patients. Nearly 20 years after the creation of the Cullen Law, no changes have been made to address the concerns many have voiced about its harmful implications. Both Pietro and Gialanella also believe the Cullen Law, by design, would not necessarily have prevented Charles Cullen from causing patients harm. 

Unfair targets Under the stricter reporting laws, Gialanella said, nurses are being reported for issues such as medication errors, substance abuse issues, or for conduct seen as incompetent but that is really the result of inexperience or a larger health system failure. And the consequences of getting reported to the New Jersey Board of Nursing (the Board), which is housed under the Division, can be devastating. One of the provisions Gialanella objects to is that under the law, the employer who reports a nurse to the Board has an obligation for the next seven years to disclose to any prospective employer that that nurse was reported. She noted even having clients being reported well beyond seven years. Prospective employers will likely think twice about hiring a nurse who's been terminated and reported to the Board (or not hire them at all), which is a huge concern, says Gialanella, who has a law office in Westfield, New Jersey. "I've had a number of clients apply for jobs that were told to come back after the Board has resolved their case," she said. Yet due to a backlog it can take the New Jersey Board several years to resolve cases. She also disagreed with the time allotted for nurses to mount a defense. "Within seven days of an action, it has to be reported to the Board. Say a nurse is accused of making a practice error and is terminated for that error -- that leaves very little time to convince the employer it made a mistake," she said. Pietro, a solo practitioner in Boontown Township, New Jersey, said nurses are also unfairly targeted because they are hospital employees and can be reported by hospitals. Physicians, on the other hand, often are not considered employees but have privileges at hospitals. Hospitals usually do not readily report physicians who make mistakes unless the error is very egregious, Pietro said. She added that many of the nurses being reported are victims of an unjust culture within their hospital or health system. "Patient safety issues are usually a multi-system error -- generally when nurses have too many patients assigned to them because the organization is understaffed." Pietro said. "And when there's an error, it all falls to the shoulders of the nurse rather than management taking responsibility and realizing they had lack of adequate staff or failed to properly supervise the nurse. Or there were a lack of supplies or availability to get things to the nurse that was needed." Despite a nationwide nursing shortage and growing need for more experienced nurses, the Cullen Law also prevents New Jersey nurses who were reported to the nursing Board from advancing or expanding their career after being reported to the Board. "If a registered nurse applies for a higher license, such as an advanced practice nursing license, or another license, such as a respiratory therapist, these applications are held up indefinitely until the underlying matter is resolved by the Board," noted Pietro. "It is patently unfair to the licensee." Both Pietro and Gialanella worry that the Cullen Law is a deterrent to entering the nursing profession at a time when the health care system is in dire need of nurses. They also noted the confusion experienced by nurses within the Nurse Licensure Compact (NLC), a legislation that allows nurses to have one license to practice in multiple states. "Nurses coming to practice in New Jersey aren't aware of how the Cullen Law might impact them and their career," noted Pietro. "They are unaware that the Health Care Professional Responsibility and Reporting Enhancement Act exists. But then they get caught into this web, they regret exercising their right or ability to work in New Jersey." 

Words of wisdom If a nurse suspects that they might be close to being reported, Gialanella and Pietro offered this advice:

  • Find another job. "If you see the handwriting on the wall, voluntarily resign and walk away," Pietro said. "If you don't leave and are terminated, you could be in a situation where you might not get another job."
  • Don't resign while you are under investigation. "The Cullen Law says that if a licensee resigns from a job while under investigation, that has to be reported to the Board," Gialanella said.
  • If you're terminated and told you're being reported because of the Cullen Law, seek an attorney's advice as soon as possible. "As the licensee tries to find new work, the former employer may be reporting information to prospective employers about the employee that may make it almost impossible to find additional work," Gialanella said.
  • Understand that you have a right to see the same reporting notice the hospital gives to the Board at the same time that it is given to the Board. Request a copy of the supporting documents as well, Pietro said.
  • Know that the law says that the professional does not have to be reported for substance abuse if that person is willing to check into a recovery and monitoring program.
  • Seek help from a union if you're part of one.

Amy Loughren, former colleague of Charles Cullen, worked with the investigators who ultimately arrested him. As portrayed in the Netflix movie The Good Nurse, Loughren weighed in on the Cullen Law and its effects on the nursing industry. "The Cullen Law was a knee jerk reaction to an incredibly complicated issue which involved hospital negligence. Nurses cannot continue to pay the price for organizations' errors," noted Loughren. "Real changes need to be made to this law including the criteria for which a nurse can be reported." "The law's heart was in the right place. However, it's the individuals who covered up Charles' crimes that have yet to be held responsible," she added. Loughren was featured in a recent NurseDot podcast episode, "The Good Nurse," in which she asserted that poor risk management systems allowed Cullen to continue killing and that the repercussions of these failures continue to impact the healthcare system today. Editor's note: This post was originally published in February 2009 and has been updated with new content. 

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