A nurse is linked to the death of at least 10 patients at two Butler County nursing homes and is accused of administering lethal doses of insulin to numerous patients at care facilities across Western Pennsylvania, the Attorney General’s Office announced Thursday, Nov. 2.

Heather Pressdee, 41, of Natrona Heights, was charged in the death of at least six patients at Sunnyview Rehabilitation and Nursing Center in Butler Township and two additional patients at Quality Life Services in Donegal Township, according to Attorney General Michelle Henry.

She is facing charges related to alleged mistreatment of 22 total patients at Butler, Westmoreland, Allegheny and Armstrong county nursing homes. Charging documents indicate Pressdee admitted to harming, with intent to kill, the patients in a series of incidents between January 2020 and May 2023.

“The allegations against Ms. Pressdee are disturbing. It is hard to comprehend how a nurse, trusted to care for her patients, could choose to deliberately and systematically harm them,” Henry said. “The damage done to the victims and their loved ones cannot be overstated.”

Charges filed in May accuse Pressdee of killing two patients and causing the hospitalization of one other at Quality Life Services in December 2022. At that time, she was charged with homicide in the deaths of a 55-year-old man and an 83-year-old man. The third victim, a 73-year-old man, survived after emergency hospitalization.

The charges filed Thursday relate to the mistreatment of 19 additional patients at five care facilities. Pressdee was charged Thursday with two counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person.

According to Henry, Pressdee is charged with first-degree murder in the cases where physical evidence is available to support the cause of death. She was charged with attempted murder in the cases where the victims either survived the excessive dosage of insulin, or the cause of death could not be determined, Henry said.

Pressdee was arraigned Thursday by Butler County Common Pleas Court Judge Maura Palumbi, who was assigned to the case when charges were filed in May. Pressdee waived her preliminary hearing on these charges and remains in custody at Butler County Prison without bail.

Charging documents indicate Pressdee, a registered nurse, worked at 12 facilities across Butler, Allegheny, Westmoreland and Armstrong counties between October 2018 and May 2023. She is accused of killing or attempting to kill patients at five of the locations.

Within Butler County, she is charged with at least four deaths at Quality Life Services, where she was employed from May to November 2022, and at least six deaths at Sunnyview Rehabilitation and Nursing Center, where she worked from January to May.

Additionally, she is accused of crimes while employed as a registered nurse at Concordia at Rebecca Residence in West Deer Township, Allegheny County; Guardian Healthcare operating as BelAir Healthcare and Rehabilitation Center in Lower Burrell, Westmoreland County; and Premier Armstrong Rehabilitation and Nursing Center in Kittanning, Armstrong County.

Her employment history includes working at the Orchards of Saxonburg in Saxonburg from February to April 2020. She also worked at these Allegheny County facilities: Encompass Health Rehabilitation Hospital of Harmarville, Allegheny Valley Hospital, Platinum Ridge Center for Rehabilitation & Healing, UPMC Passavant — McCandless, Woodhaven Care Center, and Cheswick Rehabilitation and Wellness Center.

“Pressdee often took steps to ensure her victims would expire prior to shift change so that they wouldn’t be sent to the hospital where her scheme could be discovered through medical testing,” agents said in charging documents.

“If Pressdee sensed the victim would ‘pull through,’ there is a pattern of her taking additional measures to kill the victims before they could be sent to the hospital by either administering a second dose of insulin or the use of an air embolism to ensure death.”

In regard to each incident recorded in the affidavit, agents said Pressdee typically administered the lethal doses of insulin during overnight shifts when staffing was low and the emergencies would not prompt immediate hospitalization.

Agents said coworkers disclosed Pressdee would “religiously” say that residents “just needed to die.”

During the investigation, agents said they observed numerous instances on Facebook and in text messages where Pressdee threatened people.

There are more than 20 instances detailed in the affidavit where Pressdee used the words “kill,” “stab,” “die” or “murder” in text messages to her mother between April 2022 and May 2023. The messages refer to doctors, nurses and residents, according to the document.

Agents noted that Pressdee also posted on Facebook in 2018 about the dangers of insulin overdose, and that she was familiar with insulin administration due to her mother’s diabetes.

Pressdee had posted in 2018 to a Facebook group, where she acted as a moderator, about a nurse who injected air into patients, leading to seven deaths, documents showed.

Pressdee is accused in the deaths of six people at Sunnyview between her first day of work on Jan. 2 and May 1. She worked at the location through an unspecified date in May.

Charging documents indicate she was later employed for a portion of the month by Cheswick Rehabilitation and Wellness Center — the last place to employ her before Pressdee was charged May 25 in the death of two patients and the hospitalization of a third at Quality Life Services.

Tricia Kradel, nursing home administrator at Sunnyview, said Thursday that she was not aware of any charges against Pressdee related to the Butler facility.

Only a few weeks into her job at Sunnyview, Pressdee allegedly killed an 80-year-old diabetic woman who was in hospice. The woman died Jan. 21 under Pressdee’s care.

The nurse later admitted in interviews that she injected the woman with 60 units of short-acting insulin before her death, agents said.

Two months later, Pressdee is accused of causing another death. Agents said Pressdee admitted to administering 60 units of short-acting insulin to a 104-year-old, non-diabetic woman, who died March 21.

Nurses said the 104-year-old was found foaming at the mouth after Pressdee’s shift. The coworkers said they found the death unusual and unexpected, agents said.

In an interview with agents, a nurse recalled hearing Pressdee ask, “When is she going to die already?”

Within a week, two others died during Pressdee’s watch.

On March 23, a 78-year-old woman in Pressdee’s care died while a family member was visiting, according to agents.

In an interview with agents, the family member recalled leaving the room to go to her car and finding the woman, who was on hospice, breathing irregularly upon her return.

The family member then went to the restroom when Pressdee arrived to care for the patient, agents said.

When the family member returned, the 78-year-old woman was dead, document showed.

Pressdee related in interviews with agents that she initially injected 60 units of short-acting insulin, and when that did not kill the woman, she administered another 60-unit dose.

Two days later, a 90-year-old man, who was a non-insulin dependent diabetic, died after being in Pressdee’s care, according to agents. His death, on March 25, was unusual, documents showed. Agents said nurses reported the man was foaming at the mouth at the time of his death.

Agents said Pressdee admitted to injecting long-acting insulin into the patient and then administered two “flushes” to his IV port, which she believed would lead to his death by causing an air embolism — a blockage in a blood vessel caused by air bubbles.

On April 17, an 82-year-old woman, a non-insulin dependent diabetic, died at the facility. Agents said Pressdee, in interviews, indicated she administered insulin to the woman before then administering a syringe of air into her catheter to create an air embolism.

Documents indicate that Pressdee had previously stated the 82-year-old “needed to die.”

Later that month, a 43-year-old male suffered a hypoglycemic event and was hospitalized. The man, a diabetic, died May 1 after being in Pressdee’s care, documents showed.

Documents showed that Pressdee was handling the medication cart the morning of the 43-year-old’s death. Prior to his death, agents said Pressdee remarked to other nurses that the man was “going to be the next to die anyway.”

Pressdee, in interviews with agents, did not immediately admit to harming the 43-year-old, but later said she gave him more insulin than she should have.

Agents said Pressdee said people with that kind of quality of life “did not deserve to live.”

She told investigators that, shortly before Pressdee was promoted to interim director of nursing at Quality Life Services in July 2022, she injected an 83-year-old, non-diabetic woman with insulin.

Agents said Pressdee told them the 83-year-old “slept off” the June 17, 2022, incident.

She told investigators that she administered insulin to an additional two patients, who later died.

Butler County Area Agency on Aging questioned the death of a 92-year-old, non-diabetic man on Aug. 6, 2022, who was under Pressdee’s care, agents said. Documents showed the man was found actively seizing. Pressdee wrote on his medical records his blood sugar was normal.

Pressdee related in an interview with agents that she injected the man with insulin.

On Nov. 6, 2022, agents said a non-diabetic, 99-year-old woman died while Pressdee was working. While Pressdee noted in medical records that she found the woman with no heartbeat, and that CPR was ineffective, she told agents she administered 60 units of short-term insulin.

Pressdee also told agents she knew the woman was dead and left the room, allowing another nurse to discover the death 30 minutes later. Documents showed Pressdee then assisted with performing CPR on the woman.

Charging documents revealed an alleged pattern of behavior.

On Oct. 8 and 9, 2022, agents said a 51-year-old man suffered a hypoglycemic episode while Pressdee was on duty. The man, who survived, was a type-one diabetic, and Pressdee later told agents she injected him with short-acting insulin.

Pressdee told investigators she also injected insulin into a 93-year-old, non-diabetic woman in November 2022, but the patient survived.

Charging documents indicate an 89-year-old woman died on Dec. 17, 2020, while in Pressdee’s care at Concordia at Rebecca Residence. Agents said Pressdee disclosed she had administered two doses of insulin to the non-diabetic patient, resulting in her death.

Pressdee is accused of causing four patients’ deaths while she was employed at Belair Healthcare and Rehabilitation as the assistant director of nursing from April 2021 to February 2022.

Documents showed the four patients died while in her care from lethal insulin injections: three females, ages 58, 68 and 92, and a 79-year-old male. The patients were either non-insulin dependent diabetics or not diabetic, agents said.

When asked why she administered insulin to the 58-year-old woman, Pressdee said she “looked at her like an animal would, helpless” and that the woman had “no quality of life.”

While Pressdee was employed at Premier Armstrong Rehabilitation and Nursing Center for a month — November to December 2022 — she is accused of causing two deaths.

A 90-year-old, non-diabetic woman, died in her care on Dec. 18, 2022, charging documents indicated. Documents showed that another non-insulin dependent woman was hospitalized for hypoglycemia while under Pressdee’s care, and she died 10 days later on Dec. 27, 2022.

While there were no deaths attributed to her care at Encompass Health Rehabilitation Hospital of Harmarville, agents said she was disciplined for incorrectly dosing insulin and not following doctors’ orders.

Documents also showed that she provided a false reference when employed at Platinum Ridge Center for Rehabilitation & Healing, and later at Concordia at Rebecca Residence.

Anyone with information about these incidents or Pressdee is asked to contact the Office of Attorney General’s tipline at 888-538-8541.