For the first time in Pennsylvania, critical care nurse Charles Cullen has been named a suspect in the death of a hospital patient: 78-year-old Ottomar A. Schramm, who died New Year's Eve 1998 at Easton Hospital.

Northampton County Coroner Zachary Lysek said Thursday that he ruled Schramm's death a homicide after initially ruling the cause of death as "undeterminable."

"This case has always remained an open case and ongoing investigation," Lysek said.

Northampton County District Attorney John Morganelli said Cullen's admission to investigators that he killed up to 40 patients in his 16 years as a nurse,

coupled with the presence of lethal levels of the heart medicine digoxin in two of his alleged New Jersey victims, made Cullen a suspect in Schramm's death.

Schramm also was found to have high levels of digoxin in his blood, which an autopsy showed had contributed to his death, Morganelli said.

Lysek would not release the autopsy report, saying it was the subject of an ongoing investigation.

Schramm, 78, was a resident at Northampton County's Gracedale nursing home in Upper Nazareth Township when he was admitted to Easton Hospital for treatment of a seizure on Dec. 28, 1998. He died three days later.

Schramm's widow, Lorraine, filed a wrongful death lawsuit in October 2001 against Easton Hospital and several other parties. Her attorney, Martin Cohen, said he plans to meet with the family to discuss filing a new lawsuit.

Lysek said he has launched investigations into the more than 150 deaths that occurred at Easton Hospital while Cullen worked there between November 1998 and March 1999.

"I want to assure the families of anybody that lost somebody at Easton Hospital in Northampton County that we are going to look at that case very closely," Lysek said. "If we belive Mr. Cullen could have been involved with their death, we will continue to pursue that investigation."

Lysek said he would narrow the list by determining which patients Cullen had access to, then determine whether additional testing is needed based on medical inconsistencies.

If testing is needed, Lysek said he would take the necessary steps to exhume the bodies of potential victims.

"We are confident there will be additional evidence beyond [Cullen's] admissions," Morganelli said.

Cullen, 43, of Bethlehem, was charged Monday with first-degree murder and first-degree attempted murder in the deaths of two New Jersey patients -- a Hunterdon County priest and a Basking Ridge cancer patient -- at Somerset Medical Center, Somerville. His revelation that he killed up to 40 patients has reopened investigations into patient deaths in the Lehigh Valley. Cullen worked at nine hospitals and a nursing home in eastern Pennsylvania and New Jersey since 1987.

"The statements made by Cullen, which just surfaced this week, moved these investigations a whole different step because it provided an admission by him as to use of this digoxin and responsibility for numerous deaths," Morganelli said.

Cullen had been held since Friday in Somerset County Jail on $1 million bail. He was transferred late Wednesday or early Thursday morning to Ann Klein Forensic Center in Trenton, N.J., for psychiatric evaluation.

Jeff Beach, a spokesman for the New Jersey public defender's office, would not comment on reports that Cullen was held naked in his Somerset County cell to prevent a suicide attempt.

Beach and Somerset County Prosecutor Wayne Forrest also declined to comment on Deputy Public Defender Johnnie Mask's published statements that his client would withhold the names of his victims unless guaranteed protection from the death penalty.