that he had been involved in patient deaths. Legal impact Cullen moved from facility to facility undetected mainly because of the lack of requirements to report suspicious behavior by medical workers and inadequate legal obligations on employers. New Jersey and Pennsylvania, like most other states, required health care facilities to report suspicious deaths only in the most egregious cases, and the penalties for failing to report incidents were minor. Also, many states did not give investigators the legal authority to discover workers' previous employers. Employers feared investigating incidents or giving a bad employment reference for fear of such actions triggering lawsuits. According to detectives and Cullen himself, several hospitals suspected him of harming or killing patients but failed to take appropriate legal actions. After Cullen's criminal conviction, many of the hospitals at which he had worked were sued by the families of his victims. The files and settlements against the New Jersey hospitals, all of which were settled out of court, are sealed. In some cases, individual workers took it upon themselves informally to try to prevent Cullen from being hired or to have him terminated. Some contacted nearby hospitals in secret or quietly spoke to their superiors to alert them not to hire Cullen. When Cullen took a job at Sacred Heart Hospital, in Allentown, in June 2001, a nurse who had heard rumors about him at Easton Hospital advised her coworkers. The nurses threatened to quit en masse if Cullen was not immediately dismissed, which he was. Prompted by the Cullen case, Pennsylvania, New Jersey, and 35 other states adopted new laws which encourage employers to give honest appraisals of workers' job performance and provide legal protections for reporting medical errors. The New Jersey laws, in particular, formed the model other states would follow. Firstly, the 2004 Patient Safety Act increased hospitals' responsibility for reporting "serious preventable adverse events". The 2005 Enhancement Act, a supplement to the Patient Safety Act, required hospitals to report certain details on their employees to the New Jersey Division of Consumer Affairs and mandated that complaints and disciplinary records relating to patient care be kept for at least seven years. In popular culture The 2008 direct-to-video film Killer Nurse, written and directed by Ulli Lommel, was loosely based on Cullen. On June 25, 2020, the British television channel Sky Crime aired the documentary Charles Cullen – Killing for Kindness. The UK True Crime