A US nurse who killed at least 29 patients was sent to prison for the rest of his life today.
Charles Cullen - one of the most prolific killers the US health care industry has ever seen - escaped the death penalty after making a deal with prosecutors to tell them which patients he killed with hard-to-detect drug injections.
He received 11 consecutive life terms at a tense hearing in New Jersey in which he came face-to-face with his victims' families for the first time.
"You betrayed the ancient foundations of the healing professions," Judge Paul Armstrong said as Cullen stood motionless, his eyes closed.
Cullen (46) pleaded guilty to murdering 22 people in New Jersey and trying to kill three others. He will be sentenced later for seven murders and three attempted murders in Pennsylvania.
Cullen has claimed to have killed up to 40 people during a career that spanned 16 years and 10 nursing homes and hospitals.
He was fired from five nursing jobs and resigned from two others amid questions about his practices. But he always managed to find another job, in part because hospitals did not share their suspicions for fear of being sued.
New Jersey politicians have since passed legislation protecting nursing homes and hospitals from legal action when reporting disciplinary actions taken against employees.
Cullen declined to make a statement in court, disappointing families who had hoped to hear him explain why he committed the crimes.
John Shanagher, whose father was murdered, said his family "will never feel safe in a hospital again. We will never feel we can trust the medical profession again".