Pennsylvania judges added seven additional life sentences to the prison term of New Jersey killer nurse Charles Cullen.

Cullen disrupted his afternoon sentencing hearing in Pennsylvania when he repeatedly uttered the phrase, "Your honor, you need to step down." The judge ordered court officers to gag the defendant. Despite using cloth, then duct tape, Cullen kept speaking. The gag was later removed and the hearing continued amid Cullen's disruptions.

Friday's rulings bring Cullen's punishment to a total of 18 life sentences. The defendant admitted giving lethal overdoses to seven patients at nursing homes and hospitals in Pennsylvania. Cullen killed at least 29 people in New Jersey and Connecticut. Authorities believe that number may actually be as high as 40 victims.

Cullen escaped the death penalty after agreeing to help prosecutors in seven counties identify patients to whom he had given lethal overdoses. He claims to have killed 40 patients over a 16-year nursing career. He will serve his prison sentence in New Jersey.

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