Pa. nurse who told coworkers that elderly patients ‘just needed to die’ charged with killing four with insulin overdoses

Heather Pressdee talked openly about how the elderly, frail patients she cared for at medical facilities around Western Pennsylvania “just needed to die,” state prosecutors say.

The registered nurse reportedly told her mother in a text that she wanted to give a resident “pillow therapy” — a reference to smothering them with a pillow, they said. She mocked people with intellectual disabilities, according to witnesses cited in court records, and told her colleagues that a man with a brain injury didn’t deserve to live.

As Pressdee moved from facility to facility over the last three years, 17 patients with serious, but generally stable, health conditions suddenly died, many after suffering from dangerously low levels of blood sugar. At multiple facilities, doctors and nurses who worked with Pressdee raised concerns that she might be harming patients.

They were right to be afraid, authorities now say. As of last week, Pressdee has been charged with killing four of her patients and faces four counts of murder. She also faces 17 counts of attempted murder and 19 counts of neglect of a care-dependent person, all related to her dosing patients with insulin.

Pressdee told authorities she had given nearly two dozen patients large doses of insulin, which can cause blood sugar to plummet, sometimes fatally.

The Pennsylvania Attorney General’s Office said Pressdee had been charged with murder in incidents in which there was physical evidence to show that she had caused patients’ deaths. In cases in which victims survived, or whose cause of death was unclear, she was charged with attempted murder.

In all, prosecutors said, 17 patients died in her care between 2020 and 2023.

In interviews with law enforcement officials, authorities said, Pressdee said she had injected patients with insulin in some cases because she believed their quality of life was poor, and that they would be better off dead. She told investigators she “felt bad” for patients she perceived to be suffering, they said.

Attorney General Michelle Henry called the allegations “hard to comprehend.”

“The damage done to the victims and their loved ones cannot be overstated. Every person in a medical or care facility should feel safe and cared for,” she said in a statement. The office declined to comment further.

James DePasquale, an attorney for Pressdee, said she is cooperating with law enforcement officials and plans to plead guilty. He said he was working to secure a plea agreement that avoids the death penalty. Prosecutors have not publicly said whether they intend to seek that penalty.

“I know that even though it sounds trite and sounds ridiculous, Heather Pressdee expresses deep remorse for all of this, and I think that expression of remorse is what has led her to be fully cooperative with the Attorney General’s Office,” he said.

Pressdee’s nursing license was suspended after her arrest in May, when she was initially charged with the deaths of two patients and the injury of a third.

Pressdee, 41, became a registered nurse in the summer of 2018 after working as a veterinary technician. That fall, she began working at Encompass Health Rehabilitation Hospital of Harmarville, a Pittsburgh rehabilitation hospital. Within two months, court records show, she was reprimanded for not following a doctor’s orders about how much insulin to give a patient.

Her supervisor later told investigators she was worried that Pressdee was harming patients and “took actions internally.” Pressdee left the hospital’s staff after six months. Court documents do not say whether she resigned or was fired.

In 2020, she began work at Concordia at Rebecca Residence, a senior care home in Allison Park, Pa., a suburb of Pittsburgh. In December of that year, she told investigators, she dosed an 89-year-old woman with 120 units of insulin — 60 units at first, and then another 60 units when “it did not work.”

The ideal insulin doses for people with diabetes can vary from patient to patient and rely both on what a patient is eating and how much they weigh. A daily dose of insulin for a person with type 1 diabetes who weighed 160 pounds would be about 40 units.

But the woman Pressdee dosed with insulin did not have diabetes at all, according to court documents. Pressdee later told investigators that the patient was on hospice care and “not doing well.”

She pronounced the woman dead herself, during her overnight shift, records show.

In the spring of 2021, Pressdee moved to another rehab facility, serving as the assistant director of nursing at Belair Healthcare and Rehabilitation in Lower Burrell, Pa., another Pittsburgh suburb. There, four patients died under her care — all after she gave them high doses of insulin, she later told investigators. Another patient experienced a low blood sugar emergency, but survived, according to court documents.

One doctor who treated two of Pressdee’s patients at an area hospital reported her to the state Department of Health, concerned she was harming patients.

Staff at Belair also raised concerns that Pressdee was “killing patients,” a facility official told investigators, after a 92-year-old woman died in her care. Two days before the woman’s death, another nurse had noted that the patient had been in a pleasant mood and was responding well to medications. Then Pressdee took over her care and reported a change in her condition — and eventually described her as “unresponsive,” records show.

A Belair staffer told investigators Pressdee wouldn’t allow colleagues to enter the woman’s room or touch her. Hours later, Pressdee pronounced the woman dead. She later admitted to investigators that she had dosed the woman, who did not have diabetes, with insulin, according to court documents.

Staff at Belair eventually investigated Pressdee’s conduct and suspended her, but were not able to find evidence to support concerns that she was killing patients, according to court documents. The family of one of the Belair victims is suing the facility.

By the spring of 2022, Pressdee was working at Quality Life Services Chicora, a nursing home in Butler County, where she served as assistant director of nursing and interim director of nursing. Four patients died there under her care, and another four suffered low blood sugar events, but survived. Pressdee admitted to administering insulin to all of them, according to court documents.

The deaths continued: two at Premier Armstrong Rehabilitation and Nursing Center. Five at Sunnyview Rehabiliation and Nursing Center, where, prosecutors say, colleagues reported Pressdee speaking of patients with contempt.

She called a 104-year-old woman “disgusting,” colleagues told investigators, saying, “When is she going to die already?” The woman died unexpectedly, colleagues said, and Pressdee later admitted to giving her an overdose of insulin.

Colleagues also reported Pressdee for using a slur for a 43-year-old man with a brain injury, and told investigators she said that “people with a quality of life like [him] did not deserve to live.”

Days before the man’s death, court documents say, Pressdee chastised a nurse who reminded the man, who had diabetes, to take his medications. The nurse had told the patient he should take his medications so he could stay alive — and that she loved him and wanted to see him again, according to court documents.

According to court documents, Pressdee told the nurse her conversation was “gross.” Three days later, he died, the documents say, and Pressdee approached the nurse and smacked her on the back. “Sorry to hear about [the patient], but at least you got to say your final goodbye,” Pressdee said, according to court documents.

Pressdee later admitted to intentionally giving the man 60 units of insulin, according to court documents. He was supposed to receive seven.

The Attorney General’s Office began investigating the case after receiving tips about Pressdee from the Pennsylvania Department of State and from a family member of one of the patients who died at Quality Life Services.

Reviewing medical records for three patients Pressdee treated at Quality Life — two who died, and one who suffered a low blood sugar event but survived — investigators found the victims’ lab results showed they had likely been given shots of insulin. In other words, their bodies hadn’t naturally produced the high levels of insulin that caused them to suffer low blood sugar.

In May, investigators showed up at Pressdee’s home in Natrona Heights. At first, the investigators wrote in charging documents, she told them that two patients had died naturally after their blood sugars crashed; she denied even remembering the third patient who survived.

Then, investigators said they believed the patients had been injected with insulin, and Pressdee admitted to giving them insulin. She told authorities she “felt bad for their quality of life and hoped they would just slip into a coma and die.”

In later interviews, authorities said, she admitted to overmedicating a total of 22 patients with insulin. She is being held without bail at Butler County prison.

The Attorney General’s Office has asked that anyone with information about Pressdee or the incidents at the nursing homes where she worked contact the office’s tipline at 888-538-8541.