An Italian appeals court on Tuesday upheld a life sentence for an emergency room doctor convicted of killing ten people, while acquitting him of three other murders.
The ruling by the Milan court against Leonardo Cazzaniga, 65, came just months after it upheld a 30-year-old sentence against his nurse lover for killing two people.
Dubbed the "diabolical lovers", in the Italian press, they have been incarcerated since 2016 for a series of murders while working in the emergency room of the Saronno hospital, near Milan.
Cazzaniga, the former number two in the hospital's emergency room, was found guilty of voluntary manslaughter of eight patients.
He was also convicted of killing the father-in-law of his lover, Laura Taroni, and acting in conjunction with her to kill her husband.
The court on Tuesday acquitted him of three other murders.
Prosecutors alleged that Cazzaniga killed in a "delirium of omnipotence" in administering overdoses of anaesthetic and sedative drugs to patients.
Taroni, 44, the mother of two children, was previously convicted of the murder of her husband, with Cazzaniga, and the 2014 murder of her own mother.
"From time to time, I want to kill someone. I need it..." she was heard saying in a police wiretap.
The police investigation looked at approximately 40 deaths between 2011 and 2014 that corresponded to Cazzaniga's work shift.
Both defendants are expected to appeal again, as allowed under Italian law.