Fear of litigation led to hospital inaction regarding the killer nurse:

During his 16-year nursing career, Cullen was able to move from one hospital to another – to 10 medical facilities in all – because fear of litigation prevented those hospitals from giving him a bad reference. Co-workers observed his strange behavior, and caught him in rooms of patients with medications that weren’t appropriate. But they didn’t know he was murdering people, and couldn’t prove that he was doing something illegal. So the hospitals would eventually let him go, and, when the next hospital in line asked for a reference, merely gave the stock response of all employers nowadays: “We confirm that he worked here from this to that date.”

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