A former neonatal nurse who killed seven babies in her care and tried to kill six others at a hospital in northern England was sentenced Monday to life in prison with no chance of release by a judge who highlighted “the cruelty and calculation” of her actions.

Lucy Letby, who refused to appear in court to face grieving parents who spoke of their anger and anguish, was given the most severe sentence possible under British law, which does not allow the death penalty.

Justice James Goss said that the number of killings and attempts and the nature of the murders by a neonatal nurse entrusted with care for the most fragile babies provided the “exceptional circumstances” required to impose a so-called “whole-life order,” which is exceptionally rare.

“There was a malevolence bordering on sadism in your action,” Goss said. “During the course of this trial you have coldly denied any responsibility for your wrongdoing. You have no remorse. There are no mitigating factors.”

Following 22 days of deliberation, a jury at Manchester Crown Court convicted Letby, 33, of killing the babies over a yearlong period that saw her prey on the vulnerabilities of sick newborns and their anxious parents.

The victims died in the neonatal unit at the Countess of Chester Hospital in northwest England between June 2015 and June 2016.

“I don’t think we will ever get over the fact that our daughter was tortured till she had no fight left in her and everything she went through over her short life was deliberately done by someone who was supposed to protect her and help her come home where she belonged,” the mother of a girl identified as Child I said in a statement read in court.

Prosecutor Nicholas Johnson said Letby deserved a “whole-life tariff” for “sadistic conduct” and premeditated crimes.

Defense lawyer Ben Myers said Letby maintained her innocence and that there was nothing he could add that would be able to reduce her sentence.

Letby’s absence, which is allowed in British courts during sentencing, fueled anger from the families of the victims, who wanted her to listen to statements about the devastation caused by her crimes.

“You thought it was your right to play God with our children’s lives,” the mother of twins, one of whom was murdered and the other whom Letby tried to kill, said in a statement to the court.

Politicians and victim advocates have called for changes in the law to force criminals to appear for sentencing after several high-profile convicts chose not to face their victims in recent months.

Prime Minister Rishi Sunak, who called the crimes “shocking and harrowing,” said his government would bring forward in “due course” its plan to require convicts to attend their sentencings.

“It’s cowardly that people who commit such horrendous crimes do not face their victims and hear first-hand the impact that their crimes have had on them and their families and loved ones,” Sunak said.

During Letby’s 10-month trial, prosecutors said that in 2015 the hospital started to see a significant rise in the number of babies who were dying or suffering sudden declines in their health for no apparent reason.

Some suffered “serious catastrophic collapses” but survived after help from medical staff.

Letby was on duty in all of the cases, with prosecutors describing her as a “constant malevolent presence” in the neonatal unit when the children collapsed or died. The nurse harmed babies in ways that were difficult to detect, and she persuaded colleagues that their collapses and deaths were normal, they said.

Senior doctors said over the weekend that they had raised concerns about Letby as early as October 2015 and that children might have been saved if managers had taken their concerns seriously.

Dr. Stephen Brearey, head consultant at the Countess of Chester Hospital’s neonatal unit, told the Guardian newspaper that deaths could arguably have been avoided as early as February 2016 if executives had “responded appropriately” to an urgent meeting request from concerned doctors.

Letby was finally removed from frontline duties in late June of 2016. She was arrested at her home in July 2018.

An independent inquiry will be conducted into what happened at the hospital and how staff and management responded to the spike in deaths.