An American nurse was sentenced to life imprisonment on Tuesday over the murder of seven veterans to whom she had given lethal doses of insulin while they were under her care in a hospital.
"There is no explanation and certainly no justification," Judge Thomas Kleeh told Reta Mays as her sentence was imposed. "You're the worst. You're the monster that no one sees coming."
Mays, 46, pleaded guilty in July to the seven murders and attempted homicide of an eighth man, avoiding a trial and full investigation into a dozen other suspicious deaths.
Confronted Tuesday for the first time by the loved ones of her victims, she did not provide any explanation for her actions.
"There is no word I can say that can offer the families any comfort. I can only say I am sorry for the pain I caused," she said simply, sobbing.
Her lawyer said her capacity for "clear thinking collapsed" due to mental health issues, including post-traumatic stress related to a deployment to Iraq as well as her job as a night nurse in a West Virginia veterans hospital.
Mays admitted to administering insulin between July 2017 and June 2018 to these men, aged 81 to 96, who did not need it.
The hormone, which is used to treat diabetes, is dangerous for people who do not have the condition because it lowers the level of glucose in the blood and can lead to coma and even death.
The patients' deaths initially seemed natural, but eventually a doctor sounded the alarm. An investigation was then opened, and some victims exhumed for an autopsy.
The wife of one of the men told the court of the shock she felt upon seeing the word "homicide" written on the medical examiner's report.
"I don't know why she did what she did, I don't think that we will ever know. But she took my life away from me", said Norma Shaw, wife of George Shaw, in a pre-recorded message.
Other relatives of the victims called Mays a "serial killer" or "coward", while blaming the authorities for their lack of vigilance.
The Department of Veterans Affairs, which operates the hospital, opened an investigation to determine its liability and concluded ten settlement agreements with relatives of victims.