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A former nurse at a hospital in Yokohama pleaded guilty Friday to serial murders at a hospital in 2016.

At the first hearing in a lay-judge trial at Yokohama District Court, Ayumi Kuboki, 34, admitted to killing two 88-year-old men and a 78-year-old woman who were hospitalized at former Oguchi Hospital in the capital of Kanagawa from between Sept.15-19, 2016. The killings were carried out by injecting antiseptic into the patients’ intravenous drip bags, effectively poisoning them.

Kuboki allegedly injected four other patients.

The Yokohama District Public Prosecutor’s Office detained her for psychiatric tests and concluded that she was mentally competent enough to be held responsible for crimes.

In Friday’s hearing, prosecutors said Kuboki committed the acts out of concern that she would be rebuked by bereaved families if patients died on her watch.

Given the results of a psychiatric test before her indictment and other factors, she acted in a normal mental state and is therefore considered to have been competent enough to be held responsible even though she had mild autistic spectrum disorder, the prosecutors said.

Meanwhile, her defense team said she was in a state of diminished capacity because she was strongly affected by schizophrenia, citing the results of another psychiatric test conducted after the indictment.

The court is set to issue its ruling on the case Nov. 9.

The former Oguchi Hospital stopped accepting inpatients at its general ward in December 2016 after the suspicious deaths of inpatients came to light. The hospital changed its name in December 2017 and resumed accepting inpatients in February 2018.

Once an arrest was made for the 2016 killings, the hospital suspended all activity.

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