Cullen

SOMERVILLE, N.J. — A former nurse sentenced to 11 consecutive life terms for the murders of 22 people in New Jersey left the families of his victims hurt once again.

During an emotional sentencing hearing Thursday, Charles Cullen refused to explain himself, apologize or even tell a judge why he did not want to talk after relatives of his victims confronted him for the first time, calling him "a monster" and "vermin."

Cullen — one of the worst serial killers ever discovered within the U.S. health care system — escaped the death penalty after making a deal with prosecutors to tell them which patients he killed with hard-to-detect drug injections.

He had pleaded guilty to murdering 22 people in New Jersey and trying to kill three others. He is scheduled to be sentenced March 10 for seven murders and three attempted murders in Pennsylvania.

Cullen, 46, has claimed to have killed up to 40 people during a career that spanned 16 years and 10 nursing homes and hospitals.

Cullen 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 and Pennsylvania lawmakers have since passed legislation protecting nursing homes and hospitals from legal action when reporting disciplinary actions taken against employees.

Cullen said he had "nothing to say," disappointing families who had hoped to hear him explain why he committed the crimes.

Cullen has admitted he used lethal doses of medications — usually the heart medication digoxin — to kill patients. He told authorities when he was arrested in 2003 that he killed "very sick" patients and described the slayings as mercy killings.

The killings had gone undiscovered for so long partly because many of the victims were old or gravely ill.