Vickie Dawn Jackson, 40, pleaded no contest on Wednesday and was sentenced after prosecutors presented their evidence to a judge.
Investigators believe Jackson injected the patients through their intravenous lines with a drug normally used to temporarily stop breathing when doctors insert a breathing tube.
FBI agent David Burns testified that the patients had been hospitalized for minor ailments -- including a foot sore, diarrhea or dementia -- and were about to be released.
"In general, they were the kind of patients who needed more care," Burns said at the sentencing. "I think that's probably why. They're verbose. They want this. They're thirsty. It seemed to make her angry."
Authorities became suspicious after nearly two dozen deaths were reported at Nocona General Hospital in late 2000 and early 2001, a stretch of time when the hospital should have seen only five to 10 deaths.
Authorities discovered at least 20 vials of the drug were missing. And officers searching garbage at Jackson's home found a syringe that contained traces of it, Burns said.
Jackson's attorney, Bruce Martin, said Jackson maintained her innocence and pleaded no contest to avoid a trial so her daughter would not be called to testify.
In a statement issued through her attorney, Jackson said she was "sympathetic to the families of the deceased" and "acutely aware that closure for them is necessary, if, indeed, closure can ever come for them."
Prosecutors did not seek the death penalty, meaning Jackson would have been sentenced to life in prison if convicted by a jury.
The case was moved from Nocona, 90 miles northwest of Dallas, to this West Texas town because of publicity surrounding the deaths.
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