Elizabeth Wettlaufer, self-confessed serial killer and failed health professional, was the accused sitting in the box, waiting to be sentenced for murdering eight of the people in her care.

But it was the friends and relatives of her victims who were filled with guilt during a tear-filled court hearing on Monday where they described their sorrow at having placed their loved ones in the path of a troubled nurse who relieved her personal turmoil by injecting her patients with lethal doses of insulin.

At the end of the hearing, Ms. Wettlaufer, 50, was sentenced to a life term with no chance for parole for 25 years.

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Justice Bruce Thomas of the Ontario Superior Court could have given her a longer period before becoming eligible for parole but he agreed to a joint submission from the Crown and defence, who balanced her dreadful acts with the fact that she had pleaded guilty, sparing her victims' families a lengthy trial.

In any case, Justice Thomas noted, it was unlikely that Ms. Wettlaufer would ever be granted parole.

"She was far from an angel of mercy. Rather, she was a shadow of death that passed over during the night shifts that she supervised," Justice Thomas said.

He added that "she left a trail of broken lives in her wake."

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Ms. Wettlaufer, who remained motionless for most of the morning as she listened to victims' impact statements detailing the distress she had created, then stood up, holding a sheet of paper.

"I've caused horrendous pain. I am truly sorry," she said.

Arpad Horvath Jr., whose father was Ms. Wettlaufer's last murder victim, in 2014, later told reporters that "maybe she understands the contempt and the hatred I have for her. ... I will never accept her apology."

Shortly after the sentencing, the province announced it would call an independent public inquiry into the case.

"It is our hope that through the inquiry process, we will get the answers we need to help ensure a tragedy such as this does not happen again," said a statement from Ontario Attorney-General Yasir Naqvi and Minister of Health and Long-Term Care Eric Hoskins.

The College of Nurses of Ontario is also to hold a disciplinary hearing that could help explain why Ms. Wettlaufer, who was fired from one nursing home at the end of March, 2014, for administering drugs improperly, was able to keep working elsewhere, murdering another patient and attempting to kill two others before turning herself in by the fall of 2016.

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The nurses' college said it will be able to divulge details about Ms. Wettlaufer's regulatory history at the July 25 hearing.

Her crimes took place over a nine-year span in nursing homes in and around London, Ont.

Earlier this month, Ms. Wettlaufer pleaded guilty to eight counts of first-degree murder, four counts of attempted murder and two counts of aggravated assault.

Sobbing, dabbing their eyes with tissues and hugging each other, relatives took turns on Monday to recount the anguish and grief that overwhelmed them when they learned that grandparents or parents who had died years before had actually been murdered.

Shannon Emmerton, a granddaughter of Gladys Millard, 87, who was killed on Oct. 14, 2011, said part of the emotional toll was the second-guessing. "I live in Mississauga and work in Toronto. What if I'd been closer and saw her more often? Could I have done something to prevent this?" she told the court.

"Many nights, I wake up wondering, 'What did I miss or what didn't I see?'" said the statement by Jon Matheson, son of Helen Matheson, 95, who was murdered on Oct. 27, 2011.

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One of the daughters of James Silcox, 84, who was murdered on Aug. 12, 2007, is a retired registered nurse. Dianne Crawford said in her statement that she felt "guilt for letting him down, for not keeping him safe."

Another daughter, Andrea Irwin, is a long-term care employee and blamed herself for not trying harder to get her father into the facility where she works.

Jane Silcox, a granddaughter, said her family is torn by their decision to place him at the Caressant Care facility in Woodstock, Ont., where seven of the victims were murdered.

"This terrible event has turned siblings against each other, broken up our family and caused extreme stress," she said.

She said she was terrified that one day she would have to place her own father in a nursing home, or that her children would have to do the same for her. "The thoughts of this were scary before. Now, they are almost debilitating."

Her fear was echoed in the statement given by Heather Smith, a niece of Ms. Millard. Her statement said, that when her mother was hospitalized in January, "I watched her recoil in horror whenever a nurse would approach with a needle."

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After the court hearing, Ms. Emmerton said that, as she read her statement, she looked for a reaction from Ms. Wettlaufer, who sat a few metres away. "I looked at her multiple times and called her a murderer. She was stone cold. She didn't make eye contact."

Ms. Wettlaufer confessed to her killings last fall after checking herself into Toronto's Centre for Addiction and Mental Health.

She later told police she felt overwhelmed and angry about her job and her life.

"Ms. Wettlaufer could have kept quiet and taken this to the grave and none would have been wiser," her lawyer, Brad Burgess, told the court.

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Statements from victims' families

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Sharon Young, niece of Helen Young, 90, murdered on July 14, 2013.

Beth, for that is how I've always known you – you were the registered nurse who did the intake interview for Helen with me at Caressant Care in December, 2009, reviewing her likes and dislikes and so on. I recall thinking at the time that you were not very empathetic to my tears, for someone who had chosen nursing as a career.

Apparently, empathy was only the beginning of emotions that you lacked.

… My final memory of my aunt was her resting peacefully beneath a beautiful stained-glass window in the funeral home's chapel. That comforting memory has been replaced now with one of her contorted in pain, due to a seizure from the insulin you injected, with twisted limbs and bulging eyes – fearful, pain-filled and tortured in her final moments of consciousness.

And, Beth, you have added insult to injury by recalling in your confession that I hugged you and thanked you after my aunt's murder – so not only did I introduce my aunt to her killer, by deciding to place [her] at Caressant Care, I also apparently thanked for her actions. Betrayal doesn't even begin to convey my emotions.

Cheryl Kincaid, granddaughter of Mary Zurawinski, 96, who was murdered on Nov. 7, 2011.

Mary looked good and felt good for her age and was so looking forward to celebrating her 100th birthday. She was adamant that she would live to see that day and we would all be celebrating with a big party, eating cake adorned with 100 candles on it.

She was robbed of that. We were robbed of that. Mary was made to die alone without her family by her side. Without a chance to even say goodbye.

Barb Hedges, sister of Wayne Hedges, who was living at the Caressant Care facility because he had schizophrenia and mental disabilities. Ms. Wettlaufer tried to kill him in 2008, but he survived the injection. He died a few months later.

My heart breaks when I wonder if Wayne knew what was happening, if he knew what she had tried to do. I worry that he spent the last three or four months of his life being afraid.

… His life was troubled but it was his life and no one had the right to try and take that away. I go to the cemetery often and apologize to him. I tell him how sorry I am that we didn't know.

… I take solace in the knowledge that at some point, Ms. Wettlaufer will have to answer to a power much higher than this court.

Andrea Irwin, daughter of James Silcox, 84, who was murdered on Aug. 12, 2007.

Being a senior part-time employee working in long-term care, I am continually reminded of my father and it breaks my heart knowing that his cries of emotional pain were dealt by someone taking his life and not with compassion as all elderly and LTC residents deserve.

LTC facilities are now clouded with distrust and fear. Anyone having the difficult decision of placing their loved one or even themselves in the care of a stranger has to now fear that this may happen to them as well.

… I only hope that I can forgive myself for not fighting harder to have dad placed in the facility where I work but my opinions went unnoticed.

Beverly Bertram, 68, was the last victim of Ms. Wettlaufer, who added insulin to what was supposed to be an intravenous injection of antibiotics, on Aug. 21, 2016. Ms. Bertram survived. She describes what she felt during the insulin overdose.

I have never been so ill without knowing what was wrong. It is really hard to describe. I knew I was dying. There was no control. I dirtied myself. I peed myself. I couldn't lie in bed. I was constantly moving, trying to get up. It was terrible … I was doubled over in pain, holding my stomach. Just such pain. My whole body hurt. I thought I was thrashing about but I wasn't. I was wiggling in bed but I thought I was thrashing about. That is how bad the pain was. I couldn't sleep. I don't remember sleeping at all.

… I thought I was able to speak, I thought I was screaming "Help me," but I was just moaning I guess. My thoughts weren't with me. It was like an out-of-body experience.